WINTER SYMPOSIUM · 2021. 2. 26. · of the Hellenic Society of Intraocular Implant and Refractive...

$: WINTER SYMPOSIUM · 2021. 2. 26. · of the Hellenic Society of Intraocular Implant and Refractive Surgery WINTER SYMPOSIUM VIRTUAL HSIOIRS 25-27 February 2021 THURSDAY 25. 02. 2021$
VIRTUALHSIOIRS WINTER SYMPOSIUM

Program Abstract Book&

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EYE SURGERY. SWISS MADE.

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of the Hellenic Society of Intraocular Implant and Refractive Surgery

WINTER SYMPOSIUM HSIOIRS

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Organization

of the Hellenic Society of intraocular implant and Refractive Surgery

HSIOIRSWINTER SYMPOSIUM VIRTUAL

Board of Directors of the HSIOIRS

Invited Speakers

PresidentMiltiadis Balidis

Vice-presidentVasilis Karampatakis

secretary GeneralDimitris Mikropoulos

treasurerElisavet Patsoura

Board MeMBersApostolos ManiateasKonstantinos MoschouPantelis A. PapadopoulosGiorgos RoussopoulosPetros Smachliou

Andrei FilipRomania

Zoltan NagyHungary

Gerd AuffarthGermany

Farhad HafeziSwitzerland

Ashraf ArmiaEgypt

Rajesh FoglaIndia

Renato AmbrosioBrazil

Harminder DuaUnited Kingdom

Ike AhmedCanada



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Organization

HEllENIc SocIEty oF INtRAoculAR IMPlANt AND REFRActIVE SuRGERy

198 el. Venizelou str. & 1 apollodorou str.175 63 Palaio Faliro+30.6974479906, [email protected] | www.hsioirs.org

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Welcome message

Board of Directors of the HSIOIRS

Invited Speakers

Following the successful experience of our first virtual

congress in July last year, which received from you a very

positive feedback, we decided to repeat the effort organizing a

second virtual meeting this February and postponing our main

annual congress for a later date in 2021, with the hope that we

could meet in better conditions.

We have prepared an event that for two days will bring to your

screens very interesting videos and lectures from prominent

colleagues, who we hope to have again with us in October at

Thessaloniki for our 35th HSIOIRS Congress.

We welcome you at the Virtual HSIOIRS Winter Symposium!

Miltos Balidis

HSIOIRS President

General Information

VENuEthe Winter symposium of the Hsioirs will take place virtually on 25-27 February 2021.

cME-cPD AccREDItAtIoNthe participants of the congress of the Hsioirs will be provided with 18 cMe-cPd credits by the Panhellenic Medical association.

coNGRESS lANGuAGESthe official languages of the congress will be english and Greek.

AttENDANcEregistered attendees have received the passwords for the live streaming platform. For any information or support regarding the use of the platform you can contact the congress secretariat at [email protected].

REGIStRAtIoNDoctors 90€Residents/trainees* 50€opticians - optometrists* / Nurses* 40€

The virtual registration covers:• Participation to the Main Scientific Program of the Congress via virtual

platform• Certificate of Attendance with the CME-CPD credits

The participants of the categories with * will need to present a certification of their profession (letter from the director of the clinic where they work, student ID).

In order to confirm your registration, the full deposit of the fee is required.Fees are applicable to 24% VAT upon issuance of the relevant invoice.No refunds of registration fee can be done.

coNGRESS SEcREtARIAt

ERA ltdconGresses|eVents|Business traVel|incentiVes|tourisM

a. 17 asklipiou str, 10680 athens | t. 210 3634944| F. 210 3631690 e. [email protected] | W. www.era.gr

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of the Hellenic Society of intraocular implant and Refractive SurgeryHSIOIRSWINTER SYMPOSIUM VIRTUAL

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25-27February 2021

SCIENTIFIC PROGRAM

25-27February 2021

FREE PAPERS

FP1 the impact of pupillary size on Intraoperative Floppy Iris Syndrome Argyrios tzamalis1, chrysanthos christou1, Asimina Mataftsi1, Ioannis tsinopoulos1, Nikolaos Ziakas1

12nd Dpt Of Ophthalmology, Aristotle University Of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

FP2Study of post cataract surgery accommodation in clinical practiceGeorgios-Petros Bitelis1, Petros Nousias1, Michael Karampelas1

Ophthalmology Department-Hippokration General Hospital of Athens

FP3Silodosin as a predisposing factor of Intraoperative Floppy Iris Syndrome (IFIS): a retrospective observational propensity score-matching cohort studyArgyrios tzamalis1, chrysanthos christou1, Marianna Kourouklidou1, Asimina Mataftsi1, Nikolaos Ziakas1


FP4uGH SyNDRoME in one piece pc Iol. complete resolution in timely interventionDagalaki I., Mpitelis G., Siriga M, Ioannou Z., Kokkinos Z., theodorou M.Hippokration General Hospital, Athens, Ophthalmology Clinic

FP5late-onset interface fluid syndrome after lASIKSpyridon Koronis1, Asterios Diafas1, Argyrios tzamalis1, Nikolaos Ziakas1

12nd Department of Ophthalmology, Papageorgiou General Hospital, Thessaloniki, Greece

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Welcome message from the President of the Hellenic

Society of Intraocular Implant and Refractive Surgery M. Balidis



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EP1the concerns and questions of patients before cataract surgery Sevasti tsironi1, Efstratios theofrastou1, Eleni Psimenidou1, Victoria Kapourani1, loizou Frageskos1, Panagiota-Sofia Apostolidou1, Elie Fadel1

1General Hospital G.Papanikolaou, Thessaloniki, Greece

EP2New developments in intraocular lens drug delivery systems for the prevention of cataract surgery complicationsIoanna Mylona1, Mikes Glynatsis2, Ioannis tsinopoulos3

1Ophthalmology Department, General Hospital of Serres, Greece2Ophthalmology Department, “Hippokration” General Hospital of Thessaloniki, Greece32nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece

EP3cataract Surgery in Dry Eye Disease-Management and outcomesAliki liaska1, Dimitra Mitsiou1, Styliani Stamelou1, Konstantina Andrianopoulou1, Dimitrios Papantoniou1

1General Hospital of Lamia, Lamia, Greece EP4cataract surgery in patients with diabetic macular oedemaAliki liaska1, Dimitra Mitsiou1, Styliani Stamelou1, Konstantina Andrianopoulou1, Dimitrios Papantoniou1

1General Hospital of Lamia, Lamia, Greece

EP5the effect of systemic Alpha-1 adrenergic antagonists on pharmacologic pupil dilationPanagiotis Dervenis1, Panagiotis Vasilakis1, Kiriaki Moula1, Maria Pavlaki1, Nikolaos Dervenis2, Ioannis Rebapis1

1Department of Ophthalmology, General Hospital of Trikala, Greece2St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom EP6corneal opacities and cataract surgery: this is how to do it! cataract / cornea surgical case (Video / Poster abstract)Mokka Agni*, Stampouli Despoina, Vagiakis Iordanis, Athanasiadis Vasilios, Zachariadi Sofia*Corresponding Author: [email protected]

EP7Severe chemical keratitis because of unsolicited and imprudent use of topical anaesthetic eye dropsSevasti tsironi1, Efstratios theofrastou1, Anastasia Sarafi1, Karachrysafi Sofia1, Elissavet Siskou1, lazaros Botelis1, Elie Fadel1




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EP8corneal endothelial properties in Neurofibromatosis type 1 patients: Preliminary results of an ongoing researchchrysoula Florou1, Evaggelia Aissopou2, Evangelia chalkiadaki3, Evangelia Papakonstantinou1, chrysanthi Koutsandrea1, Konstantinos Droutsas1, Ilias Georgalas1

11st Dept. Of Ophthalmology, National And Kapodistrian University Of Athens, General Hospital “G. Gennimatas”, Greece 2Macula Center, Athens,, Greece 3Department of Ophthalmology, 251 Hellenic Airforce General Hospital, Athens, Greece

EP9Akanthamoeba keratitis: time of visiting the ophthalmologist for the first time has a determinative role in the clinical outcomeGardeli I., Mouriki K., Manoli K., orfanidou M. Cornea Department, State Ophthalmology Clinic, General Hospital of Athens G. Gennimatas, Greece

EP10Welder’s eye: a challenging caseMouriki K., Gerou A., tsoutsoura S., Gardeli I.Cornea Department, State Ophthalmology Clinic, General Hospital of Athens G. Gennimatas, Greece

EP11Akanthamoeba and fungal keratitis: a complicated caseMouriki K., orfanidou M., Gerou A., Gardeli I.Cornea Department, State Ophthalmology Clinic, General Hospital of Athens G. Gennimatas, Greece

EP12corneal perforation related to Beauveria bassiana and post penetrating keratoplasty management discussion: a case reportAtzamoglou S.1, Markopoulos I.1, Kontomixos l.2, Mpatsos G.2, Paroikakis E.2, Peponis V.1

1Ophthalmiatreio of Athens, A’ Opththalmology department2Ophthalmiatreio of Athens, B’ Opththalmology department

EP13ultrathin DSEK graft using a manual techniqueP. Xanthopoulou1, Zara Ashena1, Mohamed Elanwar1, Motasim Alzyadi1, Aine Rice1, Nick Kopsachilis1

1East Kent Hospitals University Trust Foundation, Canterbury, Ηνωμένο Βασίλειο

EP14Rare case of open-globe trauma due to an olive drupeStergios chaloulis1, Aikaterini Ioannou1

1General Hospital of Volos, Greece, Greece



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EP15Bell’s palsy in a 8 year’s old child loukia Politi1, Fani Akritidou1, Eleni lazaridi1, Pelagia tsitsani1

1General Hospital Of Edessa, Edessa, Greece

EP16Age-related changes in the monocular and binocular amplitude of accommodation Dimitra Georgantaki1, Aspasia Vouza2, Sotiris Plainis3

1St. Catherine’s British School, Athens, Greece, 2OMMA, Athens, Greece, 3Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Heraklio, Greece

EP17Is a no touch Soft contact lens Insertion System (SclIS) worth Pursuing even in Single use Disposable contact lenses? D. Spourdalakis1, A.K. charonis1 1Appleye P.C.

EP18 Initial preclinical experience with a novel no touch soft contact lens insertion system. (no touch SclIS) D. Spourdalakis1,2, D. Giali1, K. tziouvara1, Α. Κoutsonikou1, A.K. charonis1,2

1Athensvision, 2Appleye P.C. EP19changes in reading patterns as elementary students grow olderIoannis M. Aslanides, Nantia Boufachrentin, Minas Aslanidis, Ioanna Aslanidi, Vasilis Andreadakis, Ioannis SmyrnakisCorresponding author: Ioannis M. Aslanides ([email protected]), Emmetropia Eye Clinic/Optotech Research Lab, Greece

EP20AlEXANDER MoNRo (Secundus), the great anatomist, and his contribution to the study of the eyeGeorgios Balanikas1, Dimitrios Peirounidis1, christine Georgiadou1, Michael Angelou3, Petros Rasoglou4, Prof. Dimitrios christodoulou2, Prof. Vasileios Karampatakis5, Stefanos Maloutas1

1A’ Ophthalmologic Clinic, AHEPA Hospital, Thessaloniki, Greece, 2Laboratory of History of Medicine, Medical School, Aristotle University, Thessaloniki, Greece, 3Private Practise, Athens, Greece, 4Institute Ophthalmica, Thessaloniki, Greece, 5Laboratory of Experimental Ophthalmology, Medical School, Aristotle University, Thessaloniki, Greece

EP21cost-effectiveness of toric intraocular lenses in cataract patients with astigmatism based on randomized clinical trials dataGiannopoulos K.1, Bakouli A.1

1Department of Ophthalmology, Sitia General Hospital, Sitia

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VIDEO PRESENTATIONS

V1cataract extraction with an extended depth of focus (EDoF) Iol implantation together with pupilloplasty, in a young patient with inflammatory glaucoma of unknown aetiology and a previous Ahmed glaucoma valve implantationKonstantinos SamarasAthens Laser Sight, Athens, Greece

V2Ιris hooks and Iris expanders in difficult cases. What we should do and what should not doG. Dalianis, G. Andriopoulos, c. terzidouDept of Ophthalmology, Konstantopouleio Gen Hptl, N.Ionia, Attica, Greece

V3Minimally invasive combined solutions for cataract and glaucomachryssa terzidou1, George Dalianis1, Georgios Andriopoulos1

1Dept of Ophthalmology, Konstantopouleio Gen Hptl, N.Ionia, Attica, Greece

V4Phaco XEN - An effective alternative?Michael tsatsos1, Dimitra Gousia1, yiannis Athanasiadis1

1Ophthalmore/ University of Southampton, Thessaloniki, Greece

V5Surgical Management of Diffuse conjunctival Melanoma Sotiria Palioura1

1Private Practice, Athens, Greece

V6Surgical Management of Recurrent Pterygium Sotiria Palioura1


V7A case of graft folding in DSAEK Gardeli I., Mouriki K.Cornea Department, State Ophthalmology Clinic, General Hospital of Athens G. Gennimatas, Greece

V8late posterior corneal perforation and intraocular migration of intracorneal ring segment possibly associated with floppy eyelid syndromeArtemis Matsou1, Samer Hamada1

1Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, United Kingdom

V9A Simple Sutureless technique for Pterygium Surgery with a dehydrated amniotic membraneParaskevi Xanthopoulou1, Mohamed Elanwar1, Motasim Alzyadi1, Aine Rice1, Nick Kopsachilis1

1East Kent Hospitals University Trust Foundation, Canterbury, United Kingdom

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10:30 - 12:30 ROUND TABLEAnterior Segment Imaging 2021Moderator: A. Maniateas

Corneal Topography: from Scheimpflug to OCT A. Maniateas: New TechnologiesV. Liarakos: The future of corneal imaging: a corneal surgeon perspective D. Kyroudis: The future of corneal imaging: a refractive surgeon perspective

New Technologies for Dry Eye Management E. Karmiris: Dry Eye Imaging and DiagnosticsG. Dalianis: New Technologies for Dry Eye Treatment

Biometry 2021M. Arvanitis: New technologiesE. Patsoura: Measuring the right Ks

Combined Phaco and GlaucomaS. Kandarakis: Angle Evaluation & MIGSCh. Terzidou: Kahook Dual Blade: Ab Interno Trabeculectomy and Goniotomy

12:30 - 13:30 LECTURES

Harminder Dua: Update on Pre-Descemet’s layer - clinical and surgical applicationsRajesh Fogla: Optimizing outcomes in EK surgery

13:30 - 15:00 BREAK 15:00 - 17:00 ROUND TABLE

2021 new advances in the early diagnosis and treatmentof keratoconusModerator: M. Balidis

M. Balidis: Keratoconus diagnostics. New kids on the blockZ. Gatzioufas: Evolution in biomechanics. An essential diagnostic tool?A. Charonis: Early keratoconus management with special contact lensesF. Hafezi: 2021 advances in cross linkingR. Ambrosio: Tomography and biomechanics: combining the best of both worlds

17:00 - 19:00 ROUND TABLEModern IOL technologyModerators: P. Papadopoulos, D. Mikropoulos

E. Patsoura: Newest technology in Preoperative Exam and IOL Calculation A. Armia: What is the Future of Trifocal IOLs?D. Siganos: Will Monovision still play a significant role tomorrow?G. Auffarth: Newer EDOF IOLsP. Papadopoulos: Perfection of surgical outcomes: Where are we now

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11:00 - 13:00 ViDEO BASED SESSiONChallenging anterior segment surgery……to the limitsModeration/Comments: V. Karabatakis, K. Moschou

Surgeons:A. Αrmia: Watch out!!! A Traumatic CataractN. Ziakas: Various traumatic cataract cases, IOL echange and iridoplasty - Posterior capsular rupture during phaco, conversion to extra caps and retropupilary Verisyse insertionP. Papadopoulos: Iris-claw – Posterior chamber IOL exchangeΜ. Balidis: Traumatic aphakia, iridodialysis and macular puckerΚ. Moschou: Intumescent cataract – Spiral capsulorhexis technique, Uveitic cataract – treatment, Morgagnian Cataract – treatment

13:00 - 13:30 LECTURE

Zoltan Nagy: Femtosecond laser assisted cataract surgery complications 13:30 - 15:00 BREAK 15:00 - 15:30 LECTURE

ike Ahmed: Managing Premium IOLs when the Capsule Isn’t All There 15:30 - 17:30 ROUND TABLE

The future of laser vision correctionModerators: G. Roussopoulos, P. Smachliou

D. Kyroudis: Analyzing and customizingK. Koufala: The evolution of superficial ablationsV. Katsanevaki: Tendencies in intrastromal treatmentsA. Filip: Any good reasons to smile?

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VIRTUALHSIOIRS WINTER SYMPOSIUM

Abstract Book

E-POSTERS

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FREE PAPERS



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FREE PAPERS2021

FP1 the impact of pupillary size on Intraoperative Floppy Iris Syndrome

Argyrios tzamalis1, chrysanthos christou1, Asimina Mataftsi1, Ioannis tsinopoulos1, Nikolaos Ziakas1


Purpose: to investigate the impact of dilated pupil diameter (pd) as a risk factor for the appearance of intraoperative Floppy iris syndrome (iFis) and its correlation with intra- and postoperative complications in cataract surgery.

Materials & Methods: 1178 cataract patients with or without a recorded iFis of any severity occurring over the last year in a tertiary care ophthalmic center during phacoemulsification surgery were identified and en-rolled in a multivariate analysis. possible predisposing risk factors for the appearance of iFis were thoroughly recorded in each case and pupil size was measured one week preoperatively after pharmacologic dilation.

Results: iFis was observed in 44 out of totally 1294 eyes (3.4%) undergoing cataract surgery, whilst the incidence of iFis in male patients was significantly higher than in women (6.03% vs 1.15%, p<0.0001). preoperative pd was statistically significantly lower in cases that developed iFis (pdiFis=6.23±1.4mm vs Pdnon-iFis=7.38±0.9mm, p<0.001), a difference that remained significant in patients receiving a1-blockers for benign prostate hyperplasia (pdiFis=5.86±1.5mm vs Pdnon-iFis=6.78±0.9mm, p=0.01). logistic regression analysis revealed that Pd and a1-blockers intake were the only significant risk factors for the appearance of iFis (p<0.001), while pd was negatively correlated with posterior capsular rupture and iris trauma rates (p=0.03 and p<0.001 respectively).

conclusion: the size of preoperative pupillary dilation seems to have a significant impact on the appearance of floppy iris and could be used as a predictive measure by surgeons in order to minimize the potentially cat-astrophic consequences of unforeseen iFis.



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FP2Study of post cataract surgery accommodation in clinical practice

Georgios-Petros Bitelis1, Petros Nousias1, Michael Karampelas1

Ophthalmology Department-Hippokration General Hospital of Athens

Aim: to measure accommodation (derived from the combined effects of pseudoaccommodation and pseu-dophakic accommodation) after cataract surgery and monofocal non-accommodative posterior chamber in-traocular lens implantation.

Methods: patients who underwent uncomplicated cataract surgery with implantation of the enVista Bausch + Lomb monofocal iOL, were tested using the Jaeger chart at 33cm distance, after full emmetropization using spherical and cylinder lenses. the following data were collected:1) the smallest fond readable by the patient under room day light and under lamp light.

2) the smallest possible convex lens subjectively satisfying the patient in reading J1 under day and lamp light.

exclusion criteria:1) ametropia > 1,50d sphere and >1d cylinder.

2) patients with history of any retinal and corneal pathology and psychiatric illnesses.

3) patients with intra/post operative complications.

4) Best corrected visual acuity <8/10.

Results: 31 eyes of 27 patients were included in this study. An amount of accommodation was noted in 81% of eyes under day light and 100% under lamp light. the average diopters of accommodation were 0,70d (0d-1,25d) under day light and 1,25d (0,50d-1,75d) under lamp light. More than 1d of accommodation was noted in 45% of eyes under day light and 77% under lamp light respectively.

conclusion: A significant amount of accommodation was noted postoperatively in the majority of eyes, most likely as a result of pseudoaccommodation and pseudophakic accommodation effects.



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FP3Silodosin as a predisposing factor of Intraoperative Floppy Iris Syndrome (IFIS): a retrospective observational propensity score-matching cohort study

Argyrios tzamalis1, chrysanthos christou1, Marianna Kourouklidou1, Asimina Mataftsi1, Nikolaos Ziakas1


Purpose: to evaluate the correlation between silodosin intake and intraoperative Floppy iris syndrome (iFis) and compare it with other a1- adrenergic receptor antagonists (a1-ArAs) and other factors predisposing to iFis.

Methods: From the patients who underwent phacoemulsification at a teriary-care ophthalmology depart-ment between 2014 and 2020, we identified all patients who, during their preoperative assessment, reported an a1-ArAs intake (exposed group). We then matched these patients by a propensity score matching analysis, with an otherwise homogenous group of patients (control group), based on demographics and systemic/ocular comorbidities.

Results: 350 patients were included in each group. in the exposed group, 177 (50.6%) patients were exposed to tamsulosin, 105 (30%) to alfuzosin, 43 (12.2%) to silodosin. regarding iFis, it was observed in 21.5% of patients on tamsulosin (38/177), 11.4% on alfuzosin (12/105), 37.2% on silodosin (16/43), and 3.4% in the controlled group (12/350). in a multiple regression model analysis, the adjusted odds ratio of silodosin and tamsulosin in developing iFis were estimated at a 95% confidence interval (ci), 8.471 (95%ci: 4.005-17.920), and 3.803 (95%ci: 2.231-6.485), respectively.

conclusions: silodosin has been demonstrated as a predisposing factor, strongly correlated with iFis devel-opment. these results should increase awareness to cataract surgeons, to carefully assess their patients pre-operatively for exposure to silodosin, and employ the appropriate prophylactic measures to ameliorate the impact of silodosin intake on the surgical outcome.



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FP4uGH syndrome in one piece pc Iol.complete resolution in timely intervention

Dagalaki I., Mpitelis G., Siriga M, Ioannou Z., Kokkinos Z., theodorou M.

Hippokration General Hospital, Athens, Ophthalmology Clinic

Purpose: A case report of UGH syndrome in posterior chamber one-piece iOL, with the inferior haptic dislo-cated into ciliary sulcus.

Methods: A 71y old white male non diabetic caucasian patient, arrived to casualties dept., complaining of blurring vision to his Le since 24hrs. BcVA found 10/10cc in the re and hand movements to the Le, ni. iOp was 11 & 29 mmHg to the rLe respectively. He reports cataract surgery since 3 yeas elsewhere.sL examination reveals deep anterior chamber, diffuse micro hyphema, 4+ cells, no visible iris details. Urgent UBM bio microscopy unveiled corrosion of the iris stroma by dislocated lens haptic in 8.00 o` clock hours.

Results: the patient underwent urgent surgical intervention with lens exchange. After removal of one-piece iol, three-piece sulcus iol implanted.A week later, BcVA to the Le was 10/10, 8/10 sc. Hyphema and inflammation were completely resolved, however iOp was controlled to 15 mmHg with dorzolamide/timolol treatment. Furthermore iris atrophy was visible with retro illumination, corresponding to the site of corrosion.

conclusions: Uveitis-Glaucoma-Hyphaema syndrome (or “ellingson” syndrome) is a rare condition caused by the mechanical trauma of an intraocular lens malpositioned over adjacent structures and a cause of blurry vision months to years after surgery. As it is a severe complication of cataract extraction all cataract surgeons must be aware of severe effects, signs, and management of UGHs. the diffuse micro hyphaema may obscure the doctor’s view of the anterior chamber, posterior chamber, and iol. uBM ultrasound is the method of choice to delineate the cause. the explantation of the iOL with lens exchange is necessary to preserve vision and avoid glaucomatic nerve damage.

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FREE PAPERS2021

FP5late-onset interface fluid syndrome after lASIK

Spyridon Koronis1, Asterios Diafas1, Argyrios tzamalis1, Nikolaos Ziakas1

12nd Department of Ophthalmology, Papageorgiou General Hospital, Thessaloniki, Greece

Introduction: interface fluid syndrome (iFs) is a relatively uncommon complication of laser in situ keratomile-usis (LAsiK) characterized by the accumulation of fluid in the LAsiK flap. this is frequently the result of elevat-ed intraocular pressure (iOp) and usually manifests in the early postoperative period of LAsiK. nonetheless, late cases of iFs have been rarely reported, years after the initial procedure. in such cases potential causative mechanisms include elevated iOp or endothelial dysfunction.

Purpose: to present a rare case of late-onset iFs 19 years after uneventful LAsiK.

case presentation: a 49-year-old woman presented with a 1-month history of gradual visual decrease in her right eye. complete ophthalmic examination revealed mild anterior stromal edema, increased central corneal thickness and iOp with asymmetrical optic disc cupping suggesting glaucomatous optic neuropathy in her right eye. Anterior segment optical coherence tomography revealed fluid accumulation in the flap interface. topical administration of antiglaucoma eye drops contributed to corneal edema regression and complete restoration of visual acuity, albeit with a permanent visual field defect.

conclusions: iFs represents an uncommon complication that could appear years after LAsiK. early recogni-tion and prompt therapeutic intervention contribute to the prevention of permanent optic neuropathy and optimal visual outcome.

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E-POSTERS

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E-POSTERS2021

EP1the concerns and questions of patients before cataract surgery Sevasti tsironi1, Efstratios theofrastou1, Eleni Psimenidou1, Victoria Kapourani1, loizou Frageskos1, Panagiota-Sofia Apostolidou1, Elie Fadel1


Purpose: to present concerns and questions of two hundred patients from our clinic before cataract surgery.

Methods and materials: in a two month period two hundred patients were examined and programmed for cataract surgery.At the time of the pre-surgical examination and briefing,we investigated their questions and fears concerning the imminent surgery.

Results: the patients manifest a variety of concerns and fears concerning the surgery.

conclusions: taking into account the patients’ answers, we ascertain that pre-surgically there is a need for an individually explanatory conversation as well as psychological approach.



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EP2Νew developments in intraocular lens drug delivery systems for the prevention of cataract surgery complications

Ioanna Mylona1, Mikes Glynatsis2, Ioannis tsinopoulos3

1Ophthalmology Department, General Hospital of Serres, Greece2Ophthalmology Department, “Hippokration” General Hospital of Thessaloniki, Greece32nd Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece

Purpose: cataract surgery is the commonest ophthalmic surgery worldwide. the replacement of the diseased lens with a synthetic one (intraocular lens—iOL) remains the treatment of choice, despite its potential com-plications that include infection, inflammation and posterior capsule opacification (pcO). the purpose of this systematic review is to assess the progress in the field of drug-eluting iOLs used in cataract surgery over the last five years.

Methods: We reviewed the progress in the field of drug-eluting iOLs over the past five years as detailed in studies published in nLM/pubMed and Web of science and surveyed the WHO international clinical trials registry platform (ictrp), clinicaltrials.gov and the ‘international standard randomized controlled trial number (isrctn) registry for ongoing clinical studies.

Results: the surveyed published research papers were grouped in two broad categories, fourteen studies that described new methods for loading a drug onto the iol and seven studies with direct assessment of the effects of drugs that were loaded to an iOL. there were no concluded or ongoing registered clinical studies during the past five years. the included studies are presented in detail and assessed for novelty and impor-tance. Lack of progress in previously researched paths is also assessed. Only two studies attempted to assess practical issues as sterilization and shelf life while potential issues with storage and transportation were not researched. On the other hand, intracameral injection of specially formulated drugs to achieve the same out-comes is progressing rapidly and achieving commercial adoption.

conclusions: While considerable progress is continually being made with regard to methods and materials, there is still little capitalization upon these research studies, with no commercially available iOL-based drug delivery system being available.



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EP3cataract Surgery in Dry Eye Disease-Management and outcomes

Aliki liaska1, Dimitra Mitsiou1, Styliani Stamelou1, Konstantina Andrianopoulou1, Dimitrios Papantoniou1


Purpose: to present the need for specific perioperative measures and the visual and surgical outcomes fol-lowing cataract surgery in dry eye disease (ded).

Methods: retrospective chart review of 2175 eyes operated in General Hospital of Lamia (GHL) between 2017 and 2019. ded diagnosis was based on clinical findings and/or report of ded symptoms. 468 eyes with ded who had cataract surgery (clear corneal phacoemulsification) and at least two months postoperative fol-low up were identified. they were divided according to aetiology in three groups: meibomian gland dysfunc-tion (MGd), blepharitis(B) and sjogren’s syndrome (ss) and according to the presence or not of ded symp-toms in two groups. the data on demographics, perioperative ded management, visual impairment, surgical technique, visual outcomes (preoperative and postoperative LogMAr best corrected visual acuity-BcVA was compared paired t-test), and complications were collected.

Results: the mean age at which cataract surgery was performed was 68 (range 47–78) years. 87 % were male All eyes underwent phacoemulsification, under local (subconjunctival anaesthesia through a temporal clear corneal incision with foldable intraocular lens implantation. LogMAr BcVA improved from 1.1 at baseline to 0.1 at 6 weeks (p < 0.0001) post-operatively. the median 6 weeks post-operative BcVA was significantly better than at baseline (p < 0.0001) in all three ded groups. the leading cause of delayed recovery of vision was persistent corneal defects (2%). in one patient (2 eyes) there was need for bandage contact lens (BcL). patients with ded-like symptoms before cataract extraction had higher ocular pain scores, and specific ocular complaints (ocular burning, sensitivity to wind and light) compared to controls with no symptoms.

conclusion: cataract surgery has good visual outcomes in patients with ded, without any disconcerting rate of complications. Keratopathy is the main determinant of the extent of post-operative visual recovery. patients should be informed about the recovery of de symptoms after cessation of postoperative treatment.



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EP4cataract surgery in patients with diabetic macular oedema

Aliki liaska1, Dimitra Mitsiou1, Styliani Stamelou1, Konstantina Andrianopoulou1, Dimitrios Papantoniou1


Purpose: despite the advancement in phacoemulsification technology, poor visual acuity following cataract extraction is still common in patients with dM. posterior capsule opacification (pcO), postoperative cystoid macular edema (cMe), diabetic macular edema (dMe) and worsening of the dr are the main complications seen in diabetic patients.

Patients: retrospective chart review of medical records of patients with diabetic retinopathy (dr) who had cataract surgery (phacoemulsification and intraocular lens implantation) and at least six months follow -up, in General Hospital of Lamia (GHL) between 2015-2019. 56 eyes (38 patients) were identified. in patients with adequate retinal view diagnosis was based on preoperative evaluation and those with inadequate retinal view prior to cataract extraction were examined closely after surgery to evaluate their dr status. patients were divided according to the presence (or not) of diabetic macular edema. in patients with dMe there was a course of anti-Vascular endothelial Growth Factor (antiVeGF) treatment prior to surgery. patients’ demo-graphics and visual outcomes (mean logMAr best corrected distance visual acuity-BcdVA) were compared between the two groups.

Results: there was greater prevalence of corneal epithelial defects and persistent erosions in dr (+) group. patients with pre-existing dMe (albeit adequately treated) had inferior visual recovery and final visual acuity postoperatively. Among dr (+) group, patients with proliferative retinopathy without any treatment at the time of surgery had poorer visual outcomes with an increased risk of vitreous haemorrhage and tractional retinal detachment following surgery. in the rest of the group, the major determinant of vision was the pres-ence of dMe at some time point preoperatively.

conclusions: carefully performed cataract surgery in diabetic patients should yield optimal postoperative re-sults. patient follow-up should be done carefully. As the number of people with dM is estimated to continue to increase, cataract surgery will remain important for diabetic patients. patients with diabetes have multiple issues to be evaluated preoperatively, perioperatively, and in the postoperative period. With the advent of modern surgical and pharmacologic therapies, these patients can, like other cataract patients without diabe-tes, recover excellent vision. postoperative monitoring and management of surgical complications will also help to alleviate the risk of vision loss in these patients.



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EP5the effect of systemic Alpha-1 adrenergic antagonists on pharmacologic pupil dilation

Panagiotis Dervenis1, Panagiotis Vasilakis1, Kiriaki Moula1, Maria Pavlaki1, Nikolaos Dervenis2, Ioannis Rebapis1

1Department of Ophthalmology, General Hospital of Trikala, Greece2St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom

Purpose: to investigate the effects of systemic a1-adrenoreceptor antagonists on pupil diameter in men un-dergoing pharmacologic pupil dilation under photopic conditions.

Setting: department of ophthalmology, General Hospital of trikala, Greece.

Methods: Male patients over 50 years old taking systemic a1-adrenoreceptor blockers for prostate pathology and healthy controls were included in the study. subjects with conditions known to affect pupil size have been excluded from the study. For an Alpha value of 0.05 and a power level of 90% a sample of just over 36 subjects in each group was calculated. Pupil diameters of the same eye for each subject have been measured before and after pharmacologic dilation with phenylephrine 2.5% and tropicamide 1.0%. All measurements have been recorded in the same light conditions using the same auto refractor keratometer.

Results: Mean pre-dilation pupil diameter for the subjects on a1-adrenergic blockers was 4.00±0.10 while for the control group it was 4.21±0.13. post-dilation pupil size was 7.449±0.1424 and 7.446±0.1747 respec-tively. Mean change in pupil diameters was 3.45±0.13 and 3.23±0.16 respectively. no statistically significant difference in pupil mydriasis has been found between groups (p=0.29). no significant correlation was found between the duration of a1-adrenergic blockers treatment and change in pupil diameter (pearson r correla-tion coefficient = -0.11, p=0.54).

conclusions: this study presents an interesting contrast to the literature, where it has been suggested that subjects on a1-adrenoreceptor antagonists suffer from impairment of pupil dilation. no statistically significant difference in pupil diameter between patients taking a1-adrenoreceptor antagonists and healthy controls has been established. duration of the medication has not been proved to play a role in the pupil diameter either. this may be of particular importance in preoperative cataract assessment, as adequate pupil diameter is a crucial factor for an uneventful operation.

Financial Disclosure: none of the authors have any financial support/ any proprietary interests or conflicts of interest related to this submission.



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EP6corneal opacities and cataract surgery: this is how to do it! cataract / cornea surgical case (Video / Poster abstract)

Mokka Agni*, Stampouli Despoina, Vagiakis Iordanis, Athanasiadis Vasilios, Zachariadi Sofia

*Corresponding Author: [email protected]

Purpose: to present a challenging surgical case of phacoemulsification and chronic extensive stromal corneal opacities. We discuss the perio-operative and intraoperative considerations to minimize the risk of complications.

Setting: ophthalmology department, General Hospital of Xanthi. Xanthi, Greece.

Methods: a 77-year-old caucasian male presented to outpatient ophthalmic services complaining of a bilateral gradual reduction in vision. He was on oral treatment for hypertension, hyperuricaemia and benign prostate hypertrophy. His previous ocular history and family history were unremarkable. there was no history of trauma. On examination, best corrected visual acuity (BcVA) was Od 2/10+ Os 1/10. Anterior segment examination revealed bilateral multiple central and peripheral extensive corneal stromal opacities, in the absence of an epithelial defect. lens opacities were dense and consisted of 2+ nuclear sclerotic as well as 3+ cortical cataracts bilaterally. Following informed written consent with a guarded visual prognosis, cataract surgery was planned in both eyes on a sequential basis.

Results: phacoemulsification surgery under topical anaesthesia was planned due to mild bradycardia (43-45 bpm). enhanced visualization with trypan Blue was key to achieve a complete continuous and round capsulorrhexis. Following this, loss of dilation and persistant iris prolapse through the main incision occurred despite adequate wound construction, at the initial introduction of the phacoemulsification probe into the anterior chamber. the extent of intraoperative Floppy iris syndrome (iFis) was resistant to pharmacological dilatation and subsequent safe progression with phacoemulsification was only achievable with four mechanical iris expansion hooks. cortical matter aspiration and intraocular lens implantation in the bag followed and the operation ended without any complications.

conclusions: corneal opacities pose challenges during phacoemulsification surgery. this cohort of patients often have multiple ocular comorbidities (resulting in delayed presentations), previous trauma, or inflammatory conditions, which cataract surgeons may encounter. We discuss the risk factors, perioperative and intraoperative considerations, and demonstrate how with careful surgical planning and utilization of surgical adjuncts, surgical complications can be avoided in cases with corneal opacification. Financial disclosure of all authors: none



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EP7Severe chemical keratitis because of unsolicited and imprudent use of topical anaesthetic eye drops

Sevasti tsironi1, Efstratios theofrastou1, Anastasia Sarafi1, Karachrysafi Sofia1, Elissavet Siskou1, lazaros Botelis1, Elie Fadel1


Purpose: presentation of an interesting case with chemical traumatic keratitis because of topical anaesthetic eye drop overuse.

Methods and materials: Fifty three year old male arbitrarily used tetracaine eye drops for a week because of photokeratitis.After a week he urgently came to the hospital due to pain in both eyes.Almost total apoptosis of corneal epithelium was found along with eyelid oedema, photophobia and severe reduction of visual acuity.

Results: immediately a pressure bandage was placed with antibiotic ointment.the pressure bandage was changed twice a day and a photo of the eye was taken for monitoring.due to severe pain and discomfort,pain-killers and sedatives were administered per os.Gradually and according to the physical examination the pres-sure bandage was discontinued and therapy was continued with topical and per os medication.

conclusions: due to the severity of the case,hospitalisation was needed for 25 days.in conclusion the impru-dent and arbitrary use of topical anaesthetic eye drops can lead to grave damage.



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EP8corneal endothelial properties in Neurofibromatosis type 1 patients: Preliminary results of an ongoing research

chrysoula Florou1, Evaggelia Aissopou2, Evangelia chalkiadaki3, Evangelia Papakonstantinou1, chrysanthi Koutsandrea1, Konstantinos Droutsas1, Ilias Georgalas1

11st Dept. Of Ophthalmology, National And Kapodistrian University Of Athens, General Hospital “G. Gennimatas”, Greece, 2Macula Center, Athens,, Greece, 3Department of Ophthalmology, 251 Hellenic Airforce General Hospital, Athens,, Greece

Purpose: the aim of this study was to evaluate the morphological properties of corneal endothelial cells and central corneal thickness (cct) in patients with neurofibromatosis type 1 (nF1) and to compare them with 1:2 age- and gender-matched healthy controls.

Design: cross-sectional study.

Methods: 23 nF1 patients and 46 healthy individuals, all free of diabetes and hypertension, were recruited. each participant underwent complete ophthalmological examination as well as noncontact specular microscopy, using the center method, to measure endothelial cell density (ecd), average cell area (AVG), coefficient of variation of cell area (cV), the percentage of hexagonal cells and cct. eyes with previous ocular trauma, inflammation or surgery and preexisting corneal and ocular surface diseases were excluded.

Results: nF1 patients had statistically significant lower cV (33.0±4.6 versus 36.9±8.9%, p=0.019) compared with healthy controls of the same age and gender. ecd and hexagonality were significantly higher (2745.1±267.4 versus 2570.7±423.4 cells/mm2, p=0.043 and 55.5±6.4 versus 50.9±9.3%, p=0.025 respectively), while AVG was lower (p=0.035) in nF1 patients. cct did not differ significantly between nF1 group and controls. conclusions: this is the first study to determine overall the morphological characteristics of corneal endothelium in patients with nF1. the functional inactivation of nF1 gene in these patients, through activation of MApK and rAs pathway, seems to induce corneal endothelial cells proliferation, thus creating a more stable and, presumably, less vulnerable to surgical stress corneal endothelium in nF1 patients.



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EP9Akanthamoeba keratitis: time of visiting the ophthalmologist for the first time has a determinative role in the clinical outcome

Gardeli I., Mouriki K., Manoli K., orfanidou M.

Cornea Department, State Ophthalmology Clinic, General Hospital of Athens G. Gennimatas, Greece

Purpose: the purpose of this paper is the presentation of the clinical course and the management of akanthamoeba keratitis in two patients that were presented to the outpatient clinic. Both patients were contact lenses wearers. these cases differ in the time of visiting the ophthalmologist for the first time: the first patient delayed the most to visit the physician, whereas the second patient visited early the ophthalmologist.setting: the first case was a 21-year-old woman who was presented with a central corneal ulcer with epithelial defect, stroma infiltration and 3600 neovascularization. the second case was a 25-year-old woman with radial keratoneuritis.Methods: the superficial corneal swab was used for cultures and polymerase chain reaction (pcr). in all cases Pcr was found to be positive for akanthamoeba. in both cases cultures of acanthamoeba were grown.

Results: in both cases we used coll desomedine and polyhexamethylene biguanide (pHMB) 0.02%. the clinical course of the first patient was poor. the clinical course of the second patient was good and the akanthamoeba keratitis was cured without any long-term complications.

conclusions: the time of visiting the ophthalmologist for the first time is a factor that may predict the clinical course among patients with Akanthamoeba karatitis. Visiting the ophtalmologist early may have a determina-tive role in preventing severe complications of the Akanthamoeba keratitis.Financial disclosure of all authors: no disclosure.



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EP10Welder’s eye: a challenging case

Mouriki K., Gerou A., tsoutsoura S., Gardeli I.


Purpose: the purpose of this paper is the presentation of the clinical course and management of a case with non infectious keratitis after welding and misuse of topical tetracaine.

Setting: this case is about a 48-year-old male that was presented to the outpatient clinic complaining of eye pain and blurry vision after welding. He also referred that he was using topical tetracaine quite frequently. He was presented with a central corneal ulcer with epithelial defect without anterior segment reaction.

Methods: the superficial corneal swab was used for culture. in this case culture was negative. results: treatment of this ulcer was challenging. to improve epithelial healing, our treatment included autol-ogous serum eye drops and therapeutic contact lens. the epithelial defect closed after 10 days and the clinical course of the patient was good.

conclusions: Autologous serum eye drops and therapeutic contact lens in cases of non infectious keratitis have an important place in the therapeutic algorithm. Financial disclosure of all authors: no disclosure.



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EP11Akanthamoeba and fungal keratitis: a complicated case

Mouriki K., orfanidou M., Gerou A., Gardeli I.


Purpose: the purpose of this paper is the presentation of the clinical course and management of a case com-plicated with Akanthamoeba and fungal keratitis. this patient was contact lenses wearer and was presented to the outpatient clinic.

Setting: this case was a 60-year-old woman that was presented with a corneal ulcer with epithelial defect and Wesseley immune ring.

Methods: the superficial corneal swab was used for cultures and polymerase chain reaction (pcr). pcr results were found to be positive for Akanthamoeba and fungi. in this case cultures of Acanthamoeba were grown.

Results: in this case we used coll desomedine and polyhexamethylene biguanide (pHMB) 0.02% for the treat-ment of Acanthamoeba keratitis, whereas for the fungal keratitis we used tab and coll voriconazole. the clinical course of the patient was good in follow up although she had received treatment for herpes simplex before she was presented to our clinic.

conclusions: prompt diagnosis and treatment of Acanthamoeba and fungal keratitis are essential for a good visual outcome.Financial disclosure of all authors: no disclosure.



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EP12corneal perforation related to Beauveria bassiana and post penetrating keratoplasty management discussion: a case report

Atzamoglou S.1, Markopoulos I.1, Kontomixos l.2, Mpatsos G.2 Paroikakis E.2, Peponis V.1

1Ophthalmiatreio of Athens, A’ Opththalmology department2Ophthalmiatreio of Athens, B’ Opththalmology department

Purpose: to present a case of corneal graft perforation due to infection by the filamentous fungus Beauveria bassiana that was successfully treated with repeat penetrating keratoplasty (pK).

Materials and methods: An 84-year-old male patient with history of bilateral pK for keratoconus presented with pain and decrease in visual acuity on his left eye. A corneal perforation was found, which was treated immediately with a full-thickness corneal transplant. the specimen was sent for bacterial and fungal cultures.

Results: topical corticosteroids were prescribed postoperatively. B. bassiana was isolated from the corneal scrapings. postoperative treatment was modified by reducing the dose of corticosteroids (topical dexameth-asone 0.1% b.i.d) and adding topical natamycin 5% b.i.d together with systemic antifungal therapy initially with posaconazole (100 mg q12h) which discontinued because of elevated hepatic enzymes and then with voriconazole (200mg q12h) for 1 month according to the in vitro antifungal susceptibly data. no recurrence occurred in the transplant 4 months postoperatively under topical dexamethasone 0.1% b.i.d.

Discussion: this is the first case of keratitis and perforation in an already transplanted cornea. due to the rar-ity of the infection, there are no clear guidelines for postoperative prophylaxis in B. bassiana infection. either the continuation of corticosteroids or the change to another immunosuppressive therapy and the selection of the appropriate antifungal regimen posed an intense therapeutic dilemma.



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EP13ultrathin DSEK graft using a manual technique

P. Xanthopoulou1, Zara Ashena1, Mohamed Elanwar1, Motasim Alzyadi1, Aine Rice1, Nick Kopsachilis1


Purpose: some studies suggested quicker visual recovery and better final visual outcome associated with thinner dseK grafts. there are a few publications reporting manual and automated techniques to achieve thin/ultrathin dseK graft. We report a series of 10 consecutive dseK procedures with thin graft using a man-ual technique.

Report: in this prospective study 10 consecutive cases of dseK were assessed. the surgery was performed by one consultant and two corneal fellows in the ophthalmic suite of Kent and canterbury Hospital in 2018. in order to achieve the thin graft, manual technique was used as a routine practice. the graft was prepared using artificial anterior chamber and a 640µ guarded diamond knife to make the initial limbal incision. the incision depth was assessed with a crescent blade. in order to achieve a thin graft, the incision depth was enhanced using crescent blade in thick donors. the dissection completed using Morlet lamellar dissector. the average time to dissect the graft was 6 minutes. the graft was then punched, loaded and inserted, using an injectable device via a 5mm scleral tunnel incision. the patients were reviewed 3 days, 3 weeks and 6 weeks post-op. the graft thickness was measured 6 weeks after the surgery using anterior segment Oct. the mean central graft thickness was 67 ± 31µm. no intraoper-ative complication, including graft perforation, occurred using this technique. One patient had graft detach-ment and needed re-bubbling.

conclusion: the previous manual techniques of descemet stripping used guarded knives with 400 µm - 500 µm depth. We used 600 µm guarded knife for initial limbal incision, with further enhancement of incision depth as needed, to achieve ultrathin dseK graft. no perforation occurred in spite of deep plane dissection and the mean dissection time was not longer than 6 minutes.



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EP14Rare case of open-globe trauma due to an olive drupe

Stergios chaloulis1, Aikaterini Ioannou1

1General Hospital of Volos, Greece, Greece

Purpose: to present an interesting case of open-globe trauma caused by an olive drupe freefall during har-vesting.

Settings: eye department, Volos General Hospital, thessaly, Greece Methods: A 66 years old female patient attended the eye casualty department due to injury in the left eye caused by an olive drupe. the patient’s visual acuity in the left eye was light perception. she presented a scleral rupture approximately 6mm from the limbus with prolapse of uvea and vitreous humor. Moreover, the patient had a flat anterior chamber, hypotony, iris deformation, lens dislocation and mild hyphaema.

Results: ct-scan was performed which illustrated lens dislocation and hyperdense elements, probably hem-orrhagic, in the vitreous cavity. Mild swelling of the optic nerve without orbital fractures or intraocular foreign body.

conclusion: the patient was referred to the regional tertiary hospital where emergency vitrectomy and sclera suturing were performed.

All authors have no financial interest to disclose



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EP15Bell’s palsy in a 8 year’s old child

loukia Politi1, Fani Akritidou1, Eleni lazaridi1, Pelagia tsitsani1

1General Hospital Of Edessa, Edessa, Greece

Pediatric case of facial nerve palsy / Bell’s palsy

case presentation: 8 year’s old male was taken to the hospital with a blunt trauma on the neck. From the pediatric examination a right facial nerve palsy was indicated Full opthalmological examination was performed: right eye: VA:10/10, full extraocular motility, no papillary deficits, punctate epithelial erosions, incomplete and reduced blinking with 1,5mm sclera exposure, epiphora with adequate corneal protection, normal fun-dus, Bell’s phenomenon Left eye: without any pathological findingsdiagnosis was posttraumatic right Bell’s palsy and the patient was treated with physiotherapy, antibiotic oint-ments and tear drops gel for corneal protection.

conclusion: Bell’s palsy is less common in children. the incidence in children younger than 10 years of age is 2,7/100.000 cases. differential diagnosis includes tumors, sclerosis, inflammations. Adequate and timely treatment is important for better prognosis



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EP16Age-related changes in the monocular and binocular amplitude of accommodation

Dimitra Georgantaki1, Aspasia Vouza2, Sotiris Plainis3

1St. Catherine’s British School, Athens, Greece, 2OMMA, Athens, Greece, 3Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Heraklio, Greece

Aim: Αmplitude of accommodation (AoA) is the standard subjective measurement of the focusing range of the eye. although aoa is usually measured monocularly, binocular viewing provides normal proximity cues and allows more natural convergence. the aim of the study was to evaluate the effect of binocular viewing on aoa age-related changes.

Methods: the AoA of 108 participants, (age range 10 to 83 years) was measured monocularly and binocu-larly. the AoA, in dioptres, was determined using a rAF rule and the push up method for the right / left eye and binocularly. the distances at which the target became blurry when pushing the target up, and at which it became clear when pushing it down was measured. this was repeated three times and the average AoA was calculated.

Results: AoA declined progressively with age for both viewing conditions. While the individual differences between the binocular / monocular amplitudes ranged up to 2.0 d, the average difference was comparatively moderate being 1.0±1.4d for the age group 10 to 14 and 0.9±0.7d for the age group 15 to 19, decreasing to an average of 0.3 d for ages between 20 and 50, and 0.2 d for ages between 50 and 60.

conclusions: Both monocular and binocular aoa decline with age, leading to presbyopia symptoms in early 40s. the higher difference between binocular and monocular AoA in young eyes is possibly due to extra con-vergence-driven accommodation, which decreases in older eyes, since there is little convergence demand. increased demand in convergence may also result in further pupil contraction and a corresponding increased depth-of-focus.



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EP17Is a no touch Soft contact lens Insertion System (SclIS) worth Pursuing even in Single use Disposable contact lenses?

D. Spourdalakis1, A.K. charonis1

1Appleye P.C.

Aim: to investigate whether prevention of Hand contamination during Habitual contact lens (cL) insertion might prove clinically relevant.

Methods: We reviewed the Literature regarding Hand contamination, cornea infiltrative events (cie) and frank Microbial Keratitis (MK) and contact Lens discomfort. (cLd) in the best possible scenario. the single Use (silicone) hydrogel disposable contact lens.

Results: despite the fact that frank MK in contemporary cL single use silicone Hydrogel soft cL is already rare (~1:500.000 insertions), even low microbial inoculum during insertion along with residues of soap, alcohol, preservatives, additives and particles play a definite if not paramount role in cie, MK and cLd at least in the initial wearing phase.

conclusions: there is ample room and enough reasoning for justifying implementation of a cheap, reliable and easy to use sterile insertion system in the multibillion dollar/year cL industry including single use cL’s.



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EP18 Initial preclinical experience with a novel no touch soft contact lens insertion system. (no touch SclIS)

D. Spourdalakis 1,2, D. Giali1, K. tziouvara1, Α. Κoutsonikou1, A.K. charonis1,2

1Athensvision, 2Appleye P.C.

Aim: to demonstrate the effectiveness of scLis in allowing touch-free contact Lens insertion among 10 Volun-teers aged between 12-54 years utilizing a soft single day disposable cL (Acuvue trueye Bc 7,5, power -4,5d).

Methods: After a single brief demonstration and hands-on tutorial of the contact Lens (cL) “refloating” pro-cess, within sclis when and if the cl was found folded, twisted, deformed, or stuck on the deformable pro-tective membrane or the loading platform, the subjects were allowed to handle the device alone and insert the contact lens on their own eyes. From the 10 subjects, 2 (aged 12 and 16 y.o) had absolutely no experience in cL use. the rest were contact lens users and/or employees of a multidisciplinary Ophthalmology practice.

Results: All subjects were able to refloat a stuck, twisted, folded, inverted onto the walls of the de-vice contact lens without difficulty. All subjects were able to place the lens onto their eye without problems.

conclusions: providing a reliable, easy to use and cheap hands-free steriLe insertion system for habitual cL use may prove valuable against cL associated cornea infiltrative events (cie), frank Microbial Keratitis (MK) and contact Lens discomfort (cLd).



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EP19changes in reading patterns as elementary students grow older

Ioannis M. Aslanides, Nantia Boufachrentin, Minas Aslanidis, Ioanna Aslanidi, Vasilis Andreadakis, Ioannis Smyrnakis

Corresponding author: Ioannis M. Aslanides ([email protected]), Emmetropia Eye Clinic/Optotech Research Lab, Greece

Background: dyslexia is still one of the main interests of the research community, due to the lack of consen-sus in its definition. this lack of a universal definition, increases the struggle of specialists to assess dyslexia and expands the lists of children waiting for assessment. therefore, the need of objective and fast tools for screening and diagnosis arises.

objective: to investigate reading behaviors of students, with and without dyslexia, in the last four years of elementary school, using eye-tracking technology.

Methods: in the present research, 110 Greek native students participated in this research from the 3rd to the 6th grade of elementary school. From them, 52 were diagnosed with dyslexia by the Greek governmental agency responsible for dyslexia diagnosis and 58 did not have reading difficulties. participants were assessed, while reading silently, in two texts of different difficulty.

Results: the current study highlights an improvement of reading speed as students grow older, despite having or not dyslexia. it is also noted that as typical students grow older, their short saccadic movements decrease while their long ones increase. dyslexics have similar patterns, but instead of an increase on long saccadic movements there is an increase on the medium ones. one parameter that can clearly separate the two groups same through the years is the number of words that are not fixated. typical readers raise the number of not fixated words as they grow older, however dyslexic students retain the same number or raise it slower.

conclusion: students with dyslexia improve their reading skills through the years, but they seem to do it in a lower scale than typical readers of the same age.



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EP20AlEXANDER MoNRo (Secundus), the great anatomist, and his contribution to the study of the eye

Georgios Balanikas1, Dimitrios Peirounidis1, christine Georgiadou1, Michael Angelou3, Petros Rasoglou4, Dimitrios christodoulou2, Vasileios Karampatakis5, Stefanos Maloutas1

1A’ Ophthalmologic Clinic, AHEPA Hospital, Thessaloniki, Greece, 2Laboratory of History of Medicine, Medical School, Aristotle University, Thessaloniki, Greece, 3Private Practise, Athens, Greece, 4Institute Ophthalmica, Thessaloniki, Greece, 5Laboratory of Experimental Ophthalmology, Medical School, Aristotle University, Thessaloniki, Greece

Purpose: Alexander Monro (secundus), a scottish physician (May 22, 1733, edinburgh,- Oct. 2, 1817, edinburgh) was a great anatomist and surgeon of the 18th century. He combined an exceptional work of anatomical es-says ‘three treatises’ (On the Brain, the eye and the ear) which was published in 1797. We are speaking about the second section of the book concerning the eye. the 1797 edition is used in this presentation.

Setting/Venue: the study of the Monro’s work was completed in the first Ophthalmologic clinic of Aristotle university of thessaloniki dr alexander Monro, secundus, lived and worked mainly in edinburgh and studied in london, paris and Berlin and died in edinburgh. in these places took place the facts of this presentation.

Methods: the second ‘treatise’ refers to the eye. it has the title’ OBserVAtiOns On tHe strUctUre and Functions of the eyes. By aleXander Monro, M.d.’ the book was published in 1797 in edinburg and consists of 264 pages, 106 of them is dedicated to the eye section. the first six chap-ters describe the anatomy of the eye with some of the physiological functions as the refraction of the eye and the route of the light towards the retina. the sixth chapter describes the cornea and the neovascularization after corneal lesions. the last chapter describes the ‘Lachrymal ducts’.

Results: Alexander Monro’s work is a concise, but complete, treatise about the eye and its basic functions and includes also anatomical engravings of the organ very useful for the ophthalmic surgeons of his era.

conclusions: Alexander Monroe, secundus (1733-1817) a member of a medical family was a prominent physician, a great anatomist and writer, who contributed to the establishment of the university of edinburgh as a powerful international center of medical knowledge and teaching. He provided useful anatomical elements to the ophthalmic surgeons with his second ‘treatise ‘dedicated to the eye from a more extensive work including the brain and the ear.

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E-POSTERS2021

EP21cost-effectiveness of toric intraocular lenses in cataract patients with astigmatism based on randomized clinical trials data

Giannopoulos K.1, Bakouli A.1

1Department of Ophthalmology, Sitia General Hospital, Sitia

Purpose: to evaluate the cost-effectiveness of toric intraocular lenses versus monofocal intraocular lenses in cataract patients with astigmatism based on randomized clinical trials data.

Material & Methods: review of bibliography. using various keywords we search in medical databases papers that evaluate the cost-effectiveness of toric intraocular lenses versus monofocal intraocular lenses in cataract patients with astigmatism based on randomized clinical trials data.

Results: Among the relative papers that we have found, only one evaluated the cost-effectiveness of toric intraocular lenses versus monofocal intraocular lenses in cataract patients with astigmatism based on ran-domized clinical trials data. this paper was referred to the netherlands health system and its title is: trial-based cost-effectiveness analysis of toric versus monofocal intraocular lenses in cataract patients with bilat-eral corneal astigmatism in the netherlands (simons r.W.p, et al. J cataract refract surg 2019; 45: 146-152. dOi: 10.1016/j.jcrs.2018.09.019).the authors of this study found that the use of toric intraocular lenses is more costly (3203 vs. 2796 euros) than the use of monofocal intraocular lenses and offers less (0.30 vs. 0.31) Quality-Adjusted life Years (QALYs). though the difference in QALYs was not significant (p=0.75)

conclusion: Authors concluded that the implantation of toric intraocular lenses is not cost-effective in cata-ract patients with bilateral astigmatism and therefore patients who wish the implantation of toric intraocular lenses should copay.


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VIDEOS2021

V1cataract extraction with an extended depth of focus (EDoF) Iol implantation together with pupilloplasty, in a young patient with inflammatory glaucoma of unknown aetiology and a previous Ahmed glaucoma valve implantation

Konstantinos Samaras

Athens Laser Sight, Athens, Greece

to describe the case of a 26-year-old patient suffering from inflammatory glaucoma of unknown aetiology. she previously underwent an Ahmed glaucoma valve implantation to control her intraocular pressure bilater-ally. due to her decreased visual acuity from a secondary anterior subcapsular cataract and an unresponsive mid-dilated iris in the right eye, the patient underwent a cataract extraction with an extended depth of focus (edOF) iOL implantation together with pupilloplasty in the right eye, to improve both her distance and near vision and improve her photophobia and her cosmesis.



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V2Ιris hooks and Iris expanders in difficult cases. What we should do and what should not do

G. Dalianis, G. Andriopoulos, c. terzidou

Dept of Ophthalmology, Konstantopouleio Gen Hptl, N.Ionia, Attica, Greece

iris hooks and iris expanders are used to safely phacoemulsify a cataract with small pupil. some difficulties can appear while using these expanders and hooks. With increasing experience the use can be more safe and the results more favorable. We present the use of iris hooks and two types or iris expanders Malyugin rig and i-ring in different cases, with special focus on details about their proper use.



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V3Minimally invasive combined solutions for cataract and glaucoma

chryssa terzidou1, George Dalianis1, Georgios Andriopoulos1

1Dept of Ophthalmology, Konstantopouleio Gen Hptl, N.Ionia, Attica, Greece

We present 4 surgical combined solutions for cataract and glaucoma which we consider minimally invasive. 1. cataract in patients with previous failed or not properly working blebs can be operated with phaco and

ab-interno revision of the bleb using Grover’s translimbal sclerostomy spatula. 2. patients with cataract and glaucoma, with up to 2 or three antiglaucoma medications and ddLs (spaeth’s

optic disc classification system) up to 6 can be operated with phaco and kahook dual-blade goniotomy. 3. cataract in glaucoma patients that need low iOp due to moderate or advanced glaucoma can be safely

operated with phaco - sMArt trabeculectomy. sMArt is a modified trabeculectomy that uses stab incision 2.4 mm and usually only 1 or sometimes 2 removable sutures, with small conjunctival opening.

4. eyes with narrow angles can be positively affected concerning iOp and angle depth by phaco and visco-go-nioplasty (VGp).



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V4Phaco XEN - An effective alternative?

Michael tsatsos1, Dimitra Gousia1, yiannis Athanasiadis1

1Ophthalmore/ University of Southampton, Thessaloniki, Greece

Glaucoma is a frequent pathology encountered by the countered surgeon. penetrating Glaucoma surgery is associated with significant risks and is ideally not combined with cataract surgery. Modern cataract surgery offers fast visual rehabilitation with very low risk and some at least transient im-provement in intraocular pressure control. Minimally invasive Glaucoma surgery (MiGs) offers a much safer alternative to traditional trabeculectomy and the long term outcomes of the different MiGs procedures re-main to be tested in time Xen, one of the most effective MiGs procedures, can be combined with cataract surgery.With this video we offer tips and tricks for the safe and effective Xen implantation in combination with cata-ract surgery. We aim to offer our condensed experience in order to speed up and assist the learning curve of the aspiring surgeon.



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V5Surgical Management of Diffuse conjunctival Melanoma

Sotiria Palioura1


Purpose: to present the steps in surgical management of an extensive conjunctival melanoma.

case Presentation: an 85-year old man with history of primary acquired melanosis was referred for management of an enlarging pigmented conjunctival lesion. on examination the lesion was very suspicious for conjunctival melanoma. it occupied several clock hours of the superior limbus and bulbar conjunctival and pigmented cells extended all around the limbus, into the fornix and in the upper tarsal conjunctiva. the main lesion was carefully excised using a no-touch technique, obtaining > 4 mm peripheral margins, performing alcohol epitheliectomy, double-freeze cryotherapy and amniotic membrane transplantation to cover the conjunctival defect. Map biopsies of the ocular surface were also performed before freezing any additional pigment on the ocular surface, the fornix and the palpebral conjunctiva. the patient recovered well with vision of 20/40 for the first post-operative year.

conclusions: a careful and methodical surgical approach should be used in all cases of conjunctival melanoma and especially when the lesion occupies a large proportion of the ocular surface.



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V6Surgical Management of Recurrent Pterygium

Sotiria Palioura1


Purpose: to present a novel technique of managing an aggressive recurrent pterygium in a young patient using intraoperative mitomycin c, a conjunctival autograft to cover the defect and amniotic membrane to prevent scarring of the medial rectus muscle.

case Presentation: An 28-year old man was referred for management of a fleshy recurrent pterygium fol-lowing two prior excisions. surgery was performed using sub-tenon’s anesthesia. the lesion was marked and carefully excised. time was taken to remove all the underlying tenon’s fascia and scar tissue that emerged from the medial rectus muscular sheath. Mitomycin c (MMc) 0.02% was applied for 1 minute. the muscle was isolated and wrapped in amniotic membrane using fibrin glue in order to prevent post-operative scar for-mation. A thin conjunctival autograft was prepared and secured in place using fibrin glue and a few stabilizing sutures. the patient followed a slow post-operative steroid taper and is free of recurrence for more than one year.

conclusions: excision of recurrent pterygium in young patients is challenging and all precautions should be taken in order to prevent recurrence. isolation and protection of the medial rectus muscle with amniotic membrane, use of intraoperative MMc, a conjunctival autograft and tissue glue are all essential steps towards that goal.



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V7A case of graft folding in DSAEK

Gardeli I., Mouriki K.


Purpose: the purpose of this video is the presentation of the management of the folding of the graft during dsAeK.

Setting: this case was about a 77-year-old woman that was presented with bullosa after cataract surgery.

Methods: in this case, during dsAeK we encountered the problem of the folding of the graft. the opening strategy that we followed was successful and the graft unfolded.

conclusions: intraocular graft unfolding techniques in dsAeK are essential.Financial disclosure of all authors: no disclosure.



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V8late posterior corneal perforation and intraocular migration of intracorneal ring segment possibly associated with floppy eyelid syndrome

Artemis Matsou1, Samer Hamada1

1Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, United Kingdom

Purpose: to report a rare case of late posterior corneal perforation with intracorneal ring segment (icrs) migration into the anterior chamber (Ac), 18 months after femtosecond-assisted (Fs) implantation of a single ring segment for keratoconus management, likely related to floppy eyelid syndrome.

case-report: A 23 year-old male with keratoconus underwent implantation of an 2100 Ferrara5 icrs to the right eye (re). Femtosecond-assisted tunnel creation at 400microns incision depth guided by pachymetric analysis and corneal topography was performed. the procedure was uneventful and post-operative reviews up to 6 months were unremarkable. during routine 18-month follow-up, reduction of re vision, redness and discomfort were reported. slit-lamp examination revealed icrs migration inferiorly with endothelial perfora-tion and protrusion of approximately 50% of the segment body into the anterior chamber with no damage to intraocular structures. there was no history of trauma or eye rubbing, although floppy eyelids were ob-served. Urgent surgical explantation of the icrs was performed. At 3-weeks follow-up the posterior cornea had healed with no signs of ac leakage.

conclusion: Femtosecond-assisted icrs implantation carries a low incidence of intra/post-operative com-plications thanks to more precise and predictable size and depth of channel creation. posterior corneal per-foration can be caused by incorrect preoperative pachymetry or deeper channel creation and is usually ap-parent intraoperatively with the presence of bubbles in the Ac. Late posterior corneal perforation with icrs migration in the Ac 18 months after femtosecond-assisted implantation is an extremely rare occurrence, with floppy eyelid syndrome likely playing a key role in this case.



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V9A Simple Sutureless technique for Pterygium Surgery with a dehydrated amniotic membrane

Paraskevi Xanthopoulou1, Mohamed Elanwar1, Motasim Alzyadi1, Aine Rice1, Nick Kopsachilis1


there are currently many surgical techniques available for the management of pterygium. excision with lim-bal conjunctival autograft is currently the most popular surgical procedure and has been shown to have low recurrence rate and fewer complications. However, the use of sutures and autograft preparation increases the procedure time significantly. postsurgical conjuctival redness and irritation is another significant com-plaint of the majority of patients after pterygium excision with this method. the use of OMniGen instead of conjuctival autograph in pterygium surgery is a new promising technique due to many advantages such as shorter operation time, easier graft fixation, reduction in comlications and less postoperative discomfort. We present a simple technique of pterygium surgery with dry amniotic membrane matrix and without the need for anchoring limbal sutures or an assistant holding the graft whilst it is glued in place.



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WINTER SYMPOSIUM · 2021. 2. 26. · of the Hellenic Society of Intraocular Implant and Refractive...

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