Hong Kong Ophthalmological Symposium 2015 Abstract Book

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HKJOphthalmol Vol.19 No.1 Supplement 1

2 7 t h A n n u a l S c i e n t i f i c M e e t i n g

Hong Kong Ophthalmological

Symposium 2015

ABSTRACT BOOK

HONG KONG JOURNAL OF

OPHTHALMOLOGY The Ofcial Publication of

the College of Ophthalmologists

of Hong Kong

DECEMBER 2015

Volume 19 Number 1Supplement

ISSN 1027-8230

Editor-in-Chief Ian Wong

CorrespondenceThe College of Ophthalmologists of Hong Kong

Room 802, 8/F, Hong Kong Academy of

Medicine Jockey Club Building

99 Wong Chuk Hang Road

Aberdeen, Hong Kong, China.

Tel (852) 2761 9128

Fax (852) 2715 0089

E-mail: [email protected]

Published byHONG KONG ACADEMY OF MEDICINE PRESS

Myopia andOculoplastics

12 – 13 December 2015 (Sat & Sun)Level 1, Hong Kong Convention and

Exhibition Centre

Invited Symposium: Hong Kong Society of

Ophthalmic Plastic and Reconstructive Surgery



HKJOphthalmol Vol.19 No.1 Supplement2

Editor-in-Chief Dr Ian Wong

Advisors

Section Editors

International Advisors

Dr Arthur Cheng

Dr Pak-Chin Chow

Dr Dorothy Fan

Prof Jimmy Lai

Dr Timothy Lai

Prof Dennis Lam

Dr Nai-Man Lam

Dr Vincent Lee

Prof Chris Leung

Dr Dexter Leung

Prof Calvin Pang

Prof Kwok-Fai So

Prof Clement Tham

Dr Donald Woo

Dr Po-Fat Yiu

Dr Alvin Young

Dr Nancy Yuen

Dr Hon-Wah Yung

Dr Can Yuen

Anterior Segment

Dr Tommy ChanDr Alex Ng

Dr Lester Yu

Neuro-Ophthalmology

Dr Carmen ChanDr Andy Cheng

Dr Ho-Wing Lau

Pediatrics and Strabismus

Dr Connie LaiDr Winnie Lau

Dr Patrick Wu

Dr Jason Yam

Basic ScienceDr Wai-Kit Chu

Dr Amy Lo

OculoplasticsDr Alvin Au

Dr Kelvin Chong

Dr Hunter Yuen

RetinaDr Derek Chung

Dr Angie Fong

Dr Lawrence Iu

Dr Callie Ko

Glaucoma

Dr Jonathan HoDr Jacky Lee

Dr Felix Li

Dr Andrew Chang (Australia)

Dr Robert Chang (USA)

Dr Gemmy Cheung (Singapore)

Dr Jay Chhablani (India)

Prof Victor Chong (UK)

Dr Makoto Inoue (Japan)

Dr Ryo Kawasaki (Japan)

Dr Hideki Koizumi (Japan)Prof Wai-Ching Lam (Canada)

Dr Ji-Eun Lee (Korea)

Dr Joo-Eun Lee (Korea)

Dr Miho Nozaki (Japan)

Prof Koh Hei Sonoda (Japan)

Dr Kiyoshi Suzuma (Japan)

Dr Yong Tao (China)

Prof Ning-Li Wang (China)

Mr Tom Williamson (UK)

Prof Tien-Yin Wong (Singapore)

Dr Sun-Yang (USA)Prof You-Xin Chen (China)

Prof Ming-Wei Zhao (China)

EDITORIAL

BOARD




Co-Chairman Dr. Dorothy S. P. FAN

Dr. Hunter K. L. YUEN

Advisors Dr. Pak-chin CHOW Dr. Dexter Y. L. LEUNG

Prof. Calvin C. P. PANG

Secretary Dr. Winnie W. Y. LAU

Treasurer Dr. George P. M. CHENG

Scientic Secretaries Dr. Kelvin K. L. CHONG Dr. Emmy Y. M. LI

Dr. Jason C. S. YAM

Dr. Wilson W. K. YIP

Publication Secretaries Dr. Tommy C. Y. CHAN

Dr. Connie H. Y. LAI

Dr. Gillian Denise J. Y. SIU

Dr. Jane C. C. YEUNG

Social Secretaries Dr. Aaron T. K. CHU

Dr. Michelle C. Y. FAN

Dr. Lawrence P. L. IU

Dr. Raymond L. M. WONG

Floor Managers Dr. Jonathan C. H. HO

Dr. Tracy Y. T. KWOK

Dr. Stephen T. L. LI

IT Managers Dr. Victor S. C. CHU

Dr. Mary HO

Dr. Simon K. H. SZETO

Dr. Gordon S. K. YAU

Immediate Past Chairman Dr. Alvin L. YOUNG

ORGANIZING

COMMITTEE




2 7 t h A n n u a l S c i e n t i f i c M e e t i n g


Symposium 2015

ABSTRACT BOOK

Hong Kong, 12-13 December 2015

HONG KONG JOURNAL OF

OPHTHALMOLOGY The Ofcial Publication of

the College of Ophthalmologists

of Hong Kong

Program at a Glance 5

Scientific Program 7

Plenary Lectures 12

Free Paper Sessions 15

1. Cataract, Cornea & External Eye Disease 16

2. Glaucoma 19

3. Myopia 21

4. Pediatric Ophthalmology, Neuro-ophthalmology & 23

Miscellaneous

5. Oculoplastics 26

6. Vitreoretina 28

Posters 32

This Abstract Book is divided into

3 sections. Each section is labeled

by a prefx (letter) and / or a

number series. Each Abstract is

identifed by a unique Abstract

Number.

Section Abstract No.

Plenary Lectures S01 – S08

Free Paper Sessions 1-1 – 6-12

Posters P01 – P44

(Example: Abstract S01 denotes

the abstract of Plenary Lectures

Paper No. 1)




PROGRAM

AT A GLANCE

12 December 2015, Saturday

Time Room

N101A

Room N101B Room N111-N112 Room

N103

Room

N104-

N110

Room

N110

East

Foyer

08:00 – 08:15 Opening Ceremony of

HKSOPRS Symposium08:15 – 08:3008:30 – 08:45

HKSOPRS Symposium 1:

State-of-art Oculoplastic

Surgeries

08:45 – 09:00

09:00 – 09:15

09:15 – 09:30

09:30 – 09:45

09:45 – 10:00Tea Break

10:00 – 10:15

10:15 – 10:30

HKSOPRS Symposium 2:Finesse in Periocular Esthetics

10:30 – 10:45

10:45 – 11:00

11:00 – 11:15

11:15 – 11:30

11:30 – 11:45

12:30 – 12:45

Bayer Lunch

Symposium

12:45 – 13:00

13:00 – 13:15

13:15 – 13:30

13:30 – 13:45 Opening Ceremony of the


Symposium 201513:45 – 14:00

14:00 – 14:15 Keynote Lecture:Oculoplastics 114:15 – 14:30

14:30 – 14:45

HKSOPRS Oculoplastics

Invited Symposium 1:

Challenges in Oculoplastic

Disorders

Bayer Retina Symposium14:45 – 15:00

15:00 – 15:15

Free Paper Session 1:

Cataract, Cornea &

External Eye Disease

15:15 – 15:30

15:30 – 15:45

15:45 – 16:00

16:00 – 16:15Tea Break

16:15 – 16:30

16:30 – 16:45 Keynote Lecture:Myopia 116:45 – 17:00

17:00 – 17:15Myopia Invited Symposium


Glaucoma

17:15 – 17:30

17:30 – 17:45 Free Paper Session 3:

Myopia17:45 – 18:00

18:00 – 18:15

HKSOPRS Oculoplastics

Invited Symposium 2:

Tips in Periocular Surgeries


Pediatric Ophthalmology,

Neuro-ophthalmology &

Miscellaneous

18:15 – 18:30

18:30 – 18:45

18:45 – 19:00

19:00 – 19:1519:15 – 19:30

19:30 – 22:00 Gala Dinner

B a u

s c h & L o m b T h e r m a g e W o r k s h o p I

C o

m m e r c i a l E x h i b i t s

P o

s t e r P r e s e n t a t i o n

E l e c t r o n i c P o s t e r s

P13

P13

P16

P19

P23

P21




PROGRAM

AT A GLANCE

13 December 2015, Sunday

Time Room N101A Room N101B Room N111-N112 Room

N103

Room

N104-

N110

Room

N110

East

Foyer

08:00 – 08:15

Novartis Breakfast

Symposium

08:15 – 08:30

08:30 – 08:45

08:45 – 09:00

09:00 – 09:15 Keynote Lecture:

Oculoplastics 209:15 – 09:30

09:30 – 09:45 Alcon Femtosecond Laser

Cataract SymposiumFree Paper Session 5:

Oculoplastics

09:45 – 10:00

10:00 – 10:15 Bausch & Lomb

Femtosecond Laser

Cataract Symposium10:15 – 10:30

10:30 – 10:45Tea Break

10:45 – 11:00

11:00 – 11:15 Keynote Lecture: Myopia 2

End at 11:2011:15 – 11:30

11:30 – 11:45AMO Cataract Symposium


Vitreoretina

11:45 – 12:00

12:00 – 12:15 Novartis Retina

Symposium12:15 – 12:30

12:30 – 12:45Bausch & Lomb ThermageSymposium12:45 – 13:00

13:00 – 13:15

Carl Zeiss Lunch

Symposium — ReLEx

SMILE

13:15 – 13:30

13:30 – 13:45

13:45 – 14:00


End at 14:20

14:15 – 14:30

Allergan Retina

Symposium

14:20 – 14:50

Resident Challenges

14:20 – 14:50

14:30 – 14:45

14:45 – 15:00

14:45 – 15:00 Keynote Lecture:

Oculoplastics 3

14:50 – 15:2015:00 – 15:20

15:20 – 15:30

Closing Ceremony

of the Hong Kong

Ophthalmological

Symposium 2015

15:30 – 16:00 Cocktail Reception

16:00 – 16:15

COHK Fellowship

Conferment

Ceremony 2015

16:15 – 16:30

16:30 – 16:45

16:45 – 17:00

B a u s c h & L o m b T h e r m a g e W

o r k s h o p I I

B a u s c h & L o m b T h e r m a g e W o r k s h o p I I I

C o m

m e r c i a l E x h i b i t s

P o s t e r P r e s e n t a t i o n s

E l e c t r o n i c P o s t e r s

P13 P26

P28

P13

P13

P14

P14




SCIENTIFIC

PROGRAM

The 1st Symposium of Hong Kong Society of Ophthalmic Plastic and

Reconstructive Surgery (HKSOPRS)

12 December 2015, Saturday / Room N101B

Bausch & Lomb Thermage Workshop

12 – 13 December 2015, Saturday – Sunday / Room N103

Time Topic Speakers

08:00 – 08:30 Opening Ceremony of HKSOPRS Symposium

08:30 – 09:45 HKSOPRS Symposium 1: State-of-art Oculoplastic Surgeries

(Chairpersons: Dr. George CHENG and Dr. Kelvin CHONG)

08:30 – 08:45 Updates in orbital inammatory diseases Prof. Timothy John

SULLIVAN

08:45 – 09:00 Computer-assisted management in orbital fractures Prof. Xian-Qun FAN

09:00 – 09:15 An overview of classic and novel techniques in lacrimal drainage surgery Prof. Reynaldo M. JAVATE

09:15 – 09:30 Contracted socket reconstruction Dr. Darmayanti SISWOYO

09:30 – 09:45 Managing congenital microphthalmia and anophthalmia Prof. Dong-Mei LI

09:45 – 10:15 Tea Break

10:15 – 11:45 HKSOPRS Symposium 2: Finesse in Periocular Esthetics

(Chairpersons: Dr. John CHANG and Dr. Aaron CHU)

10:15 – 10:30 Controversies in congenital ptosis Prof. Ashok GROVER

10:30 – 10:45 Personalizing ptosis correction Prof. Lay-Leng SEAH

10:45 – 11:00 Primary and revision double eyelid operation Prof. Yoon-Duck KIM

11:00 – 11:15 Lower lid blepharoplasties Prof. Shu-Lang LIAO

11:15 – 11:30 Optimizing botulinum toxin injections Prof. Chee-Chew YIP

11:30 – 11:45 Filler-related ophthalmic complications Dr. Chai-Teck CHOO

Date / Time Topic

12 Dec

14:00 – 17:00 Workshop I

13 Dec

09:30 – 12:30 Workshop II

14:00 – 17:00 Workshop III




SCIENTIFIC

PROGRAM

Hong Kong Ophthalmological Symposium 2015

12 December 2015, Saturday / Room N101B

Time Topic Speakers / Presenters

12:30 – 13:30 Bayer Lunch Symposium (Venue: Room N101A)

Theme: Latest Evidence on the Use of Aibercept in Common Retinal Diseases

Controversies on DME Management (Chairperson: Dr. Alvin KWOK)

What works best in DME? From trial data to clinical practice

Meet the expert

Dr. Ian WONG

13:30 – 14:00 Opening Ceremony of the Hong Kong Ophthalmological Symposium 2015

14:00 – 14:30 Keynote Lecture: Oculoplastics 1

(Chairpersons : Dr. Hunter YUEN and Dr. Raymond TSE)

My eyes are popping out, Doc! — Patient perception and orbital disease Prof. Geoffrey ROSE

14:30 – 16:00 HKSOPRS Oculoplastics Invited Symposium 1: Challenges in Oculoplastic

Disorders

(Chairpersons: Dr. Hunter YUEN and Dr. K. K. TSE)

14:30 – 14:45 Orbital vascular disorders: from imaging to intervention Prof. Lay-Leng SEAH

14:45 – 15:00 Surgical rehabilitation in Graves’ ophthalmology Prof. Shu-Lang LIAO

15:00 – 15:15 Combined endoscopy and navigation in oculoplastic surgeries Prof. Xian-Qun FAN

15:15 – 15:30 Surgical options in periocular tumours: margin-control and reconstruction Prof. Timothy John

SULLIVAN

15:30 – 15:45 Treating congenital colobomas of eyelids Prof. Ashok GROVER

15:45 – 16:00 Tips in functional upper lid blepharoplasties Dr. Darmayanti SISWOYO

16:00 – 16:30 Tea Break


(Chairpersons: Dr. Dorothy FAN and Dr. Jason YAM)

Update and prevention of myopic progression in children Prof. Terri YOUNG

17:00 – 17:25 Myopia Invited Symposium

17:00 – 17:15 Myopia and lifestyle Prof. Ernst

GOLDSCHMIDT

17:15 – 17:25 Orthokeratology: both side of the coin Dr. Xiao YANG

17:25 – 17:57 Free Paper Session 3: Myopia

(Chairpersons: Dr. Winnie LAU and Dr. C. Y. WONG)

17:25 – 17:33 3-1. Astigmatic correction after small-incision lenticule extraction and femtosecond-assisted

LASIK

Dr. Tommy C. Y. CHAN

(HKEH / CUHK)

17:33 – 17:41 3-2. To review the outcomes of cataract operations in extreme high myopes Dr. Jasmine K. M. LAM(HKEH)

17:41 – 17:49 3-3. Hong Kong Children Eye Study Dr. Jason YAM (CUHK)

17:49 – 17:57 3-4. Use of atropine for prevention of childhood myopia progression in clinical practice:

efcacy and safety during treatment and when tapering off medication

Dr. Kendrick C. SHIH

(HKU)

18:00 – 19:30 HKSOPRS Oculoplastics Invited Symposium 2: Tips in Periocular Surgeries

(Chairpersons: Dr. Lawrence LAM and Dr. Edwin CHAN)

18:00 – 18:15 Rejuvenating the eyebrows: options and complications Prof. Chee-Chew YIP

18:15 – 18:30 Double eyelid and epicanthoplasty operations Prof. Yoon-Duck KIM

18:30 – 18:45 Muller muscle conjunctival resection “plus” Prof. Shu-Lang LIAO

18:45 – 19:00 Lower blepharoplasty with mini midface list Prof. Reynaldo M. JAVATE

19:00 – 19:15 Upper and lower lid retraction correction Prof. Dong-Mei LI

19:15 – 19:30 Small-incision oculoplastic surgeries Dr. Chai-Teck CHOO




SCIENTIFIC

PROGRAM

12 December 2015, Saturday / Room N111-N112


14:30 – 15:00 Bayer Retina Symposium

(Chairperson: Dr. Alvin KWOK)

Intravitreal Aibercept in Chinese patients with wet age-related macular degeneration:outcome of the SIGHT study

Prof. Xiaoxin LI

15:00 – 16:04 Free Paper Session 1: Cataract, Cornea & External Eye Disease

(Chairpersons: Dr. Alvin YOUNG and Dr. Po-Fat YIU)

15:00 – 15:08 1-1. To compare the stromal demarcation line depth in conventional versus accelerated

collagen cross-linking

Dr. Alex L. K. NG (HKU)

15:08 – 15:16 1-2. Autologous blood for xating conjunctival graft in pterygium surgery Dr. Vanissa W. S. CHOW

(HKEH)

15:16 – 15:24 1-3. Orbital dermoid disguising as allergic lid swelling: a case report Dr. Vijay Kumar Wagh (UK)

15:24 – 15:32 1-4. Toric intraocular lens at Tuen Mun Eye Centre Dr. Rachelle CHAN (TMEC)

15:32 – 15:40 1-5. Topical olopatadine in the management of allergic conjunctivitis: a meta-analysis Dr. Ka-Wai KAM (PWH /

CUHK)

15:40 – 15:48 1-6. Descemet’s stripping endothelial keratoplasty for failed penetrating keratoplasty: theuse of oversized graft in Asian eyes

Dr. Stephen LI (TMEC)

15:48 – 15:56 1-7. Predisposing factors, microbial characteristics and clinical outcome of microbial

keratitis in a tertiary center in Hong Kong: a 10-year experience

Dr. Alex L. K. NG (HKU /

QMH)

15:56 – 16:04 1-8. Change in tear lm lipid layer thickness, corneal thickness, volume and topography

after supercial cauterization for conjunctivochalasis

Dr. Tommy C. Y. CHAN

(CUHK / HKEH)

16:00 – 16:30 Tea Break

17:00 – 17:48 Free Paper Session 2: Glaucoma

(Chairpersons : Dr. Nancy YUEN and Dr. Jonathan C. H. CHAN)

17:00 – 17:08 2-1. Neuroprotective effect of transcorneal electrical stimulation in a gerbil model of acute

glaucoma

Dr. Kendrick C. SHIH

(HKU)

17:08 – 17:16 2-2. Consensual ophthalmotonic reaction — results from a retrospective human study and

a prospective animal study

Dr. Jennifer SHUM (HKU)

17:16 – 17:24 2-3. Different means of cup-disc ratio measurement and the effects of glaucoma 5-year

risk estimation in ocular hypertensive subjects

Dr. Poeman P. M. CHAN

(HKEH)

17:24 – 17:32 2-4. A cross-sectional study on compliance with topical glaucoma medication in Hong

Kong and its associations

Mr. Man-Hin LUI (HKU)

17:32 – 17:40 2-5. Effects of collagen crosslinking on the biomechanical properties of excised cattle

conjunctiva

Dr. Harrison CHAN (HKU)

17:40 – 17:48 2-6. A retrospective study on the prevalence of normal-tension glaucoma among patients

with obstructive sleep apnea syndrome

Dr. Kenneth H. L. LIU

(HKU)

18:00 – 19:12 Free Paper Session 4: Pediatric Ophthalmology, Neuro-ophthalmology &

Miscellaneous

(Chairpersons: Dr. Simon KO and Dr. Christopher YU)

18:00 – 18:08 4-1. Predictors of retinal nerve ber layer thickness abnormalities in unilateral Posner-Schlossman syndrome

Dr. Jonathan C. H. HO(TWEH)

18:08 – 18:16 4-2. Ocular manifestations of herpes zoster ophthalmicus in a tertiary eye center Dr. Simon K. H. SZETO

(HKEH)

18:16 – 18:24 4-3. Fundus photography with smartphone: sharing of novel technique Dr. Ho-Wa LAI (TMEC)

18:24 – 18:32 4-4. Intravitreal bevacizumab for retinopathy of prematurity: local experience at Queen

Mary Hospital

Dr. Stephanie W. YUK

(QMH / HKU)

18:32 – 18:40 4-5. A novel preamplied electrode for improving electroretinography recordings Dr. Marten E. BRELEN

(CUHK)

18:40 – 18:48 4-6. Enhanced depth imaging of lamina cribrosa in non-glaucomatous optic neuropathy Dr. Lai-Ting YIP (TWEH)

18:48 – 18:56 4-7. Undergraduate ophthalmology education: a systematic review Dr. Ka-Wai KAM (PWH /

CUHK)

18:56 – 19:04 4-8. Pediatric open globe injuries: the Hong Kong experience Dr. Yoly Y. Y. FONG (CUHK)19:04 – 19:12 4-9. A review of thyroid-related strabismus at Hong Kong Eye Hospital Dr. Madeline K. M. KWOK

(HKEH)

19:30 – 22:00 Gala Dinner (sponsored by Skyview) [Venue: Room N101A]




SCIENTIFIC

PROGRAM

13 December 2015, Sunday / Room N101B


08:00 – 09:00 Novartis Breakfast Symposium (Venue: Room N101A)

(Chairpersons: Dr. Brelen MARTEN and Dr. Ian WONG)

08:30 – 08:45 Practice management of ranibizumab therapy Prof. Paul MITCHELL

08:45 – 09:00 Meet the expert Dr. Brelen MARTEN,

Prof. Paul MITCHELL,

Dr. Ian WONG


(Chairpersons: Dr. Carol YU and Dr. Alex WONG)

Tales of the unexpected Prof. Geoffrey ROSE

09:30 – 10:00 Alcon Femtosecond Laser Cataract Symposium

Optimizing surgical outcomes in cataract refractive surgery Dr. Ronald YEOH

10:00 – 10:30 Bausch & Lomb Femtosecond Laser Cataract Symposium

VICTUS: taking femto to the next level Dr. Robert ANG

10:30 – 11:00 Tea Break


(Chairpersons: Dr. Wai-Ho CHAN and Dr. Agnes TSE)

Refractive error genomics: an update Prof. Terri YOUNG

11:30 – 12:00 AMO Cataract Symposium

New frontiers in presbyopia correction Dr. Ronald YEOH

12:00 – 12:30 Novartis Retina Symposium

Long-term patient management in treating DME Prof. Paul MITCHELL

12:30 – 13:00 Invited Symposium

Non-invasive approach for skin tightening over periorbital areas Dr. Kingsley CHAN

13:00 – 14:00 Carl Zeiss Lunch Symposium — ReLEx SMILE

(Venue: Room N101A)

(Chairperson: Dr. Victor WOO)

The rst minimally invasive, apless SMILE solution Dr. Hyung-Jin KOO


(Chairpersons: Dr. Vishal JHANJI and Dr. Connie LAI)

Detection of childhood eye diseases Prof. Calvin PANG

14:20 – 14:50 Allergan Retina Symposium

Ocular pharmacotherapy on diabetic macular edema, when to inject? Dr. Shwu-Jiuan SHEU

Uveitis experience in a tertiary refer center in Taiwan Dr. Yih-Shiou HWANG


(Chairpersons: Dr. Andy CHENG and Dr. George CHENG)

Less pain, more gain — advances in orbital surgery Prof. Geoffrey ROSE




13 December 2015, Sunday / Room N111-N112

SCIENTIFIC

PROGRAM


09:30 – 10:18 Free Paper Session 5: Oculoplastics

(Chairpersons: Dr. Edwin CHAN and Dr. Marcus MARCET)

09:30 – 09:38 5-1. Iatrogenic vision loss following hyaluronic acid dermal injections: report of 2 cases and

literature review

Dr. Karen K. W. CHAN

(HA)

09:38 – 09:46 5-2. Genetic associations of interleukin-related genes with Graves’ ophthalmopathy: a

systematic review and meta-analysis

Dr. Kah-Hie WONG

(CUHK / HKU)

09:46 – 09:54 5-3. Immunoglobulin G4–related eye disorders: clinicopathological review of a Hong Kong

case series

Dr. Regine Y. C. CHAN

(PWH)

09:54 – 10:02 5-4. Clinical presentation and outcome of sebaceous cell carcinoma: a 10-year review Dr. Stacey C. LAM (HKEH)

10:02 – 10:10 5-5. Outcome of upper eyelid blepharoplasty with concurrent Mueller’s muscle conjunctival

resection

Dr. Emmy Y. LI (HKEH)

10:10 – 10:18 5-6. Ocular adnexal lymphoma: long-term clinical outcomes in a cohort of 63 Chinese

patients

Dr. Jerry K. H. LOK

(HKEH / CUHK)

10:30 – 11:00 Tea Break

11:20 – 12:56 Free Paper Session 6: Vitreoretina

(Chairpersons: Dr. Yin-Fun YUEN and Dr. Chi-Wai TSANG)

11:20 – 11:28 6-1. Inverted internal limiting membrane Flap and Peel technique for treatment of complex

macular hole

Dr. Byron T. H. CHU

(CMC)

11:28 – 11:36 6-2. Long-term efcacy of half-dose photodynamic therapy in chronic central serous

chorioretinopathy

Dr. Frank LAI (PWH)

11:36 – 11:44 6-3. Etiologies and surgical outcomes of pediatric retinal detachment in a tertiary hospital

in Hong Kong

Dr. Helena P. Y. SIN (PWH)

11:44 – 11:52 6-4. Experience of treating sight-threatening Behçet’s disease in Prince of Wales Hospital Dr. Mary HO (PWH)

11:52 – 12:00 6-5. Investigative ndings of acute zonal occult outer retinopathy in Chinese patients Dr. Joy W. Y. LEUNG

(TWEH)

12:00 – 12:08 6-6. Optical coherence tomography predictive factors for idiopathic macular hole surgery

outcome

Dr. Tracy Y. T. KWOK

(HKEH)

12:08 – 12:16 6-7. A simple modication to the 25-gauge trocar and cannula system for retinopathy of

prematurity–related lens-sparing vitrectomy

Dr. Ian WONG (HKU)

12:16 – 12:24 6-8. Initial experience on suprachoroidal macular buckling surgery Dr. Chi-Wai TSANG

(HKEH)

12:24 – 12:32 6-9. Comparison of treatment efcacy of intravitreal ranibizumab and aibercept in

polypoidal choroidal vasculopathy in a Chinese cohort

Dr. Jerry K. H. LOK (HKEH

/ CUHK)

12:32 – 12:40 6-10. Identication of the placental growth factor gene as a new genetic biomarker for

neovascular age-related macular degeneration

Dr. Lijia CHEN (PWH /

CUHK)

12:40 – 12:48 6-11. Six-year retrospective review of cytomegalovirus retinitis in patients without human

immunodeciency virus (HIV): clinical features and factors that predict visual outcome

Dr. Lawrence P. IU

(QMH / HKU)

12:48 – 12:56 6-12. Unusual ocular manifestations in patients with conrmed tuberculosis infection Dr. Helena P. Y. SIN (PWH)

14:20 – 14:50 Resident Challenges

15:20 – 15:30 Closing Ceremony of the Hong Kong Ophthalmological Symposium 2015

15:30 – 16:00 Cocktail Reception

16:00 – 17:00 COHK Fellowship Conferment Ceremony 2015 (Venue: Room N101A)



27th Annual Scientifc Meeting

Hong KongOphthalmological

Symposium 2015

Plenary

Lectures




PLENARY LECTURES

removal technologies and advanced technology lensimplants. Finally the use of intra-operative aberrometry

to further improve refractive outcomes is discussed.

S04

VICTUS: taking femto to the next level

Robert ANG

Asian Eye Institute, The Philippines

The victus femtosecond laser is a versatile machine that

empowers the anterior segment surgeon. Its multiple

functions enable it to perform cataract, Lasik aps,

arcuate incisions, intrastromal tunnels and corneal

transplantation.

This presentation will concentrate on features and stepsused in cataract surgery with the VICTUS including

docking, imaging and surgical outcomes. Tips and pearls

will likewise be discussed.

S05

Long-term patient management intreating DME

Paul MITCHELL

Department of Ophthalmology, University of Sydney (Westmead Institute), Australia

Diabetic macular edema (DME) is a major complication

seen in patients with diabetic retinopathy (DR). It may

have a sudden and debilitating impact on visual acuity

(VA), and can eventually lead to blindness. Around 40%

of patients with DME suffer from visual impairment.

DME presents as macular thickening with or without

hard exudates as assessed using stereo biomicroscopy;

thickening can occur in various patterns: focal, multifocal,

and diffuse areas of retina thickening, together with hard

exudate deposition (consisting of lipoproteins) in various

patterns, e.g. circinate rings. DME is conrmed using

optical coherence tomography (OCT) and uoresceinangiography (FA).

Available treatments for DME include laser, steroids

and anti–vascular endothelial growth factor (anti-VEGF)

therapy. Anti-VEGF therapy, including Ranibizumab, has

been found to be effective in restoring vision in DME

in many studies using different treatment approaches,

and now is recommended as the new gold standardtherapy for eyes with center-involving macular edema

and reduced vision.

The long-term studies demonstrated the superiority ofRanibizumab over laser therapy. This efcacy can be

maintained using a progressively reducing number of

injections over time in the RESTORE 3-year extension

S01

Intravitreal aibercept versusphotodynamic therapy in Chinesepatients with wet age-related maculardegeneration: primary outcome of the

SIGHT studyXiaoxin LI

Eye Center and Eye Institute of Peking University People’s Hospital, China

Age-related macular degeneration (AMD) is growing

at a faster rate in Asia compared with other regions.

SIGHT is the rst study to demonstrate the benets of

intravitreal aibercept (IVT-AFL) versus photodynamic

therapy (PDT) in an Asian population. It was a multicenter,

double-masked, Phase 3 study in which 304 patients

with predominantly classic choroidal neovascularisation

secondary to AMD were randomised 3:1 to IVT-AFL or

PDT with switch to IVT-AFL at week 28. The outcomesof IVT-AFL in SIGHT are consistent with the VIEW 1

and VIEW 2 studies.

S02

What works best in DME? From trialdata to clinical practice

Ian WONG

Department of Ophthalmology, The University of Hong Kong, Hong Kong

Diabetic macular edema (DME) is the leading cause of

vision loss in diabetes patient. Although grid or focal

laser photocoagulation has been shown to reduce the risk

of visual loss in DME, or clinically signicant macular

edema (CSME), vision is rarely improved. Differentanti-angiogenic agents have been studied to evaluate

their efcacy and safety in the treatment of DME

patient. Recent report showed that the 52-week visual

and anatomic superiority of aibercept over laser control

was sustained through week 100 in DME patients. The

relative efcacy and safety of anti–vascular endothelial

growth factor (anti-VEGF) agents for DME management,

and clinical utilization of anti-VEGFs will be discussed.

S03

Optimizing surgical outcomes in cataractrefractive surgery

Ronald YEOH

Private Practice, Singapore

The Cataract Refractive Suite by Alcon comprises

multiple innovations and advanced technologies whichwork seamlessly together to optimise cataract surgery

outcomes. This presentation will focus on diagnostics,

delivering data to the operating room, the latest in cataract




PLENARY LECTURES

to intravitreal pharmacotherapy. Limitation of current

pharmacotherapy included the need for frequent treatment

and unpredictable response to therapy. How to maximize

the treatment outcome and balance between treatment

benet, nancial burden and intervention-related risk

in individual patient is an important issue nowadays.

S08

Uveitis experience in a tertiary referralcenter in Taiwan

Yih-Shiou HWANG

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Background / aims: Uveitis can be infectious or non-

infectious, and can also be either a local eye disease or

a manifestation of systemic rheumatologic disorders.The clinical presentation of different uveitic diseases

can be similar, which makes the diagnosis and treatment

a challenge. We investigate the clinical features andcomplications of different uveitis diseases, and compare

the characteristics in patients with and without rheumatic

disease in the Chinese population in Taiwan.

Methods: A retrospective review was performed

for all patients who had been diagnosed with uveitis

between January 2009 and June 2014 at Department of

Ophthalmology, Chang Gung Memorial Hospital, Taiwan.

Results: A total of 823 uveitis patients were enrolled

in the study, including 123 patients with rheumaticdiseases. The most frequent rheumatic diseases included

ankylosing spondylitis (5.8%), followed by Behçet’sdisease (2.8%), sarcoidosis (1.4%), psoriasis (1.1%),

and juvenile idiopathic arthritis (1.1%). Compared

with the patients without rheumatic disease, those with

rheumatic disease-related uveitis had a lower mean

age at onset (35.1 ± 15.8 years vs. 44.0 ± 17.5 years),

a longer follow-up period (27.1 ± 25.3 months vs. 22.2

± 23.0 months), a higher incidence of anterior uveitis

(69.0% vs. 46.3%), less frequent posterior uveitis (4.9%

vs. 21.4%), a higher incidence of recurrence (26.8% vs.

14.1%), more frequent bilateral involvement (53.7% vs.

38.8%), and more frequent posterior synechiae (17.2%

vs. 9.4%).

Conclusion: The disease course and clinical manifestations

of rheumatic disease–related uveitis were different from

those unrelated. Patients with rheumatic disease–related

uveitis had a higher recurrent rate and the more frequent

posterior synechiae than those without. Besides, some

specic infectious disease, especially viral, can be seen

in Taiwan.

study and the DRCR.net 5-year study, respectively.

The RISE/RIDE 3-year study showed the efcacy of

Ranibizumab is not only in DME, but also in reducing

DR progression.

Different injection and monitoring modes have beenconducted. A “Treat & Extend (T&E)” approach was

non-inferior to “Pro Re Nata (PRN)” in efcacy and

safety in the RETAIN 2-year study. The RELIGHT

18-month study showed that bi-monthly monitoring was

also effective and may be feasible in many DME patients.

By comparing different studies of anti-VEGF treatment,

the strong correlation between baseline VA and VA gain

was conrmed, and “ceiling effects” of treatment was

also demonstrated.

Data from these studies have provided different and

effective options for both doctors and patients, and havealso reduced the DME treatment burden.

S06

Non-invasive approach for skin tighteningover the periorbital areas

Kingsley CHAN

Honorary Consultant Dermatologist, the Hong Kong Hospital Authority

In the past, surgery was the only way to tighten theskin over the periorbital area. With the advancement

of technology, new methods such as laser, monopolar

radiofrequency and high intensity focused ultrasound

can now be used to stimulate collagen re-modeling

leading to skin tightening. To ensure safety and efcacy,

physicians must exercise care in selecting appropriate

patients for the procedure over the periorbital area. A

thorough understanding of the mechanism, indication

and risks of these procedures is also crucial.

S07Ocular pharmacotherapy on diabeticmacular edema, when to inject?

Shwu-Jiuan SHEU

Kaohsiung Veterans Hospital, Kaohsiung, Taiwan

Diabetic macular edema (DME) is a major cause of visual

impairment in diabetic patients at working age. It can lead

to blindness if left untreated. The breakdown of blood-

retinal barrier due to vascular endothelial growth factor

(VEGF) and inammatory mediator plays an important role

in the pathogenesis of DME. These pathways lead to thetreatment by using anti-VEGF and corticosteroid. Large

multicenter clinical trials have triggered a paradigm shift

in the management of DME, from laser photocoagulation





Symposium 2015

Free Paper

Sessions




FREE PAPER SESSIONS

versus autologous blood clot.

Results: There were 12 eyes in the suture group and

15 eyes in the autologous blood clot group. Operating

time was signicantly shorter in the autologous bloodclot group (p=0.020). Recurrence rate was similar

(p=1.00). Minor complications occurred more frequently

in the autologous blood clot group that did not occur in

the suture group, such as graft dislodgement (2 eyes,

p=0.487), graft edema (9 eyes, p=0.001) and corneal

dellen (3 eyes, p=0.231).

Conclusion: This new technique requires attention in

the intraoperative and early postoperative period, which,

when attended to, yields very satisfactory outcome.

1-3

Orbital dermoid disguising as allergic lidswelling: A case report

Vijay Kumar WAGH, Ki Crystal LAM, A. M. S. MORLEY

Department of Ophthalmology, Guy’s and St. Thomas’ NHS Foundation Trust, London,

England

Orbital dermoids are rare developmental choristomas

that often presents as a painless, slowly expanding

subcutaneous mass in the superotemporal region. A

36-year-old woman suffering from intermittent right

eyelid swelling for 10 years was initially diagnosed withallergic eyelid edema, blepharitis and dry eyes. There

was no blurring of vision, double vision or ocular pain.

Right eye examination showed a painless 4 mm proptosis

and 2 mm hypoglobus, with elevation restriction. No

mass was palpable. Magnetic resonance imaging (MRI)

of the orbits showed right-sided lobulated extraconal

lesion while computerized tomography (CT) showed

the mass causing right sphenoidal wing thinning and

right superior oblique muscle deviation. Orbitotomy

with histology conrmed the lesion as a dermoid cyst.

She had full symptom recovery 6 months post-operation.

To the best of the author’s knowledge, this was the rstcase of orbital dermoid which was misdiagnosed asallergic eye disease for more than 10 years. Abnormal

presentation of dermoid therefore requires high alertness,

good examination and appropriate imaging for diagnosis.

1-4

Toric intraocular lens at Tuen Mun EyeCentre

Rachelle CHAN, C. T. YEUNG, W. H. YU, P. F. YIU

Tuen Mun Eye Centre, Hong Kong

Toric intraocular lens (IOL) is a relatively new type

FREE PAPER SESSION 1. Cataract, Cornea & External Eye Disease

1-1

To compare the stromal demarcation linedepth in conventional versus accelerated

collagen cross-linking

Alex L. K. NG,1 Tommy C. Y. CHAN,2 Jimmy S. M. LAI,1 Arthur C. K. CHENG3 1Department of Ophthalmology, The University of Hong Kong, Hong Kong

2Hong Kong Eye Hospital, Hong Kong3Hong Kong Sanatorium & Hospital, Hong Kong

Objective: To compare the stromal demarcation line

depth in conventional versus accelerated collagen cross-

linking (CXL).

Methods: 33 keratoconus patients receiving either

conventional CXL (3.0 mW/cm2 for 30 minutes;

Group 1, 18 cases) or accelerated CXL (9.0 mW/cm2

for 10 minutes; Group 2, 15 cases) were included. The

stromal demarcation line depth at the corneal center and

3-mm periphery measured on anterior segment optical

coherence tomography (AS-OCT) were compared 1month postoperatively.

Results: The mean demarcation line depth at center was

295 ± 62 μm in Group 1 and 203 ± 45 μm in Group 2

(p<0.001). The mean depths at 3-mm periphery (nasal,

temporal, superior and inferior) were 260 ± 64 μm,

269 ± 44 μm, 232 ± 46 μm and 242 ± 66 μm in Group

1 respectively; and 204 ± 62 μm, 201 ± 55 μm, 196 ±

68 μm and 189 ± 53 μm in Group 2 respectively. Apart

from the superior peripheral cornea (p=0.064), the

demarcation line depth at other peripheral regions was

deeper in Group 1 (p<0.015).

Conclusion: The stromal demarcation line depth was

shallower after accelerated CXL compared to conventional

CXL at corneal center and its periphery.

Disclaimer: The manuscript of this abstract is currently

under review by Cornea at the time of submission.

1-2

Autologous blood for xating conjunctivalgraft in pterygium surgery

Vanissa W. S. CHOW,1,2 Victoria W. Y. WONG,1,2 Alvin YOUNG2,3

1Hong Kong Eye Hospital, Hong Kong 2Department of Ophthalmology and Visual Sciences, The Chinese University of Hong

Kong, Hong Kong3Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong

Objective: Use of patient’s own blood clot derivedfrom the surgical site to secure conjunctival grafts

during pterygium surgery has been reported with results

comparable to sutures and brin glue. This study discussedour initial experience in using this new technique.

Methods: A retrospective review was done comparing

outcomes of pterygium surgery with conventional suturing




FREE PAPER SESSIONS

of IOL used in Hong Kong’s public sector. Our center

has seen increasing use of toric IOL over the years in

correcting our patient’s astigmatism. We have conducted

a retrospective study of all the toric IOL surgeries done

in our center from January 2012 to the present. Several

surgeons were included in the study. Our ndings showthat our postoperative residual astigmatism outcomematches that of international studies. Methods to improve

the nal outcome include accumulative experience,

precise IOL power calculations and keratometry, as well

as meticulous preoperative marking and intraoperative

techniques.

1-5

Topical olopatadine in the management ofallergic conjunctivitis: a meta-analysis

K. W. KAM,1,2 Noel WAT,2 L. J. CHEN,1,2 Alvin L. YOUNG1,2

1Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong

Kong 2Department of Ophthalmology and Visual Sciences, The Chinese University of Hong

Kong, Hong Kong

Objective: To assess the efcacy and safety of topical

olopatadine versus placebo and other topical anti-allergic

medications in treating allergic conjunctivitis.

Methods: We searched for randomized controlled trials

on topical olopatadine versus placebo and other topical

medications in treating allergic conjunctivitis publishedin MEDLINE, EMBASE, the Cochrane Central Register

of Controlled Trials, ClinicalTrials.gov and the WHO

ICTRP, and performed a meta-analysis.

Results: A total of 1589 eyes and 958 subjects from

24 qualied studies were included. When compared

with placebo, topical olopatadine was associated with

signicantly decreased ocular itch and hyperemia, with

a pooled mean difference of -1.41 (p<0.00001) and-0.91 (p<0.00001), respectively. When compared with

epinastine, alcaftadine and ketotifen, the effects of topical

olopatadine were comparable. All studied medications

had similar safety outcomes.

Conclusions: Topical olopatadine is safe and effective

in reducing ocular itch and hyperemia in allergic

conjunctivitis.

1-6

Descemet’s stripping endothelialkeratoplasty for failed penetratingkeratoplasty: the use of oversized graft inAsian eyes

Stephen LI, Evan YIU, Lester W. H. YU, Angela H. Y. WONG, John C. T. YEUNGTuen Mun Eye Centre, Hong Kong

Objective: To review the surgical outcomes of eyes

with failed penetrating keratoplasty (PKP) treated with

oversized Descemet’s stripping automated endothelial

keratoplasty (DSAEK) by a single surgeon.

Methods: Retrospective review of cases performed in

Tuen Mun Hospital from 2011 to 2015 was performed.

Results: 11 eyes of 11 patients with a mean age of 68.8(range, 52-79) years were reviewed. The mean follow-up

period was 16.27 (range, 4-33) months. DSAEK graft

oversizing that of PKP graft from 0.5 to 1.0 mm were

used. Attachment rate was 100%; 81.8% achieved a best-

corrected visual acuity within 3 months. Eight (72%)

eyes maintained clear grafts at 3 months; 1 developed an

episode of rejection at 1 year. There were no wound- or

suture-related problems.

Conclusion: Performing DSAEK with oversized graft

in failed PKP is a feasible option in Asians. This series

demonstrated good attachment rate and offered advantages

of faster visual recovery and absence of wound-related

problems compared with repeated PKP.

1-7

Predisposing factors, microbialcharacteristics and clinical outcome ofmicrobial keratitis in a tertiary center inHong Kong: a 10-year experience

Alex L. K. NG,1 Kelvin K. W. TO,2 Kendrick C. SHIH,1 Michelle C. M. FAN,3 S. M.

YIM,3 Keith S. K. CHAN,3 Jimmy S. M. LAI,1 Ian Y. H. WONG1

1

Department of Ophthalmology, The University of Hong Kong / Queen Mary Hospital,Hong Kong

2Department of Microbiology, The University of Hong Kong / Queen Mary Hospital, Hong

Kong3Department of Ophthalmology, Queen Mary Hospital, Hong Kong

Objective: To study the risk factors, microbial prole,

antibiotic susceptibility pattern and treatment outcome

for microbial keratitis over the past 10 years in Queen

Mary Hospital (QMH).

Methods: All cases with corneal scraping performed in

QMH from 2004 to 2014 were reviewed.

Results: 347 scrapings were included, growing 130microorganisms (32.3% culture-positive rate). The

commonest isolates were coagulase-negative Staphylococcus

and Pseudomonas aeruginosa. Susceptibilities to

uoroquinolones, aminoglycosides and ceftazidime

were 94%, 88% and 100% respectively. Contact lens use

was the commonest risk factor (42.7%). Pseudomonas

was the commonest isolate in the contact lens group

and it remained 100% susceptible to uoroquinolones,

aminoglycosides and third-generation cephalosporin.Overall, 90.7% of cases had good visual outcome.

Old age (p=0.03), trauma (p=0.006) and ulcer size of

>3 mm (p=0.039) were independently associated with

poor outcome.Conclusion: There was no shifting trend in the isolate

distribution nor emergence of resistant strains in our

study population over 10 years.




FREE PAPER SESSIONS

Disclaimer: The manuscript of this abstract has just

been published in the Journal of Ophthalmology at the

time of submission.

1-8

Change in tear lm lipid layer thickness,corneal thickness, volume and topographyafter supercial cauterization forconjunctivochalasis

Tommy C. Y. CHAN,1,2 Paul K. F. NG,1 Cong YE,1 Emmy Y. M. LI,1,2 Hunter K. L.

YUEN,1,2 Vishal JHANJI1

1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong

Kong, Hong Kong 2Hong Kong Eye Hospital, Hong Kong

Objective: To evaluate the change in tear lm lipidlayer thickness, corneal thickness, volume and

topography after supercial cauterization of symptomatic

conjunctivochalasis.

Methods: Bilateral supercial conjunctival cauterization

was performed in 36 eyes of 18 patients with symptomatic

conjunctivochalasis.

Results: The mean age of patients was 68.6 ± 10.9 years. At

1 month postoperation, the severity of conjunctivochalasis

decreased signicantly (p<0.001). The mean Ocular

Surface Disease Index score decreased from 31.5 ±15.2 preoperatively to 21.5 ± 14.2 at the end of 1 month

postoperatively (p=0.001). There was a statisticallysignicant increase in mean tear lm lipid layer thickness

1 month after the surgery (49.6 ± 16.1 nm vs 62.6 ± 21.6

nm; p<0.001). The central corneal thickness, thinnest

corneal thickness and corneal volume signicantly

decreased postoperatively (p<0.001).

Conclusions: Supercial conjunctival cauterization is an

effective technique for management of conjunctivochalasis.




FREE PAPER SESSIONS

over both eyes up to 1 week after SLT.

Results: COR was observed in Chinese patients

undergoing monocular ltration surgery and rabbits

receiving monocular SLT.

2-3

Different means of cup-disc ratiomeasurement and the effects of glaucoma5-year risk estimation in ocularhypertensive subjects

Poemen P. M. CHAN, Vivian S. M. CHIU, Mandy O. M. WONG, Kevin Y. E. CONG,

Christopher K. S. LEUNG

Hong Kong Eye Hospital, Hong Kong

Objective: To observe the effect of vertical cup-disc

ratio (vCDR) measurements on the 5-year estimatedrisk of glaucoma development.

Methods: The vCDR of ocular hypertensive subjects

were measured by Cirrus ocular coherence tomography

(OCT), Heidelberg retina tomography (HRT) and

stereophotography. Full-frame optic nerve head stereoscopic

images were obtained by fundus camera and were viewed

through a stereo viewer by a glaucoma specialist. The

sites of cup and disk were marked by the software ImageJ.

The 5-year risk was estimated using these vCDR values

together with other parameters.Results: 151 eyes of 80 patients were included. The

mean age, intraocular pressure, central corneal thickness

(CCT) and pattern standard deviation were 59.81 ± 13.83

years, 22.40 ± 4.09 (range, 14-34) mm Hg, 563.49 ±

31.24 µm and 1.71 ± 0.58 dB, respectively. The mean

vCDR were 0.44 ± 0.14 (stereophotography), 0.58 ±

0.16 (OCT) and 0.51 ± 0.24 (HRT). The mean calculated

5-year risk estimation was 12.06 ± 10.81 when vCDR of

stereophotography were used, which differed signicantly

from that calculated by OCT (15.57 ± 13.33; p<0.001)

and HRT (14.29 ± 13.61; p<0.001).

Conclusion: The clinical signicance of these differencesof 5-year risk estimation requires further investigation.

2-4

A cross-sectional study on compliancewith topical glaucoma medication in HongKong and its associations

M. H. LUI,¹ Jason C. H. LAM,¹ Y. L. KWONG,¹ T. S. WONG,¹ P. L. CHEUNG,¹ Sherri

S. Y. LAI,¹ P. L. YUEN,¹ W. Y. LAM,¹ H. Y. CHAN,¹ Y. F. WONG,¹ Jimmy S. M. LAI, 2,3

Kendrick C. SHIH2,3

1Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, The University of Hong Kong, Hong Kong3Department of Ophthalmology, Queen Mary Hospital, Hong Kong

2-1

Neuroprotective effect of transcornealelectrical stimulation in a gerbil model of

acute glaucoma

Kendrick C. SHIH, Lin FU, Amy C. Y. LO, Jimmy S. M. LAI


Objective: This study investigated the neuroprotective

effect of transcorneal electrical stimulation (TcES) after

acute ocular hypertension–related retinal injury in gerbils.

Methods: Intraocular pressure was elevated to 85 mm Hg

for 1 hour. In the treatment group, TcES was applied to

the surgical eye immediately and 3 days after the ocular

hypertensive injury. In the control group, sham TcES

was applied to the surgical eye at the same time points.Full-eld ash electroretinogram was performed on day 3

and day 6. The number of retinal ganglion cells (RGCs)

and astrocytes were counted by immunouorescence

staining after the gerbils were sacriced on day 7.

Results: There was a signicant RGC loss in the superior

area of the retina and corresponded with reduction in

retinal function. TcES preserved RGC cell count as well

as retinal function.

Conclusion: Early treatment with TcES in gerbils

protected the RGCs from damage and preserved retinal

function in acute ocular hypertensive injury.

2-2

Consensual ophthalmotonic reaction —results from a retrospective human studyand a prospective animal study

Jennifer SHUM,1 Bonnie CHOY,1 Catherine CHIU,1 W. L. HO,2 Jacky LEE,3 Jonathan

CHAN,2 Jimmy LAI1

1Department of Ophthalmology, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, Queen Mary Hospital, Hong Kong3Department of Ophthalmology, Caritas Medical Centre, Hong Kong

Objective: Consensual ophthalmotonic reaction (COR)

was rst described in 1924. Studies following monocular

application of glaucoma drops showed a drop in fellow

eye intraocular pressure (IOP). However, studies

following trabeculoplasty and monocular surgery showed

heterogeneous results. The purposes of this study were

to (1) investigate COR in Chinese patients who hadreceived monocular ltration surgery; and (2) investigate

COR in rabbits undergoing monocular selective laser

trabeculoplasty (SLT).

Methods: A retrospective review of ltration surgeries

performed in Queen Mary Hospital from 2014 to 2015was conducted. IOP in both eyes was documented

preoperatively and postoperatively up to 2 weeks. 12

rabbits underwent monocular SLT. IOP was measured

FREE PAPER SESSION 2. Glaucoma




FREE PAPER SESSIONS

2-6

A retrospective study on the prevalence ofnormal-tension glaucoma among patientswith obstructive sleep apnea syndrome

Kenneth H. L. LIU,

1

W. H. LEUNG,

1

Samuel H. T. POON,

1

Matthew K. Y. HO,

1

Kendrick C. SHIH,2 Christopher K. M. HUI,3 Jennifer W. H. SHUM2

1Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, The University of Hong Kong, Hong Kong3Department of Medicine, The University of Hong Kong, Hong Kong

Objective: To estimate the overall prevalence of normal-

tension glaucoma (NTG) for a predominantly Chinese

population who has undergone sleep polysomnography

(PSG) for suspected obstructive sleep apnea in a specialty

sleep clinic in a publicly funded tertiary care hospital

in Hong Kong.

Methods: This was a retrospective cross-sectional study.

Overall, 1678 subjects underwent PSG between 1 January2005 and 31 December 2014. Their patient records were

retrieved for data collection and analysis. The PSG

apnea-hypopnea index was considered the diagnostic

denition for obstructive sleep apnea syndrome (OSAS)

while Anderson’s criteria was used for the diagnosis of

NTG. Univariate analysis was conducted for potential

risk factors, including patient age, gender, presence of

hypertension, body mass index and severity of OSAS.

Results: Among the 1678 subjects who underwent PSG

during the study period, 426 were seen at the ophthalmology

outpatient clinic of Queen Mary Hospital. The cumulative

prevalence of NTG among them was 7.04%. Patientswith severe OSAS had a higher prevalence of NTGthan the normal population (7.69% vs 1.6%). Risk

factors including older age, male gender, and presence

of hypertension and severity of OSAS were associated

with higher prevalence of NTG but they were shown to

be statistically insignicant.

Conclusions: Chinese patients with symptoms suggestive

of OSAS are at signicantly higher risk of developing

NTG than the normal population. This suggests thatscreening measures for glaucoma in this asymptomatic

population should be further investigated. However,the underlying mechanism linking the 2 conditions

remains to be understood. Lastly, continuous positive

airway pressure therapy was postulated to be a potential

protective factor for NTG but further study is required

to dene this relationship.

Objective: To estimate the overall drug compliancefor glaucoma patients on long-term topical treatment

in local tertiary care settings.

Methods: This was a retrospective cross-sectional study.

57 primary glaucoma patients from the subspecialty

clinic of a publicly funded tertiary care hospital in HongKong completed a questionnaire on compliance with

topical glaucoma medications. Relationships between

non-compliance, predictors and disease status were

studied, together with an estimation of cost incurred.

Multivariable logistic regression on non-compliancewas performed.

Results: Compliance was calculated as 75% (95%

condence interval, 64%-87%). Younger age (p=0.048)

and forgetfulness (p=0.064) might be possible predictors

of non-compliance. The societal cost of non-compliance

was estimated to be over 2510 life-years and HK$30

million.

Conclusion: The compliance of Chinese glaucoma patientsin Hong Kong is comparable to worldwide gures, and

carries detrimental impacts to patients and health care

systems. Younger age and forgetfulness were possible

independent predictors for non-compliance.

2-5

Effects of collagen crosslinking on thebiomechanical properties of excised cattleconjunctiva

Harrison CHAN,1 Bonnie CHOY,2 Barbara CHAN,1 Jimmy LAI2

1Department of Engineering, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, The University of Hong Kong, Hong Kong

Objective: To evaluate the biomechanical effects ofcollagen crosslinking on cattle conjunctiva.

Methods: In the treatment group, excised cattle

conjunctivas were soaked in riboavin, followed by

ultraviolet light illumination. The control group did not

receive any intervention. Samples were subsequently

tested by the Fourier transform infrared spectroscopy

(FTIR) test to identify the presence of amide bonds,

permeability test to assess the diffusion of methylene

blue across the conjunctiva, and indentation rupture force.

Results: FTIR test showed a signicantly higher amide

I band after crosslinking (p=0.043), as well as in amide

II, A and B (but not statistically signicant). The cross-

linked samples were less permeable (p=0.03) and had

a higher maximal rupture force (p=0.07) compared to

the controls.

Conclusion: The results suggested that collagen

crosslinking strengthened cattle conjunctiva by increasing

its amount of covalent bonds, reducing permeabilityand possibly improving resistance to rupture. Clinical

application includes strengthening conjunctiva in cysticblebs.




FREE PAPER SESSIONS

2010 to January 2014.

Results: Two hundred and fty eyes were included.

IOL was implanted in all eyes with 97 eyes receiving

negative-power IOL, 31 receiving plano-power IOL and122 receiving positive-power IOL. The mean follow-

up duration was 27.9 months. Intraoperatively, 3 eyes

had zonulysis and 3 had posterior capsular rupture.

Postoperatively, 4 eyes had retinal detachment, 20 had

posterior capsular opacication, 3 had retinal break, 1 had

persistent anterior uveitis, and 1 had IOL decentration.

The logMAR best-corrected visual acuity 6 to 12 months

postoperatively was 0.56. Mean absolute biometry

prediction error was 0.96 D in all eyes, and was greater

in eyes receiving negative-power IOL (1.08 ± 0.85 D)

than in eyes receiving positive-power IOL (0.81 ± 0.81

D) [p=0.021]. Regression analysis showed lower-powerIOL as an independent predictor for biometry error but

not preoperative visual acuity axial length or use of IOL

master (p=0.007).

Conclusions: Incidence of cataract operations–related

complications in eyes with extreme high axial myopia

was similar to normal populations except for tendency

of hyperopic shift especially in those receiving negative-

power IOL.

3-3

Hong Kong Children Eye Study

Jason YAM

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong

Kong, Hong Kong

Purpose: To report the design, methods and mid-term

preliminary baseline data of the Hong Kong Children

Eye Study (HKCES), aiming to determine the prevalence,

incidence and risk factors of myopia and other ocular

diseases in children in Hong Kong.

Methods: The HKCES was a population-based school-

based cohort study conducted in Hong Kong. A total of3000 students aged 6 to 8 years of age will be recruited

for detailed comprehensive examination, and will

be followed up every 2 years. Ocular examinations

included visual acuity, identication of amblyopia and

strabismus, ocular biometry, corneal biomechanics,

optical coherence tomography, retinal photography, and

cycloplegic autorefraction. A questionnaire survey was

performed to collect risk factors for myopia including

near work, outdoor activity, parental myopia, birth

history, habits of wearing spectacles and reading, living

habits, food habits and so on. Results of the mid-term

pilot preliminary data will be presented and discussed.

3-1

Astigmatic correction after small-incisionlenticule extraction and femtosecond-

assisted LASIK

Tommy C. Y. CHAN,1,2 Alex L. K. NG,3 George P. M. CHENG,4 Zheng WANG,5 Cong

YE,2 Victor C. P. WOO,4 Clement C. Y. THAM,1,2 Vishal JHANJI1,2


Kong, Hong Kong3Department of Ophthalmology, The University of Hong Kong, Hong Kong4Hong Kong Laser Eye Center, Hong Kong5 Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China

Objective: To compare astigmatic correction between

femtosecond-assisted laser in-situ keratomileusis (LASIK)and small-incision lenticule extraction (SMILE).

Methods: 57 eyes were treated with LASIK and 54eyes were treated with SMILE for myopia with low-

to-moderate (-0.25 to -4.0 diopters) astigmatism. Visual

and refractive outcomes at 3 months were reported.Changes in refractive astigmatism were evaluated using

vector analysis.

Results: Preoperative characteristics were similar between

the 2 groups. The uncorrected distance visual acuitywas better in the LASIK group compared to the SMILE

group (p<0.009). Postoperative cylinder was higher in

the SMILE group (p<0.001). Vector analysis showed

no signicant difference in target-induced astigmatism

(p=0.091) and angle of error (p>0.596) between the 2

groups. Surgically induced astigmatism was signicantly

lower in the SMILE group (p<0.023), while the difference

vector (p<0.001) and absolute angle of error (p<0.016)

were signicantly higher in the SMILE group.

Conclusions: Our results showed that SMILE offered

a less favorable astigmatic correction comparable tofemtosecond-assisted LASIK in eyes with low-to-

moderate myopic astigmatism.

3-2

To review the outcomes of cataractoperations in extreme high myopes

Jasmine K. M. LAM, Tommy C. Y. CHAN, Vanissa W. S. CHOW, Victoria W. Y. WONG


Objective: To review the outcomes of cataract operations

in extreme high myopes.

Methods: Eyes with axial length of ≥30.0 mm were

identied retrospectively from a consecutive series of

cataract operations performed at Hong Kong Eye Hospitalusing a single intraocular lens (IOL) type from January

FREE PAPER SESSION 3. Myopia




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3-4

Use of atropine for prevention ofchildhood myopia progression inclinical practice: efcacy and safetyduring treatment and when tapering off

medicationKendrick C. SHIH,1 Arthur C. K. CHENG,1,2 Walton W. T. LI,1,2 Jimmy S. M. LAI,1

Dorothy S. P. FAN2

1Department of Ophthalmology, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong

Objective: To assess the efcacy and safety of daily

0.125% topical atropine solution in preventing childhood

myopia progression.

Methods: Patients aged 6 to 12 years with spherical

equivalent of -1.00 D or more were offered treatment with

daily 0.125% atropine solution. Cycloplegic refraction

was noted at baseline and then 6 monthly afterwards. Iftreated eyes had slow myopic progression, the frequency

of application was reduced. Those who demonstrated

fast myopia at subsequent follow-ups were resumed on

their previous application frequency.

Results: Twenty seven patients with 54 eyes were treated

with 0.125% topical atropine solution for at least 1 year

during the study period. The mean myopia progression

during study period was -0.29 (standard deviation, 0.27).

Ten patients were able to initiate weaning off treatment

during the study period. There were no reported adverse

effects related to the drug.

Conclusions: Daily application of atropine 0.125% waswell tolerated and effective in clinical practice.

history, habits of wearing spectacles and reading, living

habits, food habits and so on. Results of the mid-term

pilot preliminary data will be presented and discussed.




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This is a retrospective case series of all patients diagnosed

with herpes zoster ophthalmicus (HZO) attending theHong Kong Eye Hospital during the period from July

2011 to July 2014.

Overall, 177 patients were included in the study with a

similar proportion of women and men. Half of the cases

(55.9%) were aged ≥60 years. The most common ocular

complication was conjunctivitis (63.3%), followed by

blepharitis (36.7%) and anterior uveitis (16.4%). Other

less common ocular complications included: cellulitis

(7.3%), interstitial keratitis (6.8%), pseudodendrite (6.2%)

and anterior scleritis (3.4%). No vitritis nor retinitis was

noted in our series.

There was no signicant difference in the pattern of

HZO ocular manifestations between patients of different

age-groups (<60 years vs ≥60 years).

Hutchinson’s sign was present in 40 (22.5%) of ourpatients. Interestingly, the presence of Hutchinson’ssign was signicantly more common in male patients

(p=0.004) and in eyes presenting with anterior uveitis

(p=0.003).

4-3

Fundus photography with smartphone:sharing of novel technique

H. W. LAI, C. K. HO, P. F. YIU


Objective: Smartphone fundus photography offers a lot

of advantages: ease of sharing, portability and ability to

image bed-bound patients. We describe a novel technique

with an easily hand-made device to facilitate fundus

photography with smartphone.

Methods: A hand-made device was built with an ordinary

smartphone camera adaptor, illumination system with

beam splitter, simple lens, capture system with 90Dlens and smartphone macrolens. Photos could be taken

single-handedly, and could be printed instantly withWi-Fi printers.

Results: Basic diagrams, video of operation, and sample

photos will be shared. Alternative techniques will also

be discussed.

Conclusion: A novel hand-made device could greatly

facilitate fundus photography with smartphones, offering

great versatility with relatively low cost.

4-1

Predictors of retinal nerve ber layerthickness abnormalities in unilateralPosner-Schlossman syndrome

Jonathan C. H. HO, Simon T. C. KO

Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong

Objective: This was a diagnostic test study evaluating

consecutive Posner-Schlossman syndrome (PSS) patients

of ≥18 years old who consented to undergo a series of

investigations including Humphrey visual eld (HVF;

Carl Zeiss Meditec), optical coherence tomography

(OCT) retinal nerve ber layer (RNFL) circular scans

(Spectralis HRA+OCT; Heidelberg Engineering).

Methods: Subjects who had normal HVF and were not

on long-term anti-glaucoma treatment were included.

Comprehensive examination and chart review to gather

information on previous attacks were performed.

Results: Thirty patients (mean age: 57.0 ± 12.2 [range:

27-82] years; 15 males) were included for analysis. The

mean attack episodes (dened as ≥22 mm Hg) were 10.9

± 8.2 (2-28) and mean maximum intraocular pressure

(IOP) was 38.8 ± 6.1 (30.2-55.0) mm Hg. The mean

cumulative pressure load (CPL), dened as summation

of documented IOPs of ≥22 mm Hg, was 326.7 ± 272.0

mm Hg. Attack eyes had HVF mean deviation 1 dB worsethan fellow eyes and vertical cup-disc ratio (VCDR) of

0.1 more. Global RNFL was thinner in attack eyes than

in fellow eyes (88.6 vs 100.0 µm; p<0.001). One third

of PSS eyes had global RNFL classied as ‘borderline’

or ‘outside normal limits’. Half of the attack eyes had

global RNFL of ≥10%, and 1/6 ≥20% thinner than fellow

eyes. Overall, 40% of attack eyes had RNFL at anyquadrants classied as ‘borderline’ or worse, whereas

27% classied as ‘outside normal limits’. Regression

analysis revealed that the number of attacks and CPL

were consistent predictors of global RNFL thickness and

its color code, overall disc classication and sectoralRNFL thickness classied as ‘borderline’.

Conclusions: Signicant proportion of PSS patients

suffer from pre-perimetric structural damage. Periodic

assessment of structural and functional parameters is

crucial to management.

4-2

Ocular manifestations of herpes zosterophthalmicus in a tertiary eye center

Simon K. H. SZETO, Tommy C. Y. CHANHong Kong Eye Hospital, Hong Kong

FREE PAPER SESSION 4. Pediatric Ophthalmology, Neuro-ophthalmology & Miscellaneous




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4-6

Enhanced depth imaging of laminacribrosa in non-glaucomatous opticneuropathy

L. T. YIP, C. H. HO, T. C. KODepartment of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong

Recent advances in optical coherence tomography

including enhanced depth imaging provide a means to

image the lamina cribrosa in vivo. Recent studies have

shown signicant differences in the lamina cribrosa

between glaucomatous disc and normal controls, between

different types of glaucoma, and between different stages

of glaucoma.

In this study, lamina cribrosa was imaged using spectral-

domain optical coherence tomography with enhanced

depth imaging in 6 patients with non-glaucomatous opticneuropathies, including arteritic and non-arteritic optic

neuropathy, optic neuritis, optic nerve meningioma and

optic nerve hypoplasia. Most cases showed shallower

anterior lamina cribrosa depth compared with the normal

fellow eyes. We also describe the morphology of the

optic nerve head and the difculties encountered in the

imaging.

4-7

Undergraduate ophthalmology education:a systematic review

K. W. KAM,1,2 P. Y. CHIEN,2 L. J. CHEN,1,2 Alvin L. YOUNG1,2



Kong, Hong Kong

Objective: To review the literature on the topic of

undergraduate ophthalmology education.

Methods: We searched for English articles published in

PubMed on the topic of undergraduate ophthalmology,

using key words ‘ophthalmology curriculum’, ‘medical

education’, ‘undergraduate teaching’ and ‘ophthalmology’.

Studies reporting undergraduate ophthalmology curricula

were compared and analyzed in terms of the mode of

learning, duration of curriculum, included contents, mode

of assessment and feedback from students.

Results: A total of 29 articles were included in ouranalysis. The duration of mandatory undergraduate

ophthalmology clinic exposure ranged from 5 days

to 4 weeks, with a majority offering a 1-week course.

Lectures are still the most common means of delivering

knowledge.

Conclusions: Undergraduate ophthalmology educationis an important part of medical education. Didactic

lectures are still the most common mode of teaching

but a paradigm shift to problem-based learning and

4-4

Intravitreal bevacizumab for retinopathyof prematurity: local experience at QueenMary Hospital

Stephanie W. YUK, Lawrence P. IU, Connie H. LAI, Ian Y. WONG, Jimmy S. LAIDepartment of Ophthalmology, Queen Mary Hospital, The University of Hong Kong,

Hong Kong

Objective: To evaluate the safety and efcacy of

intravitreal bevacizumab (IVB) for advanced retinopathy

of prematurity (ROP).

Methods: This was a retrospective cases series. Ten

eyes from 5 consecutive infants who received IVB for

advanced ROP in Queen Mary Hospital between January

2014 and June 2015 were reviewed.

Results: Eight eyes had aggressive posterior ROP and

2 eyes had threshold ROP. IVB was used as an initial

treatment in 6 eyes and salvage treatment in 4 eyes.All ROP regressed at nal visit and none developed

retinal detachment. There were no ocular complications

related to IVB.

Conclusion: IVB is a safe and effective treatment for

ROP and should be considered when conventional laser

treatment is inappropriate or ineffective.

4-5

A novel preamplied electrode for

improving electroretinography recordings

Marten E. BRELEN, Clement C. Y. THAM, Christopher K. S . LEUNG, Calvin C. P.

PANG


Kong, Hong Kong

There are many electrodes used in electrodiagnostics

which are preamplied. The placement of the amplier

close to the recording electrode is well known to reduce

the noise and improve the quality of electrical recordings.

The electroretinogram (ERG) has always been recorded

with passive electrodes. In this study, a preamplied

ERG recording electrode was built and tested on 6 eyes

of 6 rabbits and compared with recordings taken from

the fellow eye with traditional passive ERG recording

electrodes. The results show an improved signal-to-noise

ratio and higher common mode rejection ration in the

active versus passive electrode. The improved signal

quality allows higher amplitude and more reproducible

recordings to be made. Features such as the early receptor

potential can be seen at lower photopic light stimulation

intensity and the scotopic threshold response as well

as the photopic negative response can be more easily

obtained.




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interactive tutorials are gaining popularity.

4-8

Pediatric open globe injuries: the HongKong experience

Yoly Y. Y. FONG, Wilson W. K. YIP, Henry H. W. LAU, Alvin L. YOUNG


Kong, Hong Kong

Objective: To report a case series of pediatric openglobe injuries.

Methods: Medical records of children aged 0 to 6 years old

with open globe injuries documented between 1 January

2005 and 1 January 2015 were reviewed retrospectively.

The demographics, clinical features, type of operations

performed, preoperative and postoperative visual acuitiesand complications were collected and analyzed.

Results: A total of 7 cases (2 males and 5 females)were identied. The mean age of presentation was 5

years. Five open globe injuries occurred at home. Four

subjects had improvement of visual acuity postoperatively

compared to preoperative visual acuity. Only 1 case had

postoperative visual acuity of hand movement or worse

at 1 year due to a failed corneal graft.

Conclusions: Pediatric open globe injuries are uncommon

in our locality but can result in a high morbidity. Special

challenges are encountered during assessment and

management, especially to prevent amblyopia in children.

4-9

A review of thyroid-related strabismus atHong Kong Eye Hospital

Madeline K. M. KWOK,1 Carol P. S. LAM,1 Jason C. S. YAM,2 Winnie W. Y. LAU1


Kong, Hong Kong

Thyroid-related eye disease is a distinct clinical entitywhereby autoimmune inammation of the ocular and

orbital tissues occurs. The classical manifestations

involve the orbit, extraocular muscles and eyelid. A

restrictive-type strabismus typically develops and affected

patients can be troubled with diplopia and cosmetically

disguring strabismus.

We retrospectively reviewed all the patients who underwent

strabismus correction in the context of thyroid-related

strabismus at Hong Kong Eye Hospital over a 10-year

period from 2005 to 2014. Outcome measures were pre-

and post-operative strabismus and angle of deviation,over- and under-correction, new-onset strabismus,

postoperative diplopia, the number of operations, need

for reoperation and postoperative use of prism.




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warranted to conrm the association of various IL-related

genes with GO among different ethnic groups.

5-3

Immunoglobulin G4–related eyedisorders: clinicopathological review of aHong Kong case series

Regine Y. C. CHAN,1 C. L. LI,1 Kelvin K. L. CHONG,2 Alvin L. YOUNG1 1Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong


Kong, Hong Kong

Objective: To describe the clinical and pathologicalfeatures of immunoglobulin G4 (IgG4)–related eye

disease in a series of patients managed in a tertiary eye

unit in Hong Kong.

Methods: A retrospective chart review of 17 patients

managed in Prince of Wales hospital and Alice Ho Miu

Ling Nethersole Hospital from January 2010 to July

2015 were reviewed. All 17 patients were conrmed

with IgG4 disease via orbital biopsy.

Results: Bilateral painless lid swelling was the commonest

presenting symptom. Radiological enlargement of

lacrimal glands and extraocular muscles were common

but ocular motility limitations were rarely documented.Orbital biopsies typically showed lymphoplasmacytic

inltrates with raised IgG4/IgG ratio (over 30%) and

brosis. Most patients responded to oral steroid but a

few required immunosuppressant for recurrent disease.

Conclusion: IgG4 disease is a systemic bro-inammatory

disease rst described in 2001 with the orbit being one

of the most commonly involved sites. Ophthalmologists

should be aware of this disease entity, which requires

systemic workup.

5-4

Clinical presentation and outcome ofsebaceous cell carcinoma: a 10-yearreview

Stacey C. LAM, Emmy Y. LI, Hunter K. YUEN


Objective: To describe the clinical features, management

and prognosis of this rare but malignant neoplasm.

Methods: This was a single-center retrospective case series.

18 consecutive patients with sebaceous cell carcinoma

of the eyelid were studied. Main outcome measuresincluded presenting features, location, management,histopathological ndings, incidence of recurrence,

5-1

Iatrogenic vision loss following hyaluronicacid dermal injections: report of 2 cases

and literature review

Karen K. W. CHAN,1 Dennis S. C. LAM2 1Hospital Authority, Hong Kong

2Dennis Lam & Partners Eye Center, Hong Kong

Hyaluronic acid (HA) injections are under rising

demand in facial rejuvenation since its introductionin 2003. It is the second most common non-surgical

cosmetic procedure globally, and accounts for 85% of

soft tissue augmentation. HA gels are considered safe,

and have the advantage of being non-immunogenic,

biocompatible, biodegradable and susceptible to breakdown by hyaluronidase. Common adverse effects

include swelling, erythema, and nodule formation; but

an alarming increase in reports of visual loss following

injections was observed. The authors will report 2 cases

of iatrogenic visual loss secondary to HA injection and

conduct a systematic review on the properties of HA,

as well as the pathophysiology, clinical features andpossible treatments when visual loss is encountered.

5-2

Genetic associations of interleukin-relatedgenes with Graves’ ophthalmopathy: asystematic review and meta-analysis

K. H. WONG,1,2 S. S. RONG,1 Kelvin K. L. CHONG,1,3 Alvin L. YOUNG,1,3 C. P. PANG,1

L. J. CHEN1,3


Kong, Hong Kong 2The University of Hong Kong, Hong Kong3Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong

Kong

Graves’ ophthalmopathy (GO) is the most commonextra-thyroidal manifestation of Graves’ disease (GD).

Studies have reported an association between interleukin

(IL)-related gene polymorphisms and GO in different

populations. We aimed to conrm this association by

conducting a meta-analysis. Among the 382 publications

retrieved in MEDLINE and EMBASE (1 May 1989 to 25

February 2015), 16 studies were eligible for meta-analysis,

involving 8 IL-related genes and 12 polymorphisms with

a total of 1650 GO cases and 2909 GD controls. The

combined odds ratio (OR) and 95% condence intervals

(CI) were estimated. IL1A (rs1800587, c.-889C>T)

was the only polymorphism that was signicant in themeta-analysis (p<0.050). No association with GO was

detected for the 7 other genes (IL1B, IL1RA, IL4, IL6,

IL12B, IL13 and IL23R; p>0.050). Future studies are

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5-6

Ocular adnexal lymphoma: long-termclinical outcomes in a cohort of 63Chinese patients

Jerry K. H. LOK,

1,2

Emmy Y. M. LI

1,2


Kong, Hong Kong

Objective: To evaluate the long-term (>60 months)clinical outcomes in patients diagnosed to have ocular

adnexal lymphoma in a Chinese population.

Methods: A retrospective case series of 63 Chinesepatients with histology-proven ocular adnexal lymphoma

during the period of 1994 to 2012 was reviewed.

Results: The mean age of the patients at diagnosis was

60.3 ± 15.8 (range, 26-92) years, with a mean follow-

up period of 99.1 ± 50.3 months. Extranodal marginalzone lymphoma constituted 87.3% (55 patients), while

follicular lymphoma and diffuse large B cell lymphoma

each constituted 3.2% (2 patients). Recurrence occurred

in 22.2% (14 patients) with a mean time of recurrence

being 53.3 ± 32.5 months. Overall, 27% (17 patients)

died during the study period, of which 11.8% (2 patients)

was disease-related. The 5-year overall survival rate was

73.9%, with a disease-free survival of 69.5%.

Conclusion: Long-term clinical outcomes of ocularadnexal lymphoma in a Chinese cohort were presented.

metastasis and mortality.

Results: The median age at presentation was 63.9

years. Of the patients, 67% were female, and laterality

(left-to-right ratio) was 1:1, with 83% of lesions onthe upper lid. Initial diagnosis was chalazion (61%),

suspicious mass for investigation (33%) and recurrentblepharoconjunctivitis (11%). All had pathologicallyconrmed diagnosis of sebaceous cell carcinoma. Overall,

17% showed intraepithelial (pagetoid) involvement and

11% positive for fat staining; 72% of patients underwent

excision with local reconstruction, 11% with orbitalexenteration, 6% with radiotherapy, and the rest opted

for conservative treatment.

Conclusion: Despite the fact that clinical features of

sebaceous cell carcinoma have been widely reported, a

time lag from presentation to diagnosis is still common.

5-5

Outcome of upper eyelid blepharoplastywith concurrent Mueller’s muscleconjunctival resection

Emmy Y. LI, Bonnie L. LEUNG, Hunter K. YUEN


Objective: To determine the effect of concurrent

blepharoplasty and Mueller’s muscle conjunctival resection

(MMCR) surgery on eyelid position.

Methods: This was a retrospective case series. Medicalrecords of 22 patients having received concurrent upper

eyelid blepharoplasty and MMCR were reviewed. In

this study, blepharoplasty consisted of skin removal,debulking of orbicularis and fat, leaving the tarsus

intact. Conjunctival mullerectomy was performed after

blepharoplasty and the wound was closed with a single-

run of prolene suture.

Results: There were 18 cases of bilateral blepharoplasty

with bilateral MMCR and 6 cases of bilateral blepharoplasty

with unilateral MMCR. Operating time and complications

were documented. Preoperative and postoperative

palpebral ssure height and margin-reex distance

were compared. Patient satisfaction on functional and

cosmetic outcomes was assessed.

Conclusion: Combining MMCR surgery with upper

eyelid blepharoplasty provides a reliable and satisfactory

option to correct dermatochalasis and ptosis in the same

setting with a relatively short operating time.




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One (3.4%) eye had choroidal neovascularization and 1

(3.4%) eye developed macular scar.

Conclusion: Patients with chronic CSCR treated with

PDT could achieve long-term stable visual acuity andresolution of SRF. Adverse side-effects were uncommon.

6-3

Etiologies and surgical outcomes ofpediatric retinal detachment in a tertiaryhospital in Hong Kong

Helena P. Y. SIN, Wilson W. K. YIP, Vesta C. K. CHAN, Alvin L. YOUNG

Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong

Objective: To evaluate the etiologies and surgical

outcomes of pediatric retinal detachment cases in atertiary hospital over an 8-year period.

Methods: A retrospective case study of children (aged

0-18 years) who received primary retinal detachment

surgery at Prince of Wales Hospital between January

2007 and June 2015 was conducted.

Results: A total of 39 eye operations (37 patients) were

identied. The mean age was 13.4 years. The mean

follow-up period was 35 months. All 7 children below

10 years old had congenital ocular pathologies that led

to retinal detachment. Overall, contributing etiological

factors were identied in 31 (84%) of the cases. These

included high myopia (22%), trauma (14%), post-

intraocular surgery (11%) and eczema (8%). Successful

retinal reattachment was achieved in 84% (30/36 eyes)

of patients. The proportion of patients with vision better

than 20/100 improved from 37% preoperatively to 44%

at the nal follow-up.

Conclusions: These data can provide more information

for doctors to discuss retinal detachment surgery with

parents.

6-4

Experience of treating sight-threateningBehçet’s disease in Prince of WalesHospital

Mary HO,1 Helena P. Y. SIN,1 Vesta C. K. CHAN,1 Marten BRELEN,2 Alvin L. YOUNG1



Kong, Hong Kong

Objective: Behçet’s disease with uveoretinitis is a chronic

refractory disease with sight-threatening consequences.

The aim of this study was to describe the treatmentexperience of Behçet’s disease with posterior segment

6-1

Inverted internal limiting membraneFlap and Peel technique for treatment of

complex macular hole

Byron T. H. CHU

Department of Ophthalmology, Caritas Medical Centre, Hong Kong

Inverted internal limiting membrane (ILM) ap technique

introduced by Michalewska et al in 2010 has signicantly

improved closure rate for complex macular holes,

which include myopic macular hole with or withoutretinal detachment and large macular hole. We modied

the technique to Flap and Peel, whereby a central

1-disc diameter ILM ap was inverted, followed by

circumferential peeling of the remaining ILM up to4-disc diameter. 20 eyes of 20 patients with complex

macular holes underwent this procedure at a single center

by a single surgeon (BC) from March 2014 to August

2015. After single surgery, hole closure was achieved

in 90% (18/20), and retina reattached in 100% (12/12).

Central scotoma and metamorphopsia improved in all

patients (20/20). None experienced visual acuity loss.

Inverted ILM Flap and Peel technique is highly effective

in treating complex macular holes, and may become the

standard technique in the future.

6-2

Long-term efcacy of half-dosephotodynamic therapy in chronic centralserous chorioretinopathy

Frank LAI,1 Marten BRELEN,2 Vesta CHAN,1 Alvin YOUNG1



Kong, Hong Kong

Objective: To evaluate long-term efcacy and safetyof half-dose photodynamic therapy (PDT) in chronic

central serous chorioretinopathy (CSCR).

Methods: Medical records of patients with chronic CSCR

treated with half-dose PDT between January 2007 and

December 2012 were retrospectively reviewed. Study

outcomes included change in best-corrected visual acuity,

resolution of subretinal uid (SRF), recurrence rate and

complications.

Results: Twenty nine eyes of 27 patients, with a mean

age of 48.2 ± 7.52 years, were followed up for a mean

period of 52.6 ± 21.0 months. The pre-treatment and

post-treatment mean logMAR visual acuity was 0.247± 0.201 and 0.101 ± 0.183, respectively. All eyes had

resolution of SRF at the last follow-up. Two (6.9%) eyes

had recurrence of SRF and 1 eye required repeated PDT.

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Objective: To evaluate the use of preoperative spectral-

domain optical coherence tomography (SD-OCT) image

and some related indexes as predictive factors for the

surgical outcomes of idiopathic macular hole (IMH) afterpars plana vitrectomy and internal limiting membrane

peeling.

Methods: 21 eyes from 20 patients with IMH whounderwent surgery were retrospectively studied.

Preoperative SD-OCT parameters including basal

diameter, minimal diameter, MH height, hole form factor

(HFF), Macular Hole Index, Diameter Hole Index and

Tractional Hole Index were measured.

Results: Primary anatomical success was achieved in

90.5% (19/21) eyes. The mean follow-up was 14.9 (range,

8-22) months. Postoperative best-corrected visual acuity

(BCVA) improved in 14/21 (66.7%) eyes, worsened in

2/21 (9.5%) and remained unchanged in 5/21 (23.8%).MH minimal diameter (p=0.006) and HFF (p=0.037)

correlated signicantly with postoperative BCVA.

Conclusion: SD-OCT indexes may be useful in predicting

surgical outcome of IMH.

6-7

A simple modication to the 25-gaugetrocar and cannula system for retinopathyof prematurity–related lens-sparing

vitrectomy

Ian WONG,1 Lawrence IU,2 Connie LAI2

1Department of Ophthalmology, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, Queen Mary Hospital, Hong Kong

Objective: Recently, the use of 25-gauge vitrectomy

has become more popular with the advancement ofinstrumentation. However, most surgeons still perform

vitreoretinal surgery in infants with the use of the

regular adult-sized trocars and cannulas. This is because

pediatric-sized trocar and cannula are not readily

available. However, use of adult-sized instruments may

risk inadvertent lens touch if used.

Methods: Standard adult 25-gauge cannulas and standard

270-silicone Watzke sleeves were used. The sleeveswere cut into spacers of 2 mm long. One sleeve was

rst introduced up the shaft of the cannula. The second

sleeve was then overlaid on top of the rst one using

a sleeve spreader. This would shorten the length of the

cannula from 4 mm to 2 mm.

Results: This modication was successfully used in 2

vitrectomies.

Conclusion: This is a simple modication using standard

adult 25-gauge cannulas and standard 270-silicone

Watzke sleeves, which shorten the length of the cannula,enabling these instruments to be used in pediatric cases.

involvement in our center.

Methods: This was a retrospective case series of all

patients with a diagnosis of Beçhet’s-related sight-

threatening ocular inammation seen in our center from

2012 to 2015.

Results: Seven cases with sight-threatening Behçet’sdisease were identied, with age ranged from 16 to 35

years old. Three patients suffered from severe visual loss

(≤20/200) in 1 eye, all patients presented with symptoms

of retinal vasculitis or retinitis. Of the patients, 78%

(11/14 affected eyes) had good visual outcome (≥20/30).

Six (85%) cases were on cyclosporine A, 2 (29%) cases

remained in disease quiescent stage with cyclosporine

A as the sole agent. Three cases developed progressive

retinitis despite high-dose immunosuppressant and

steroid, further requiring biologic agents in disease

control. Iniximab (1 case) and adalimumab (2 cases)

were adopted in the recalcitrant cases.

Conclusion: Behçet-associated uveitis predominantlyaffects young men in Asia, with bilateral panuveitisassociated with retinal vasculitis as the most common

manifestation. A substantial proportion of cases remained

disease-active despite multiple immunosuppressantsrequiring biologic (anti–tumor necrosis factor alpha)

agents in prevention of blindness.

6-5

Investigative ndings of acute zonal occult

outer retinopathy in Chinese patients

Joy W. Y. LEUNG, Jonathan C. H. HO


This was a retrospective case series of 9 consecutive

Chinese patients with typical symptoms of acute zonal

occult outer retinopathy (AZOOR), who presented to

Hong Kong East Cluster Ophthalmology Clinics from

2005 to 2014 and underwent a series of investigations

to demonstrate functional and structural features of the

disease.

Photopsia and central eld defect unexplained by any

abnormality of the fundus were typically seen in this

series of Chinese AZOOR patients.

Abnormal visual eld, optical coherence tomography,

fundus autouorescence and visual electrophysiology

were observed. Prognosis was rather variable.

6-6

Optical coherence tomography predictive

factors for idiopathic macular holesurgery outcome

Tracy Y. T. KWOK, Fiona O. J. LUK




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6-8

Initial experience on suprachoroidalmacular buckling surgery

C. W. TSANG


Objective: To evaluate the short-term outcome andresults of suprachoroidal buckling procedures using a

suprachoroidal catheter in treating myopic tractionalmaculopathy.

Methods: A suprachoroidal catheter was used to deliver

stabilized, cross-linked and long-acting hyaluronic acid

as a ller in the suprachoroidal space to form a choroidal

indent effect in the macula. The results of 3 consecutive

cases (2 myopic foveoschisis with foveal detachment

and 1 myopic macular hole retinal detachment) were

reviewed with a minimum follow-up of 3 months.

Results: All cases showed anatomical foveal retinallayer restoration. The best-corrected visual acuity was

improved from 0.1, 1/60, 0.4 preoperatively to 0.3, 5/60

and 0.7, respectively at postoperative 3 months. Nomajor intraoperative and postoperative complications

were noted.

Conclusions: Suprachoroidal macular buckling surgery is

a new technique of treating myopic tractional maculopathy

with promising short-term outcomes.

6-9Comparison of treatment efcacy ofintravitreal ranibizumab and aiberceptin polypoidal choroidal vasculopathy in aChinese cohort

Jerry K. H. LOK,1,2 Raymond L. M. WONG,1,2 Fiona J. O. LUK,1,2 Timothy Y.Y. LAI2


Kong, Hong Kong

Objective: To evaluate the treatment efcacy of

ranibizumab versus aibercept in polypoidal choroidal

vasculopathy (PCV) in a Chinese cohort.

Methods: A single-center retrospective comparativestudy was conducted. Clinical data were extracted from

case records of 42 Chinese adults with treatment-naïve

PCV on indocyanine green angiography, treated with

monthly injection of either intravitreal ranibizumab or

aibercept with or without photodynamic therapy. Primary

outcomes were change in logMAR visual acuity (VA)

and central macular thickness (CMT) on spectral-domain

optical coherence tomography (Heidelberg Engineering,

GmbH, Dossenheim, Germany).

Results: There were 26 (62%) adults in the ranibizumab

group and 16 (38%) adults in the aibercept group.The mean follow-up period was 6.28 ± 1.60 (range:3.02-9.07) months. The mean change in logMAR VA

for ranibizumab and aibercept was -0.09 ± 0.32 and

-0.31 ± 0.36, respectively (p=0.758), while the mean

change in CMT was -159.64 ± 151.73 μm and -112.25

± 210.15 μm, respectively (p=0.247).

Conclusion: Ranibizumab and aibercept are comparable

in terms of treatment efcacy (logMAR VA and CMT)for PCV in a Chinese cohort, although a trend of greater

logMAR VA improvement was demonstrated for the

aibercept group.

6-10

Identication of the placental growthfactor gene as a new genetic biomarkerfor neovascular age-related maculardegeneration

L. J. CHEN, Li MA, Marten E. BRELEN, Alvin L. YOUNG, C. P. PANGDepartment of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The

Chinese University of Hong Kong, Hong Kong

Objective: This study was to evaluate the placentalgrowth factor (PGF) gene as a genetic biomarker for

neovascular age-related macular degeneration (nAMD).

Methods: The PGF, a new target of anti-vascular

endothelial growth factor therapy, plays an important

role in angiogenesis. In a Chinese cohort of 230 nAMD

patients and 360 controls, we genotyped 3 haplotype-

tagging single-nucleotide polymorphisms (SNPs) in PGF

and 2 candidate SNPs that had been correlated with theserum level of PGF. Single marker and haplotype-based

association analyses were performed.

Results: Two PGF SNPs were signicantly associated

with nAMD (p<0.005). Haplotype analysis revealeda signicant omnibus association (p = 6 × 10-6) and a

haplotype (C-A) that conferred a 13.9-fold of increased

risk of nAMD.

Conclusions: This study revealed PGF as a new

susceptibility gene for nAMD. Patients with a C-A

haplotype have an increased risk of nAMD by nearly

14-fold. This nding will facilitate genetic screening

for individuals at high risk.

6-11

Six-year retrospective review ofcytomegalovirus retinitis in patientswithout human immunodeciency virus(HIV): clinical features and factors thatpredict visual outcome

Lawrence P. IU, Michelle C. FAN, Jordy K. LAU, Ian Y. WONG, Jimmy S. LAI

Department of Ophthalmology, Queen Mary Hospital, The University of Hong Kong,

Hong Kong

Objective: To evaluate clinical features and visual

outcomes of cytomegalovirus (CMV) retinitis in patients




FREE PAPER SESSIONS

without human immunodeciency virus (HIV) infection,

and to determine factors that predict visual outcome.

Methods: This was a retrospective cohort study of 20

eyes from 13 consecutive patients with CMV retinitis

without HIV infection.

Results: At presentation, 44% of eyes had visual acuity(VA) of <20/70 and 28% had VA of <20/400. Signicant

vitreous haze ≥grade 2+ occurred in 25%. Recurrence

occurred in 37.5% at a mean time of 7.1 ± 4.3 weeks

after discontinuation of anti-CMV therapy. After a

median follow-up time of 14 months, 56% had nal

VA of <20/70 and 33% had nal VA of <20/400. Poor

presenting VA of <20/70 was signicantly associated

with nal VA of <20/70 (odds ratio=16.33, p=0.028).

Macular involvement was signicantly associated with

nal VA of <20/400 (odds ratio=25.00, p=0.016).

Conclusion: CMV retinitis without HIV infection is often

aggressive at presentation and signicant intraocular

inammation may occur. Visual outcome is often poor.

6-12

Unusual ocular manifestations in patientswith conrmed tuberculosis infection

Helena P. Y. SIN, Mary HO, Vesta C. K. CHAN, Marten BRELEN, Alvin L. YOUNG


We report rare ocular manifestations in 2 patients with

conrmed tuberculosis (TB) infection.

Case 1

A 55-year-old male, with underlying treated pulmonary TB

and newly diagnosed diabetes mellitus with nephropathy

and neuropathy, presented with both eyes retinal

neovascularization and neovascular glaucoma. Multiple

extensive panretinal photocoagulation (PRP) was

performed. One eye was salvaged with repeated intravitreal

anti-vascular endothelial growth factor injections.

Case 2

A 45-year-old woman presented with swinging fever

for 3 weeks, right eye branch retinal artery occlusion

and bilateral retinal vasculitis. Workup conrmed

extrapulmonary TB infection in her lymph nodes. Vasculitic

changes resolved soon after anti-TB regimen was started.

However, she developed left eye central retinal artery

occlusion at 3 months with recurrence of fever while

on anti-TB medications. Steroid was prescribed with

additional drugs to her of anti-TB regimen.

TB infection is not uncommon in Hong Kong and rare

blinding ocular conditions can occur.

ions except for tendency of hyperopic shift especially

in those receiving negative-power IOL.

cy and safety of daily 0.125% topical atropine solution





Symposium 2015

Posters




POSTERS

P03

Case report and review of literature:Miller-Fisher syndrome–induced acuteangle closure

Joyce J. T. CHAN, Jerry K. H. LOK, Hunter K. L. YUENHong Kong Eye Hospital, Hong Kong

We report the case of an 83-year-old female with Miller-

Fisher syndrome–induced acute angle closure. She

presented with bilateral ptosis, complete ophthalmoplegia

and generalized areexia, which were preceded by

symptoms of an upper respiratory tract infection. Five

days after admission, she was noted to have left eye

redness. Examination revealed bilateral dilated pupils,

immature cataracts, a patent peripheral iridotomy inthe right eye, and left-eye acute angle closure with no

patent peripheral iridotomy seen. The attack was aborted

with medical therapy and a peripheral laser iridotomy.Miller-Fisher syndrome causes autonomic dysfunction

and pupillary dilatation and may precipitate acute angle

closure in anatomically susceptible eyes. Three other

cases of Miller-Fisher syndrome–induced acute angle

closure have been previously reported in the literature

and are reviewed.

P04

Non-allergic eyelid edema after botulinum

toxin type A injection: case report andreview of literature

Karen K. W. CHAN,1 Y. S. CHANG,2 J. H. SHEN,2 Y. T. CHEN,3 C. C. CHANG2

1Hospital Authority, Hong Kong 2Chang Gung Memorial Hospital, Taiwan3Taipei Municipal Wang Fang Hospital, Taiwan

Periocular botulinum toxin type A (BoNTA) injections

are generally safe. Ptosis is the most common adverse

effect while eyelid edema is rarely reported. There is

no consensus on the latter’s incidence, clinical course

or treatment strategy.

We managed a 59-year-old woman who developed

periorbital edema and erythema after injections.

Preliminary diagnosis was allergy, but lack of response

to corticosteroids suggested edema instead. It eventually

resolved with conservative treatment. At 4 months,another course of BoNTA was requested and given at

half the dose. Frequent blinking was instructed and

outcome was satisfactory.

Our literature review revealed 1.4% incidence of BoNTA-

induced eyelid edema, with self-resolution in 2 to 4

weeks. Patients at risk, including Asians, dermatochalasis,and poor periocular muscle tone, are advised to receive

halved dosages. The tone of orbicularis oculi and

levator palpebrae superioris should be examined before

P01

Difcult reconstruction of cicatricialectropion secondary to maxillectomy andradiotherapy

K. H. AU, E. CHAN, T. C. KODepartment of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong

Patients with malignant sinus tumor often receive treatment

by radical maxillectomy and radiotherapy. The resultant

lack of bony support and adherent scarring between the

tarsus and residual periosteum causes severe cicatricial

ectropion. Apart from poor cosmesis, the ectropion can

often result in vision-threatening exposure keratopathy.

This form of ectropion is resistant to treatment. Apart

from difcult correction for the above pathogenic factors,

radiotherapy-induced vasculopathy impedes healing and

survival of free grafts used in reconstruction.

After freeing all scars, our preferred reconstruction

involves replacing the bony volume by a free dermal fat

graft harvested from the peri-umbilical region, followed

by transposing a relatively well-vascularized bipedicular

myocutaneous ap from the upper lid. Two cases are

presented using the above technique with satisfactory

anatomic and functional outcome.

P02Complications after implantable collamerlens insertion for high myopia

C. K. CHAN, Jackey YAU


Objective: To report cases of complications after inserting

implantable collamer lens (ICL).

Methods: A 28-year-old male and a 36-year-old female

with high myopia underwent bilateral ICL implantation

in private centers.

Results: One case showed increased intraocular pressure

(IOP) with corneal edema of right eye 1 month after

implantation. The IOP was fairly controlled by topical

anti-glaucomatous drugs, steroid and laser iridotomy.

Later, it developed corneal decompensation. Another case

had right ICL explantation done 12 days after insertion

due to angle closure glaucoma. However, permanent loss

of visual acuity and visual eld were resulted.

Conclusion: ICL can provide the freedom from glasses

or contact lens; however, it has various complications

which may lead to permanent vision loss.




POSTERS

treatment, and application of hot pads, frequent blinking,

and massage of the affected areas improve outcome.

P05

Identication of posterior polar cataractwith the use of anterior segment opticalcoherence tomography

Leo W. L. CHAN, L. WONG, W. K. WU, C. Y. YUEN


Objective: To review the preoperative use of anterior

segment optical coherence tomography (AS-OCT) for

the diagnosis of posterior polar cataract before cataract

extraction.

Methods: 42 patients with suspected posterior polar

cataract identied under slit-lamp examination wereincluded in the study and subsequently underwent cataract

extraction. Of them, 14 patients conrmed to have

pre-existing posterior capsule defect or posterior polar

cataract intra-operatively. Retrospectively, preoperative

AS-OCT of these 14 cases all showed pre-existing

capsular defect or posterior polar cataract, consistent

with the intra-operative ndings.

Results: Preoperative AS-OCT ndings were conrmed

intra-operatively after cataract extraction in all patients

with suspected pre-existing posterior capsule defect or

posterior polar cataract preoperatively.

Conclusions: AS-OCT could play an important rolepreoperatively in patients with posterior polar cataract,

identifying cases at high risk of posterior capsule rupture

to enhance surgical planning and counseling.

P06

Clinical outcomes of toric intraocular lensimplantation in Hong Kong East Cluster

Janice CHEUNG, Gloria Y. S. LEUNG, Simon T. C. KO


Patients with cataract extraction and toric intraocular lens

(IOL) insertion done in Tung Wah Eastern Hospital during

the period of 2013-2014 were retrospectively reviewed.

Baseline uncorrected distance visual acuity (UDVA),

corrected distance visual acuity (CDVA), and corneal

astigmatism were measured preoperatively. Postoperative

outcomes included UDVA, CDVA, refractive errorsmeasured at 1 month, 3 months, 6 months, or longer

intervals. The target induced astigmatism and surgically

induced astigmatism were compared. Other factors

associated with over-correction or under-correction of

astigmatism, including postoperative IOL rotation, typeof baseline corneal astigmatism were also looked into.

P07

Outcome of orbital wall reconstructionwith the use of titanium implants

Janice J. C. CHEUNG,1,2,3 Theresa S. T. MAK,1,2,3 Kenneth K. W. LI,1,2,3 C. H. TANG,1,2,3

Alex L. K. NG,

3

Derek K. YU,

1,2,3

S. C. FUNG

1,2

1Department of Ophthalmology, United Christian Hospital, Hong Kong 2Tseung Kwan O Hospital, Hong Kong3The University of Hong Kong, Hong Kong

Objective: To study outcomes of orbital wall repair using

titanium mesh for orbital wall reconstruction.

Methods: A retrospective review of patient records for

9 patients with orbital reconstruction surgery done from

2011 to 2014.

Results: These 9 patients (8 male, 1 female) aged from

20 to 56 years had orbital fractures and reconstruction

after tumor resection. Postoperative diplopia improved

in 77.8%, remained the same in 11.1%, and worsened in11.1%. Ocular motility improved in 77.8%, no change

in 11.1%, and worsened in 11.1%. Overall, 57.1% had

improvement in enophthalmos, 14.3% had no change,

and 28.6% had an increase in enophthalmos. No intra-

operative complications were noted. One case had

worsening diplopia at primary gaze and upgaze with

chin-up position. There was hypotropia that was corrected

with Fresnel prism. Reoperation was not required.

Conclusion: Titanium plate in orbital reconstructionsurgery is safe with low complication rate and satisfactory

outcomes.

P08

A case of glaucoma drainage device tuberetraction and blockage in a patient withiridocorneal endothelial syndrome

Carol P. Y. CHIEN, Bonnie N. K. CHOY


We report a case of refractory intraocular pressure (IOP)

control in a patient with iridocorneal endothelial syndrome

(ICE) due to blocked glaucoma drainage device (GDD)

by the ICE membrane.

In July 2014, the patient presented with a sudden

elevated IOP to 67 mm Hg in the right eye despite a

well-controlled IOP in previous years. She was treated as

acute angle closure due to peripheral anterior synechiae

closure. Ahmed glaucoma valve was implanted but was

complicated by tube retraction and blockage by brinous

membrane. Repeated Nd:YAG laser membranectomy

was performed to restore the patency and the IOP was

normalized.

To our knowledge, this is the rst reported case of

treatment with Nd:YAG laser to restore the patency of

the tube lumen obstructed by ICE membrane. This may




POSTERS

corneal involvement in SJS group were 20%, 40% and

20% respectively, and that in TEN group were 33%,

75% and 33% respectively. Comparison of both groups

showed no signicant differences in all 3 parameters

(p=0.433, 0.076 and 0.433, Fisher’s exact test).

Conclusion: Ocular involvement was common in bothgroups. However, a diagnosis of TEN was not associated

with more extensive ocular involvement or worse visual

outcome.

P11

Bilateral optic disc swelling and uveitis ina 29-year-old woman

P. C. CHOW, Nelson YIP, Alvin YOUNG


We present a case of bilateral disc swelling and uveitis

with positive cerebrospinal uid (CSF) beta-D-glucan.

A 29-year-old woman presented with headache, scotoma

and fever after traveling to Phuket. Her visual acuity

was 20/20 OU with bilateral disc swelling. Visual eld

showed bilateral scotoma. Lumbar puncture showed raised

opening pressure. She did not respond to antibiotic or

anti-tuberculosis treatment, but showed marked clinical

improvement with steroid. She later developed anterior

uveitis and her serum and CSF beta-D-1,3-glucan were

positive and she was started on antifungal treatment.

This is an interesting case of bilateral disc swelling and

uveitis with no conrmed etiology, albeit positive beta-

D-glucan in serum and CSF. Levels of beta-D-glucan in

CSF decreased after a course of amphotericin B though no

clinical improvement was observed. She showed marked

improvement, however, to systemic corticosteroid. She is

now on observation after stopping antifungal treatment

and tailing down of steroid.

P12An atypical triggering factor of ocularmyasthenia gravis

Sharon S. W. CHOW,1 Kendrick C. SHIH,2 Jimmy S. LAI2

1Department of Ophthalmology, Queen Mary Hospital, Hong Kong 2Department of Ophthalmology, The University of Hong Kong, Hong Kong

We present a man with good past health presenting with

ocular myasthenia gravis (MG) after u vaccination.

Ocular MG can be aggravated by many factors such as

infection, pregnancy, excessive alcohol, but vaccination is

rarely reported. Many studies have reported vaccinationto be safe in patients with MG. However, we report our

patient presenting with right eye ptosis on the same day

after receiving u vaccine. He subsequently developed

be an effective treatment option to avoid another surgery.

Further study is needed to compare the effectiveness of

different modalities in managing a blocked GDD tube.

P09

A patient with periorbital swelling, sorethroat and facial pain

K. Y. CHIN, C. L. LI, A. L. YOUNG


Kong, Prince of Wales Hospital, Hong Kong

We report a case of Streptococcus milleri infraorbital

abscess secondary to parapharyngeal abscess via stula.

This is an unusual case of orbital emphysema secondary

to S. milleri parapharyngeal abscess.

A 35-year-old male presented with fever, sore throat

and facial pain for 1 day. The patient was diagnosed to

have left-sided quinsy, complicated with left infraorbital

swelling. Computed tomography showed multiple gas

pockets in left oral pharyngeal wall and subcutaneous

emphysema around left orbit. Incision and drainage of

left parapharyngeal abscess was done, and pus culture

showed S. milleri. Further debridement of necrotic tissue

around left infraorbital space was done. The patient was

put on prolonged course of systemic Augmentin tillclinical and radiological resolution of infection.

Non-clostridial orbital gas producing infection was

rarely reported in literature. We proposed that gas and

bacteria had spread by way of a mechanical means to

form an infected stula between parapharyngeal space

and infraorbital space.

P10

To describe and compare the acute ocularmanifestations in an Asian cohort withStevens-Johnson syndrome and toxic

epidermal necrolysis

Loraine L. W. CHOW,1 L. K. NG,2 Kendrick C. SHIH,2 S. M. YIM,1 S. K. CHAN,1

Michelle FAN,1 Jimmy S. LAI2

1Department of Ophthalmology, Queen Mary Hospital, Hong Kong 2Department of Ophthalmology, The University of Hong Kong, Hong Kong

Objective: To describe and compare the acute ocular

manifestations of Stevens-Johnson syndrome (SJS) and

toxic epidermal necrolysis (TEN) in a Chinese population.

Methods: Retrospective audit of SJS and TEN cases

during the period 1998 to 2013 was carried out. Medical

records were reviewed for their demographics andspectrum of ocular involvement.

Results: Overall, 20 SJS and 12 TEN patients were studied.

The rates of symblepharon formation, conjunctival and




POSTERS

were identied and 209,331 individuals ranging from

0 to 95 years of age were included. In Asians aged 20

to 29 years, the pooled prevalence estimate of myopia

was the highest (48.1%; 95% condence interval [CI],

22.3-74.1%). In elderly patients of >70 years old, the

prevalence of myopia was higher compared to middle-aged adults (35.9%; 95% CI, 28.2-44.9%) which revealed

nuclear cataract and myopic shifts.

Conclusions: A large variation of myopia prevalence

exists in Asian countries. Overall, the myopia prevalence

in Asian is similar to that of western countries for middle-

age and elderly patients. Myopia is more prevalent among

younger generations in urban Asian communities than

in western counterparts.

P15

Evaluation of seasonal differences inpatients with self-reported dry eyesymptoms

Harry DANG

Faculty of Medicine, University of Ottawa, Ottawa, Canada

Objective: A systematic review and meta-analysis of data

on dry eye studies was performed to evaluate seasonal

differences in self-reported dry eye symptoms.

Methods: A longitudinal database was constructed using

self-reported symptoms scores from 11 dry eye clinical

trials over a 7-year period. A cohort of 281 patients whohad partaken in at least 1 summer (April-September) study

and 1 winter (October-March) study were identied and

included in the study. Differences in dryness symptoms

and self-reported ocular discomfort were compared

between summer and winter seasons to identify seasonal

uctuations in the severity of symptoms.

Results: A signicant seasonal difference was observed

for symptoms of self-reported ocular discomfort (summer

vs. winter, -0.119 vs. 0.916, p=0.025), with higher levels

of discomfort during winter season. Patients also reported

high levels of dryness during winter season (p=0.033).

Conclusions: Seasonal uctuations in self-reported

symptoms were analyzed, with higher levels of ocular

discomfort noted during winter season.

P16

Is routine visual eld screening ofunexplained visual loss necessary?

Nikki Y. FAR, Nelson K. F. YIP, Alvin L. YOUNG


Objective: To investigate the diagnostic outcome of visualeld testing in patients with unexplained visual loss.

Methods: All patients who underwent Humphrey visual

eld tests for screening of unexplained visual loss from

diplopia with limitation in extraocular movements. Blood

test was positive for anti-acetylcholine receptor antibody,

and nerve conduction test also conrmed MG. He was

treated with intravenous immunoglobulin and was put

on systemic prednisolone, carbimazole and mestinon.

Thymectomy was done for compatible nding of thymichyperplasia. Symptoms of ocular MG recovered after 5

months of treatment. Currently, there are limited studies

on the report of vaccination as a triggering factor of MG;

our case is an atypical presentation.

P13

Ten-year experience of adjustable suturestrabismus surgery in Kowloon EastCluster

Emily TANG, Victor CHUKowloon East Cluster, Hong Kong

Objective: Adjustable suture strabismus surgery hasbeen available for many years as a tool to potentially

enhance the surgical outcomes. Our center has 10 years’

experience of adjustable suture in strabismus surgery. In

this retrospective case series, we would like to review

the outcome after the intervention.

Methods: 11 patients aged between 28 and 66 years, who

underwent adjustable strabismus surgery from January

2005 to April 2015 in our center, were included in this

study. Surgical results were followed up for a periodranging from 2 to 40 months. The outcome measure

was the success rate and the re-operation rate. Success

rate was dened as no diplopia at primary gaze or ≤15

prism diopters, relief of symptoms and no re-operation

till June 2015.

Results: The success rate was 81.8% while the re-

operation rate was 9.1%. Surgical results were found to

be comparable with other international studies.

P14

A meta-analysis and systematic review ofthe prevalence of myopia in Asia

Harry DANG,1 Mirian M. H. DANG2

1Faculty of Medicine, University of Ottawa, Ottawa, Canada 2Faculty of Health, York University, Toronto, Canada

Objective: To estimate the prevalence of myopia in Asia.

Methods: Literature searches on Web of Science,

EMBASE, and PubMed were conducted from inception

to July 2015 for population-based studies and surveys

reporting the myopia prevalence in children and adults

in Asia. Using a random effects model, the prevalenceestimates for myopia were pooled.

Results: 51 eligible population-based studies reporting

the prevalence of myopia from 15 Asian countries




POSTERS

such as post-transplantation, autoimmune disease onimmunosuppressants and malignancies especially

haematological. This study aimed to review different

causes of CMV retinitis and their presentations andtreatments.

Methods: Four cases of CMV retinitis in Tuen Mun EyeCentre from 2011 to 2014 were identied and reviewed.

Results: All the 4 cases had different causes of

immunosuppression. The presentation of CMV retinitis

were highly variable among them. The treatment options

were also different.

Conclusion: CMV retinitis has a wide range of presentation

that may not be classical as in AIDS patients. They also

receive different treatment modalities and suffer from

different side-effects. We have to maintain high level

of vigilance against CMV retinitis in patients who are

immunocompromised and presented with posterior

segment signs and symptoms.

P19

Congenital ptosis and frontalis slingoperation: a review of 3 years

Madeline K. M. KWOK,1 Winnie W. Y. LAU,1 Jason C. S. YAM2


Kong, Hong Kong

Children with congenital ptosis are at risk of developingamblyopia. In those patients with such a risk, an operation

to correct the ptosis and thus, prevent amblyopia, isnecessary.

We retrospectively reviewed all the children with the

diagnosis of congenital ptosis who underwent frontalis

sling operation using allogenic material in Hong Kong

Eye Hospital from 2011 to 2014. Outcome measures

were amblyopia, ptosis recurrence, complications ofinfection, slippage, granuloma formation and extrusion

arising from the operation, and the need for re-operation.

Of the 8 patients in our series, 3 had residual mild ptosis

that did not cover the visual axis. None of the patients

had amblyopia or procedure-related complications. And

none of them required re-operation.

P20

Painless acanthamoeba keratitis presentedwith perineuritis: a case report

Rachel P. W. KWOK,1 Aziz K. W. KAM,1 Vishal JHANJI,2 Alvin L. YOUNG1 1

Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong 2Department of Ophthalmology and Visual Sciences, The Chinese University of Hong

Kong, Hong Kong

January to June 2013 were retrospectively reviewed.

Results: 115 patients were included and 4 (3.5%) of

them had signicant visual eld ndings. Overall, 22

(19.1%) and 89 (77.4%) were found to have unreliable

and normal ndings, respectively. Neuroimaging was

performed for the 4 patients who demonstrated visualeld defects respecting the vertical midline. Two of them

were diagnosed with occipital lobe infarct while theother 2 were found to have pituitary tumor. The number

needed to test for one signicant visual eld test was 29.

Conclusion: Although the yield was not remarkably

high, our results suggested that it would be crucial to

perform visual eld test for patients presenting with

unexplained visual loss.

P17

Capsular block syndrome: a case report

C. Y. FONG, H. Y. WONG, C. T. YEUNG, T. L. LI, W. H. YU, P. F. YIU


Capsular block syndrome (CBS) is a rare complication

that can occur with a continuous curvilinear capsulorrhexis

and implantation of a posterior chamber intraocular

lens (PCIOL). It is caused by circumferential adherence

between the anterior capsular rim and the optic of the

PCIOL.

Our case is a 79-year-old man who had uneventful cataractoperations for both eyes in 2009. He presented to us with

left eye blurring of vision for 2 months, 6 years after

operation. Physical examination of left eye revealed a

quiet eye with milky material posterior to the PCIOL

with best-corrected visual acuity (BCVA) being 6/18. A

diagnosis of late postoperative CBS was made clinically.

An elective operation with the removal of lens epithelial

cells was done. He recovered well postoperatively with

BCVA of 6/7.5 with a clear capsular bag.

CBS can occur intra-operatively, early and late

postoperatively with different presentations and

management.

P18

Cytomegalovirus retinitis: a case review of4 cases

C. Y. FONG, C. Y. MOK, H. W. LAI, Hilary K. TSANG, N. YANG, C. K. HO


Objective: Cytomegalovirus (CMV) retinitis has

become less prevalent after the era of highly activeantiretroviral therapy for acquired immunodeciency

syndrome (AIDS) patients. However, it can occur in

patients who are immunocompromised for other reasons




POSTERS

the long-term survival analysis of bilateral lateral

rectus recession plus upward transposition for V-pattern

exotropia versus bilateral lateral rectus recession alone

for comitant exotropia.

P22

Post-radiation macular telangiectasia in apatient with retinoblastoma

Carol LAM, Gary LEE, Winnie LAU


We report a case of a 29-year-old woman with a history

of bilateral retinoblastoma and post-radiotherapy macular

telangiectasia treated with lateral canthotomy and focal

laser. She received enucleation of the left eye at 1 year

old and external beam radiotherapy to right eye formultiple local tumors. There was recurrence of the tumor

with repeated cryotherapy done. Her disease was stable

since 2 years old. However, she developed right eye

macular hemorrhage in 2014, suggestive of secondary

macular telangiectasia after radiotherapy. She received

3 cycles of intravitreal Lucentis, 2 cycles of Eylea and

1 cycle of focal laser by indirect biomicroscopy but the

result was unsatisfactory with persistent active disease.

Indirect laser was used due to small palpebral ssure

height post–external radiotherapy. She was successfully

treated with lateral canthotomy and direct focal laser

with contact lens afterwards.

P23

Modied squint surgery for patient withabnormal horizontal muscle insertion

Charles S. L. LAU, Justin M. K. TONG, E. W. TANG, K. K. LI

Department of Ophthalmology, United Christian Hospital, Hong Kong

Objective: To evaluate the result of modied squint

surgery for cases with abnormal horizontal rectus insertion.

Methods: All squint surgery cases from February 2014 to

June 2015 were recruited. Location of horizontal rectus

insertion was measured from limbus before disinsertion.

Planning of surgery was referenced to the modied

Parks gures. Cases with signicant deviation of rectus

insertion were identied and surgery was adjusted as

follows: adjusted amount of muscle recession = planned

recessed length + difference between measured location

and normal insertion.

Results: Of 69 patients, 14 were noted to have abnormal

horizontal rectus insertion. Abnormal insertion was

noted in 24/28 operated muscles in those 14 patients

(13 medial recti [4.5-5 mm from limbus], 11 lateralrecti [6-6.5 mm from limbus]). Postoperative horizontal

alignment was within 5 prism diopters on day 1 and at

1 month post-operation.

We present an atypical case of painless acanthamoeba

keratitis and its management.

A 15-year-old contact lens user initially presented to our

department for mild blurring of vision and redness of

her right eye. There were multiple perineuritis over herright cornea. There was no epithelial defect or inltrate.

Except for mild discomfort, she did not complain of

any pain. She was initially treated as herpetic keratitis

without any improvement.

Corneal scraping showed acanthamoeba trophozoites.

She was given topical Brolene and polyhexamethylene

biguanide over a 6-month period. Topical steroid was

given at fourth month of the treatment for inter-stromal

haze. Since there was all along no epithelial defect,serial scrapings were performed in the initial stage for

monitoring.

The patient had complete cessation of all medication

after 6 months. Her best-corrected visual acuity was

20/20 for both of her eyes.

P21

Comparison of postoperative drift ofV-pattern versus comitant intermittentexotropia

Tracy H. T. LAI,1,2,3,4

Jason C. S. YAM,1

Henry H. W. LAU,1,2,3,4

Wilson W. K. YIP,1,2,3,4

Alvin L. YOUNG1,2,3,4


Kong, Hong Kong 2New Territories East Cluster Ophthalmology Service, Hong Kong3Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong

Kong4Department of Ophthalmology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong

Objective: To compare the postoperative exodrift in

patients who underwent bilateral lateral rectus recession

plus upward transposition for V-pattern intermittent

exotropia without inferior oblique overaction versus

patients who underwent bilateral lateral rectus recession

alone in comitant intermittent exotropia in the NewTerritories East Cluster Ophthalmology service from2009 to 2015.

Methods: A retrospective review was performed.

Results: A total of 28 cases underwent bilateral lateral

rectus recession plus upward transposition for V-pattern

intermittent exotropia without inferior oblique overaction

during the study period. A matched control group

with comitant intermittent exotropia who underwentbilateral lateral rectus recession alone was identied.

Any difference in the degree of postoperative exodrift

would be presented.Conclusion: Literature review suggests that postoperative

exodrift is less in V-pattern exotropia when compared

to comitant exotropia. This study specically presents




POSTERS

Conclusion: Modied squint surgery offers reliable

treatment outcome for cases with abnormal horizontal

rectus insertion.

P24

Case of iris and ciliary body metastasessecondary to papillary thyroid carcinoma

Tiffany W. S. LAU, Emmy Y. M. LI, Hunter K. L. YUEN


This is a rare case of iris and ciliary body metastases

secondary to papillary thyroid carcinoma in a 50-year-

old man with good past health. He rst presented with 2

days of blurring of vision of the right eye. Examination

revealed right panuveitis with a pigmented mass posterior

to the iris inferiorly. Magnetic resonance imaging ofthe orbit showed a contrast-enhancing lobulated nodule

posterior to the iris, suspicious of uveal neoplasm. Whole-

body positron emission tomography (PET) showed a

left lower pole thyroid nodule with mild FDG uptake.

Total thyroidectomy was performed and the histological

diagnosis was papillary thyroid carcinoma. He underwent

an iridocyclectomy of the right eye and the histological

diagnosis was metastasis of papillary thyroid carcinoma

to the right iris and ciliary body. In cases of suspected

uveal neoplasm, whole-body PET may be useful inidentifying the site of the primary tumor.

P25

No nails, no teeth and not enough tears: acase of ectodermal dysplasia

Allie LEE, Victoria WONG


This is a case report of a young woman presenting with

worsening vision and foreign body sensation in both

eyes for few years.

Ocular examination revealed bilateral corneal scarring,

vascularization and unstable tear lm with her left eye

more severely affected. Systemic review showed poor

dental development, progressive loss of ngers and toe

nails since childhood. The clinical features are compatible

with bilateral limbal stem cell deciency secondary to

ectodermal dysplasia. The patient also had persistent

epithelial defect treated with lubricants and subsequently

amniotic membrane transplant.

This is a rare clinical entity and the diagnosis is dependent

on careful ophthalmic and systemic examination.

P26

Surgical outcomes of treating limbaldermoid: a 10-year review

Stephen LI, Evan YIU, Lester W. H. YU, Angela H. Y. WONG, John C. T. YEUNG


Objective: To review the outcomes of limbal dermoid

requiring surgery.

Methods: Retrospective case review of cases performed

in Tuen Mun Hospital from 2005 to 2014.

Results: Six eyes of 6 patients with a mean age of 7.26

years (range, 16 days to 14 years) were reviewed. Three

patients received excision with lamellar keratoplasty; 2

patients received excision alone and 1 patient received

excision with cryotherapy. The visual acuity, refraction

and cosmetic outcome are presented. Different surgical

approaches and their pros and cons are discussed.

P27

Evaluating surgical outcome of V-patternexotropia: 5-year retrospective review

Julie Y. C. LOK,1 Wilson W. K. YIP,1 Henry H. W. LAU,1 Jason C. S. YAM,2 Alvin L.

YOUNG1



Kong, Hong Kong

Objectives: To evaluate the surgical outcomes of

patients with V-pattern exotropia with different grades

of inferior overaction who underwent bilateral lateral

rectus recession combined with half-tendon upwardtransposition of lateral rectus muscles or bilateral inferior

oblique recession.

Methods: The surgical records between 2009 and 2013

of all patients with V-pattern exotropia who underwent

either of the above procedures and who had at least 12

months’ follow-up were retrospectively reviewed. Pre-

and post-operative visual acuity, pattern, strabismus and

stereoacuity were analyzed.

Results: There were a total of 28 patients in transposition

group and 40 patients in inferior oblique group. Successful

outcome was achieved in 19 (67.9%) patients in thetransposition group and 22 (55%) in the inferior oblique

group. Reduction of V-pattern was achieved in 24 (85.7%)

cases in the transposition group and 30 (75%) cases in

the inferior oblique group.

Conclusion: Both operations were effective in eliminating

V-pattern exotropia.




POSTERS

on this rare entity of relapsing migratory orbital myositis

would be discussed.

P30

Rare complication of a common oculardevelopmental anomaly: recurrentvitreous hemorrhage in a young adult

Shaheeda MOHAMED


We report on a young woman who presented with reduced

visual acuity and oaters. She was diagnosed with recurrent

episodes of spontaneous vitreous hemorrhage. Closer

examination revealed a white dot at the superonasalpart of the posterior lens capsule (Mittendorf dot, the

anterior attachment of the partly patent hyaloid artery).A thread-like mobile structure was seen posteriorly.The vitreous hemorrhage had occurred due to rupture

of a patent hyaloid artery. Tractional force on a freely

oating hyaloid artery may occur due to posterior vitreous

detachment or during rapid eye movements (REMs) such

as the REM phase of sleep. Fluorescein angiography,

ultrasonography and optical coherence tomography were

performed. A patent persistent hyaloid artery is a rare

cause of vitreous hemorrhage in healthy young people.

P31

Intra-operative adjuvant intravitrealtriamcinolone for combinedphacoemulsication and vitrectomyin patients with vitreous hemorrhagesecondary to age-related maculardegeneration

C. Y. MOK, Hilary K. TSANG, R. CHAN, N. YANG, C. K. HO, P. F. YIU

Department of Ophthalmology, Tuen Mun Hospital, Hong Kong

Objective: To describe the outcomes and complications

of intra-operative adjuvant intravitreal triamcinolone (4mg) for combined phacoemulsication, intraocular lens

implant and pars plana vitrectomy (phaco-vitrectomy)

in patients with vitreous hemorrhage (VH) secondary

to age-related macular degeneration (ARMD).

Methods: This was a retrospective case series of 18

eyes of 18 consecutive patients managed at the New

Territories West Cluster between January 2013 and

December 2014 and literature review.

Results: Baseline demographics would be described.

Postoperative outcome measures would be analyzedand discussed, including best-corrected visual acuity,

denitive diagnosis on uorescein angiogram andindocyanine green angiography, subsequent treatment

modalities (photodynamic therapy, intravitreal anti-

vascular endothelial growth factor, laser), re-bleeding

P28

Retinopathy of prematurity: applicabilityand compliance to screening guidelines inHong Kong

Abbie S. W. LUK, Henry H. W. LAU, Wilson W. K. YIP, Alvin L. YOUNGDepartment of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong

Objectives: Retinopathy of prematurity (ROP) is a

devastating complication in premature infants, with

local studies on compliance and effectiveness of current

screening guidelines for at-risk ROP neonates in Hong

Kong remaining scarce. This study aimed to analyze the

incidence, compliance to screening recommendations

and treatment of ROP in the newborn intensive care

unit of a tertiary referral center.

Methods: A retrospective review was performed forall premature neonates screened for ROP from 2007

to 2013 in our neonatal intensive care unit in Prince ofWales Hospital, Hong Kong, using the Royal College

of Ophthalmologists ROP screening guideline (2008).

Results: A total of 566 infants were screened, with the

incidence of ROP in 31.2% and type 1 ROP in 4.4%.

Overall adherence to screening criteria was 99.6% with

22.1% being screened earlier or later than the guidelines.

Comparison of differences between established screening

guidelines from China, USA and UK and the impact on

ROP in our population, subsequent management and

applicability of these screening guidelines would befurther analyzed and discussed.

P29

Relapsing migratory idiopathic orbitalmyositis involving superior obliquemuscle: a case report

C. Y. MAK, R. CHAN, C. L. LI, K. K. CHONG, Alvin L. YOUNG


A 17-year-old healthy Chinese female presented with

subacute left upper lid swelling, pain, proptosis andrestricted left eye movement. Computed tomography

showed isolated contrast-enhanced enlarged left lateral

rectus with tendon involvement. Levels of immune

markers were normal. Treated as orbital myositis with oral

prednisolone 1 mg/kg/day, her symptoms recurred when

prednisolone was tapered to 15 mg daily. Biopsy of the

lateral rectus muscle showed non-specic inammatory

changes. Two further episodes of relapses were noted 4

and 6 months later while patient was on oral prednisolone

and methotrexate. Disease remained quiescent for a year

after steroid and methotrexate were tapered off until she

developed pain, swelling over the contralateral eye with

acquired Brown syndrome on motility testing. Magneticresonance imaging showed contrast-enhanced diffuse

swelling of the right superior oblique muscle. The latest

outcome would be presented and brief literature review




POSTERS

correction. The clinical features, surgical techniques and

possible complications were discussed.

P34

A 9-tier triage system for vitreoretinalsurgeries: audit of idiopathic macular holesurgery waiting time

Gillian D. J. Y. SIU, Ernie C. F. LO, Alvin L. YOUNG


Kong, Prince of Wales and Alice Ho Miu Ling Nethersole Hospitals, Hong Kong

This study aimed to audit the waiting time for macular hole

surgery and its secondary outcomes. The recommended

operation waiting time for stage 2 to 4 macular hole

surgeries is within 6 months of onset of symptoms.

This audit reviewed the preoperative waiting time of

idiopathic macular holes from February 2011 to October

2012. The new 9-tier vitreoretinal operation listing system

was implemented and put into use in February 2014,

aiming to better prioritize and shorten the operationwaiting time for more sight-threatening vitreoretinaldiseases. A re-audit was conducted to review the macular

hole operation waiting time who had been listed since

February 2014 till December 2014.

There was a statistically signicant increase in proportion

of patients having their operation done by 6 months ofthe onset of symptoms after implementation of the 9-tier

listing system.

P35

Orbital liposarcoma: “common” raritywith diagnostic and managementchallenge

Nicole TSIM, Regine CHAN, C. L. LI, Alvin YOUNG, Kelvin CHONG

Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The

Chinese University of Hong Kong, Hong Kong

Reported as the commonest adult orbital sarcoma, orbital

liposarcoma is indeed extremely rare and often presented

with diagnostic and management challenge.

We report on a 55-year-old man who presented with left

eye gradual painless swelling for 6 months with proptosis,

hyperglobus, and limited abduction and elevation. Orbital

imaging demonstrated heterogeneous, inltrative lesion

of fat density. Incisional biopsy showed lipomatoustissue with foci of bro-myxoid stroma and muscularized

vessels surrounded by chronic inammatory inltrates,compatible with spindle cell lipoma. Final pathology

obtained after image-guided debulking showed low-to-intermediate grade liposarcoma. While oncological

rate and other complications (including elevation ofintraocular pressure and postoperative endophthalmitis).

Conclusion: Intra-operative adjuvant intravitreal

triamcinolone of 4 mg with combined phaco-vitrectomy

is a viable option as an interim measure to treat patients

with VH secondary to ARMD before denitive diagnosiscould be made.

P32

The efcacy of selective lasertrabeculoplasty to lower intraocularpressure: a case series

K. K. POON, W. Y. LEUNG, H. W. YUNG, P. F. YIU


Objectives: Tuen Mun Eye Centre has launched selectivelaser trabeculoplasty (SLT) service since July 2013 for

patients suffering from glaucoma. This retrospectivestudy aimed to examine the effect of SLT in lowering

intraocular pressure (IOP) and reducing the use of

medication in primary open-angle glaucoma, normal-

tension glaucoma and ocular hypertension.

Methods: Patient demographics, diagnosis, numberof medications used and IOP of patients who received

1 session of SLT from July 2013 to April 2015 were

documented. Post-SLT IOP and number of medications

were recorded at regular intervals.

Results: 97 eyes (left 47, right 50) were included. Patients’baseline mean IOP was 18 (± 5) mm Hg and number of

medications was 2.6 (± 0.86). There was no statistically

signicant decrease in the number of medications used

within 1 year after the application of SLT, but there was

a statistically signicant decrease of IOP 1 year after

laser that 17% (p<0.05) reduction of IOP was shown.

Conclusion: SLT potentially has a role to slow down

the progression of visual eld loss and to defer the need

to operate.

P33Lacrimal gland prolapse in a youngChinese woman

K. K. POON, Wendy LAM, S. K. IP, P. F. YIU


Lacrimal gland prolapse, being an uncommon disease

entity, is one of the differential diagnoses of chronic eyelid

swelling. Autoimmune, traumatic or degenerative processes

are proposed to be the etiologies. Despite its rarity,

missing the diagnosis before upper eyelid blepharoplasty

could lead to serious complications, resulting in ocularsurface problems and patient dissatisfaction. We report

an unusual occurrence of lacrimal gland prolapse in a

16-year-old Chinese woman that necessitated surgical




POSTERS

(28% of children and 24% of young adults respectively)

were noted to have various degrees of subconjunctival

bands / stricture limiting full adduction of the involved

eye. After lateral rectus recession was performed, there

was still extraocular movement restriction. Hence, the

conjunctival restriction was released in order to achievefull adduction. The patients were then followed up on

postoperative day 1 and 1 month.

Results: The mean preoperative angles were 38.5 ± 7.4

prism diopters of exotropia. The mean postoperative

angles were straight to 0.38 ± 3.3 prism diopters ofexo/esophoria. All patients did not require reoperation.

Conclusions: Conjunctival strictures in the form ofsubconjunctival bands are more common than expected

in primary pediatric strabismus cases. Satisfactory results

may not be achieved with muscle surgery unless such

restrictions are released.

P38

Idiopathic orbital inammatory diseasepresenting as acute euthyroid Graves’orbitopathy with bilateral dysthyroidoptic neuropathy: case report and reviewof literature

Karen WONG


Idiopathic orbital inammatory disease (IOID) is thesecond commonest orbital disorder and an important

differential diagnosis in euthyroid Graves’ orbitopathy

(EGO). Here we report a 41-year-old male chronic

smoker presenting with bilateral subacute swelling and

blurring without any systemic upset.

Pinhole vision were right eye 20/60 and left eye

20/50. He had bilateral subtle optic disc swelling,

proptosis, ophthalmoplegia, severe chemosis and exposure

keratopathy. Thyroid function was normal and orbital

computed tomography showed symmetrically enlarged

extraocular muscles without tendon involvement while

the lateral recti were most enlarged causing apical

compression. Serum thyroid-stimulating immunoglobulin

(Ig), IgG4 and other immune markers were normal.

His presumable bilateral EGO and dysthyroid opticneuropathy responded quickly with daily pulse steroid

but the inammatory orbitopathy recurred shortly on

drug tapering. Endoscopic-navigation biopsy of lateral

recti revealed lymphocytic myositis compatible withIOID. He was given a combination of weekly pulsesteroid, tapering dose of daily oral steroid and weekly

methotrexate without further recurrence.

referral suggested exenteration with postoperative

radiotherapy, the patient opted for serial clinical and

interval radiological surveillance.

While diagnosis of orbital liposarcoma is histological,

it should be considered in any inltrative orbital lesion.Limited by its rarity, treatments can only be based on

anecdotal reports and long-term prognosis is thus unknown.

P36

Parasitic lid mass

Kelvin H. N. WAN, Wendy P. F. LAM, S. K. IP, Evan P. F. YIU


Objective: To review the clinical presentations,

investigation results and intra-operative ndings ofpathologically conrmed parasitic eyelid infections.

Methods: This was a retrospective case series.

Results: Two males and 1 female presented with

insidious onset of unilateral subcutaneous lid masses

that required surgical excision. Dense adhesions to

surrounding subcutaneous tissues were encountered intra-

operatively during excisional biopsy. Specimens were

sent for pathologic analysis and revealed granulomatous

inammatory changes with the presence of parasitic

fragments and/or remnants. The exact species were not

identied. Eosinophil count and erythrocyte sedimentation

rate were mildly elevated and other systemic workupsfor parasitic infection were negative.

Conclusions: The diagnosis of an eyelid mass due to

parasitic infection is often unknown until excisional biopsy

is performed. This serves twofold as a diagnostic tool

and also as a denite treatment. Workup is important to

exclude systemic involvement, but it is often unremarkable.

P37

Subconjunctival bands in pediatric squintsurgery

E. WONG,1 E. TANG,2 K. LI2

1Department of Ophthalmology, Tseung Kwan O Hospital, Hong Kong 2Department of Ophthalmology, United Christian Hospital, Hong Kong

Objective: We report on 7 cases and 8 eyes in children

and young adults receiving primary squint surgery where

subconjunctival band lysis was required intra-operatively

in order to achieve full range of extraocular movement

after muscle surgery.

Methods: We reviewed all patients with intermittent

exotropia receiving primary surgical correction at the

Kowloon East Cluster from 1 January 2015 to 1 August2015 (25 cases, 33 eyes). Overall, 7 patients with a mean

age of 9.2 years (range, 18 months to 21 years) and 8 eyes




POSTERS

Conclusion: In this study, surgical intervention for

congenital glaucoma achieved high success rates, with

most patients requiring a single procedure for each eye

to achieve disease stability. Goniotomy was the most

common procedure performed, with a clear cornea and

essential prerequisite. No patients required long-termsystemic IOP-lowering therapy postoperatively.

P41

Review of treatment outcome of lamellarkeratoplasty in Kowloon West Cluster inyear 2012 to 2015

Macy M. S. WU, Amy L. WONG, W. K. WU


Over the last decade or so lamellar keratoplasty thattargets at replacement of diseased corneal layers has

become more prevalent worldwide, changing the practice

of conventional penetrating keratoplasty to various types

of lamellar keratoplasty depending on corneal pathology.

While thinner and more precise tissues are transplanted

with recent advancement in technology and surgicaltechniques, anterior lamellar keratoplasty that replaces

diseased corneal stroma and endothelial keratoplasty that

replaces diseased endothelium remain the most commonly

performed surgery. In this presentation, we review all the

patients with lamellar keratoplasty performed in Caritas

Medical Centre (Kowloon West Cluster, Hong Kong)from year 2012 to 2015. This includes deep anterior

lamellar keratoplasty, endothelial keratoplasty with or

without endothelium stripping of the recipient bed. We

aimed to evaluate the indications, treatment outcomes

including visual function, corneal graft status, central

corneal thickness, endothelial cell density, complications

and general patient satisfaction.

P42

Multimodal imaging of a case of

presumed topiramate retinopathy

Tiffany L. M. YEUNG, Patrick S. H. LI, Kenneth K. W. LI

Department of Ophthalmology, United Christian Hospital, Hong Kong

We report a case of peripheral pigmentary retinopathy and

visual eld loss during topiramate use for uncontrolled

seizure. Such ophthalmological side-effects have not been

well documented despite this drug being increasingly

used in the past 10 years. A 48-year-old female developed

blurred vision after 9 months of topiramate use. The

visual acuity of both eyes dropped from 1.2 to 0.7, with

bilateral diffuse pigmentary retinopathy and a constrictedvisual eld. Despite an improvement of visual acuity after

cessation of drug, the other ophthalmological effects of

topiramate persisted. The temporal relationship between

P39

Miller Fisher syndrome in an elderlypatient presenting with wall-eyed bilateralinternuclear ophthalmoplegia

Cherie Y. K. WONG,

1

Kendrick C. SHIH,

2

Jimmy S. M. LAI

2

1Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, The University of Hong Kong, Hong Kong

This is a case of Miller Fisher syndrome (MFS) in an

80-year-old woman who presented with a 3-day history of

dizziness and vertigo, and developed diplopia in bilateral

lateral gaze and ptosis. This was preceded by an episode

of upper respiratory tract infection. Cerebrospinal uid

analysis revealed elevated protein and serum anti-GQ1b

antibody was strongly positive. MFS is characterized by

acute onset of oculomotor dysfunction, ataxia and loss of

deep tendon reexes. Anti-GQ1b antibody activities are

associated with disease severity. Dense GQ1b gangliosidein oculomotor, trochlear and abducens nerves may explain

the classic symptom of ophthalmoplegia in MFS.

There is no difference in outcome of patients who

received immunomodulatory treatment and those who

did not. The prognosis of MFS is usually good, with a

mean recovery time of 10 weeks. This patient was treated

conservatively and regained all reexes and full ocular

movements without ptosis at 10 weeks.

P40

Outcomes after surgery for congenitalglaucoma: the 5-year experience at theUniversity of Hong Kong

Stephanie C. WOO,1 Kendrick C. SHIH,2 Jimmy S. M. LAI2

1Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 2Department of Ophthalmology, The University of Hong Kong, Hong Kong

Objective: To determine the treatment efcacy for

primary congenital glaucoma at the Department of

Ophthalmology, The University of Hong Kong overthe recent 5 years.

Methods: This was a retrospective study.

Results: A total of 5 pediatric patients with 9 eyes

were diagnosed with primary congenital glaucoma and

underwent surgical treatment during the study period.

Of them, 4 patients and 7 eyes underwent goniotomy

as the primary procedure while 1 patient and 2 eyes

underwent trabeculotomy as the primary procedure due

to poor anterior chamber view. The mean age on the day

of operation was 106 (range, 13-365) days after birth.

The mean preoperative intraocular pressure (IOP) was

27.4 mm Hg. Surgical success was noted in 3 out of 5

patients. For those without surgical success, 1 patientrequired additional goniotomy in both eyes and another

patient requiring additional trabeculotomy and then

further trabeculectomy with mitomycin C in both eyes.



POSTERS

of adjuvant therapy performed alongside with pterygium

excision, locality, postoperative complications, recurrence

rate under 1 year and over 1 year were recorded.

the initiation of topiramate and the visual disturbance

suggested that topiramate could be the cause of such

signs and symptoms. We are concerned about the possible

rare instances of this occurrence in future patients and

hence would like to propose a presumed correlation.

P43

Terson syndrome without neurologicalsymptoms: the rst reported case

L. T. YIP, C. H. HO, C. Y. KOO, T. C. KO


Any kind of intraocular hemorrhage in patients with

subarachnoid hemorrhage (SAH), traumatic brain injury

or intracerebral hemorrhage is described as Terson

syndrome (TS). Terson syndrome occurs in 12.1% to46% cases of SAH. All reported cases with TS had acute

neurological symptoms such as headache or alteredmental state, before or shortly after ocular symptoms.

We report a case of a 66-year-old woman presented with

left eye oaters. She has no acute headache, no focal

neurological signs and no history of trauma. Fundalexamination revealed bilateral retinal hemorrhage and

left vitreous hemorrhage. Computed tomographic brain

was normal while magnetic resonance imaging of the

brain revealed signals suggestive of prior SAH. To the

best of our knowledge, this is the only reported case

of TS with only eye symptoms. We will discuss thecharacteristic optical coherence tomography featuresof TS and the possible explanation for the absence of

neurologic symptoms in this case.

P44

A three-year retrospective study of thepterygium recurrence rates at the HongKong Eastern Cluster ophthalmologydepartments

Andrew KUKDepartment of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong

This was a 3-year retrospective study of the pterygium

recurrence rates at the Hong Kong Eastern Cluster

(HKEC) ophthalmology departments. Application ofmitomycin C and utilization of limbal conjunctival

autografts are recognized effective adjuvants in pterygium

excision surgery. These methods are practiced within

the 2 HKEC ophthalmology departments and this study

has been conducted to review the application of these

adjuvant therapies the recurrence rates of pterygia at

Documents

Hong Kong Ophthalmological Symposium 2015 Abstract Book