Sunday 3rd November


Sunday 3rd November 0645–0745

Bayer Breakfast Symposium Topic: First Year Of Clinical Experience with EYLEA in Australia Speakers: A/Prof Alex Hunyor, NSW Prof Paul Mitchell, NSW Dr Andrew Chang, NSW A/Prof Tony Kwan, QLD Dr Nitin Verma, TAS TBC Venue: City Hall, corner of Macquarie and Campbell Streets, Hobart




P01: The Australian Society of Ophthalmologists AGM


P02: The Ophthalmic Research Institute of Australia AGM


P03: The Royal Australian and New Zealand College of Ophthalmologists AGM


Morning Tea


L01: GLAUCOMA UPDATE LECTURE Prof Kuldev Singh Venue: Concert Hall Topic: Myths and Misconceptions Regarding Glaucoma Care Chair: Dr Catherine Green Synopsis: Over the past two decades, a series of large prospective, multicentre, randomized clinical trials conducted in North America and Europe have shed much light on the natural history of open angle glaucoma and the therapeutic benefit of intraocular pressure lowering for glaucomatous disease. The enormous volume of data from these studies has confirmed the benefits of existing therapeutic practices as well as led to novel diagnostic and treatment paradigms in glaucoma care. While such studies have undoubtedly moved our field forward, they have led to the propagation of a few myths and misconceptions regarding glaucoma care that will require further elucidation in the coming years. Examples of such myths include the belief that every mm Hg of IOP reduction is associated with a therapeutic benefit and that the relative importance of various IOP parameters such as mean, peak and variability as risk factors for glaucoma progression is well understood. Another area of glaucoma care that has been influenced by recent data is the role of cataract surgery as an IOP lowering procedure. A critical review of the literature reveals that not all conclusions from the landmark glaucoma clinical trials have withstood the test of time.


L02: COUNCIL LECTURE A/Prof Julian Rait Venue: Concert Hall Topic: Is patient experience the early warning system for patient safety? Chair: Dr Stephen Best Synopsis: Hoteliers, restaurateurs and performing artists have long been exposed to either praise or derision in the court of public opinion. Improved disclosure of information and online customer satisfaction ratings have made everything from travel planning to purchasing a car easier while allowing vendors to compete more effectively via higher quality products and/or better prices.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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Likewise, modern day healthcare is becoming more patient driven. Consequently patient feedback is increasingly being recognized as an integral part of cultivating a more positive experience of health care and may be a “smoke detector” for patient safety. Ophthalmologists have been fortunate to deliver technologies that have dramatically improved clinical outcomes over the past few decades. However, our patients no longer view great outcomes as a differentiator – they now expect these as the norm. In recent years, leading practices and hospitals in Australia have begun to focus more on providing an outstanding patient experience and on embedding this ethos into their organisational culture. Therefore being polite, helpful, courteous and kind is seen as the minimum level expected, and increasingly patients are speaking up about their care – both good and bad – via Facebook or Twitter. This lecture explores the disconcerting new world of online transparency and provides practical advice about to how to proactively manage your online reputation, cultivate positive patient feedback, and manage negative messages. Furthermore, the greater challenge of how to change culture and create a more caring and safety conscious environment will be explained. 1130–1300

P04: PLENARY College and Research “Highlights of Australian Research”: ORIA, RANZCO Eye Foundation and CPD Venue: Concert Hall Chairs: Prof David Mackey and Prof Peter McCluskey The Ophthalmic Research Institute of Australia (ORIA) Speakers and Topics: As this year is the 60th anniversary of the ORIA we are taking an historical slant with our presentation to the RANZCO Congress. We have searched our archives and come up with the names of researchers we have supported from the 1953–1983 period; 47 in total, after pulling out their post 1953 publications. We propose to describe the methodology of the research and show some historical pictures and documents. We have chosen some contemporary researchers in the same field as the ORIA funded researcher to give a 2–3 minute summary of the individual, 2–3 minute summary of their life’s work and then the remaining time on the ORIA papers. Prof Ted Maddess on behalf of Prof Peter Bishop A/Prof Angus Turner on behalf of Dame Ida Mann Dr Catherine Green on behalf of Dr Ronald Lowe Dr Alex Hewitt on behalf of Dr Geoffrey Harley AM Dr Penelope Allen on behalf of Prof Gerard Crock AO RANZCO Eye Foundation Speakers and Topics: Dr Mark Loane and Ms Jacinta Spurrett – Update CPD Speakers and Topics: Dr Peter Macken – Our CPD – What’s New




CONCURRENT SESSIONS S01: COURSE: Conquering Capsule Complications – A Video Primer Venue: Concert Hall Chair: David F Chang MD Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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Synopsis: Video cases will illustrate a spectrum of techniques for avoiding and managing anterior and posterior capsule complications: trypan blue dye, vitreous tap for crowded anterior chamber, torn continuous curvilinear capsulorrhexis (CCC) options, secondary CCC enlargement, capsule tear-out rescue technique, posterior CCC, CCC capture of the optic, early recognition of posterior chamber rupture, conversion from top/clear corneal incision to extracapsular cataract extraction, posterior polar cataracts, IOL fixation with torn anterior or posterior capsule, capsular tension ring and capsule hooks for weak zonules, small pupil/floppy iris strategies (hooks, Malyugin and other expansion rings), pars plana bimanual anterior vitrectomy (± triamcinolone), and Viscoat posterior-assisted levitation (PAL) + trap for descending nuclei. Objective: To use video cases to systematically review techniques of preventing, recognizing, and handling complications with either the capsulorrhexis or posterior capsule. Speakers: Prof John Grigg Dr Michael Goggin S02: SYMPOSIUM – Ocular Oncology Symposium Venue: Grand Ballroom 1 Chair: Dr Peter Hadden Outline: We will present a series of interesting cases that highlight important or controversial points in ocular oncology, followed by a group discussion and questions from the floor. This will be of interest to both subspecialists and general ophthalmologist who occasionally see such patients, so there will be a wide variety of presentations. Speakers: Dr Peter Hadden Dr Michael Giblin Prof Glen Gole Dr Adrian Fung and others TBC S03: COURSE – What’s New in the Management of Diabetic Retinopathy? Venue: Grand Ballroom 2 Chair: Prof Paul Mitchell Speakers & Topics: 1. Current systemic issues in diabetes and retinopathy – what you should know in 2013 – A/Prof Salmaan Al-Qureshi This will briefly summarise the findings from the DCCT, UKPDS, DIRECT, RASS, FIELD, ACCORD-Eye with implications for ophthalmologists in terms of advice we can provide patients and their doctors 2. How should we now classify diabetic retinopathy and diabetic macular oedema (DME)? – Prof Paul Mitchell This will briefly summarise the ETDRS, AAO and other classifications and the new approaches being developed to score or classify prognostic SD-OCT signs in DME 3. How and which DR/DME patients should we continue to treat with conventional laser?: What do newer technologies (pattern & micropulse laser, etc) add? – A/Prof Alex Harper This talk will emphasise the clinical decision making process for laser based on current evidence, how to incorporate FA findings, and how to monitor the results of laser, as well as the proposed new modalities with their limited trial data. It will also cover the morbidity of laser treatment. 4. Is there now a maturity in our understanding of the role for anti-VEGF therapy in diabetic macular oedema? When should you consider this approach, how should you apply and monitor the use of these drugs, and what are their limitations? – Prof Paul Mitchell This talk will summarise the most recent data from the key RCTs (RESOLVE, RESTORE, Protocol I and others, RISE/ RISE, READ 1, 2 & 3, BOLT, REVEAL, etc) to argue principally for an ‘as needed’ rather than fixed monthly dosing approach. It will cover SD-OCT and VA monitoring and the question of indications for re-treatment and for suspending therapy, as well as the morbidity of treatment. Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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The course will be very interactive, with a lot of photo examples, and will follow the growing evidence base on this topic, as illustrated in our Lancet Seminar from last year, and including all the new trial data, as below. It will be quite practically focused and will provide a good opportunity of questions and robust discussion. This has been the pattern in previous years. We will also distribute literature at the course. S04: RAPID FIRE PAPER SESSION – Glaucoma Venue: Grand Ballroom 3 Chairs: Prof Bill Morgan and Prof Robert Casson

0401 1. ANTERIOR SEGMENT IMAGING – AN INVALUABLE TOOL IN THE ASSESSMENT OF GLAUCOMA Roxana Ursea1, Ronald H. Silverman2 Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ, USA, 2Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA


Purpose: To better understand the etiology of glaucoma, clinical assessment of the anterior chamber angle is essential. Our goal was to review clinical applications of ultrasound biomicroscopy and optical coherence tomography for the assessment of the anterior segment in glaucoma. Method: A retrospective review of 30 patients (48 eyes) examined with ultrasound biomicroscopy (UBM) (Quantel, Clermont-Ferrand, France and/or Sonomed, Lake Success, NY) or the high-speed optical coherence tomography (OCT) (Visante™, Carl Zeiss Meditec) at the University of Arizona Department of Ophthalmology over a period of 18 months. UBM systems use frequencies ranging from approximately 35 to 50 MHz, providing axial resolution of approximately 30 microns. The time-domain Visante OCT system uses 1310 nm low-coherence, near-infrared light to provide detailed images of anterior segment structures with an 18 micron axial resolution. Our patients had various pathology including pigment dispersion syndrome, lens-induced glaucomas, ciliary block, iris and/or ciliary body cysts, anterior segment tumors and ocular trauma. Findings were determined and clinical relevance analyzed. Results: Both AS-OCT and the UBM provide tomographic images of the iridocorneal angle and iris and an objective, quantitative description of angle anatomy superior to the traditional methods such as gonioscopy exam and van Herick method. Anterior-chamber angle parameters measured by both techniques had similar reproducibility and sensitivity–specificity profiles. OCT is advantageous in allowing a noncontact exam and providing finer resolution. The UBM systems are superior for the visualization of retroiridal structures,

including ciliary body, posterior chamber and zonules, which can provide crucial diagnostic information for the assessment of glaucoma. UBM can offer information on the anatomy/pathology involving the anterior segment, including regions obscured by overlying optically opaque anatomic/pathologic structures. UBM was instrumental in understanding the pathophysiology of various forms of angle-closure glaucoma, such as pupillary block, plateau iris syndrome, malignant glaucoma, iridociliary cysts, peripheral anterior synechiae, supraciliary effusions. In certain cases UBM clarified the mechanism of increased IOP by showing the relationship between the peripheral iris and the trabecular meshwork. Conclusion: Anterior segment imaging has become an essential tool in glaucoma patients. Ultrasound provides real-time cross-sectional images in a very costeffective manner, even in the presence of optically opaque intervening structures. Both UBM and OCT supply detailed views of anterior segment anatomy. Precise quantitative evaluation of the anterior chamber angle structures associated with impaired outflow can help in diagnosis of various pathologies related to glaucoma, thus being a valuable tool in the management of these cases. 0402 2. AMPLITUDE OF RETINAL VENOUS PULSATIONS ARE ASSOCIATED WITH RETINAL NERVE FIBRE LAYER THICKNESS IN GLAUCOMA Golzan S. Mojtaba, Stuart Graham Macquarie University, NSW, Australia Purpose: To study the relationship between amplitude of spontaneous retinal venous pulsatility (SRVP) and retinal nerve fibre layer (RNFL) thickness in four regions (i.e. temporal-superior (TS), nasal-superior (NS), temporal-inferior (TI) and nasal-inferior (NI)) of glaucomatous eyes. Method: 40 glaucoma subjects were included (17 males, 67 ± 10 yrs). IOP was measured using Goldman tonometry. SRVP was measured using the Dynamic Vessel Analyser (DVA, Imedos, Germany) at four Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Sunday 3rd November regions within one disc diameter from the optic disc. This was followed by RNFL thickness measurement using the Spectralis (Heidelburg, Germany). The correlation between SRVP amplitude and RNFL thickness was assessed by means of linear and non-linear (i.e. logarithmic) regression. The slopes of linear regressions were compared using analysis of covariance (ANCOVA). Results: Larger SRVP amplitude was associated with thicker RNFL. The correlation coefficients of the nonlinear regression between RNFL and SRVP at TS, NS, TI and NI quadrants were r2 = 0.51, 0.57, 0.5 and 0.52 respectively. Mean SRVP amplitude and RNFL thickness for TS, NS, TI and NI quadrants were 3.9 ± 1.3, 2.8 ± 1, 4.6 ± 1.6, 2.7 ± 0.7 μm and 93 ± 28, 72 ± 24, 82 ± 37 and 83 ± 32 μm, respectively. The ANCOVA test showed that the slopes of linear regression between SRVP and RNFL at four regions were not significantly different (p > 0.05). Therefore, it is possible to calculate one slope for all the data. The pooled slope was16.7 (i.e. RNFL = 16.7SRVP + 23.1) Conclusion: While SRVP was present in all individuals, the amplitude of SRVP is altered in glaucoma. Our findings suggest degree of SRVP may be a marker for glaucoma severity.

0403 3. DIAGNOSING GLAUCOMA WITH AN IBOPAMINE CHALLENGE A/Prof John Landers1,2, Prof Jamie Craig1,2 1 Flinders Medical Centre, Adelaide, South Australia, 2 Flinders University, Adelaide, South Australia Purpose: To investigate novel techniques for assessing glaucoma suspects (GS) and predicting glaucoma progression using ibopamine, a topical drug which temporarily increases aqueous production. Normal eyes show no change, however those with glaucoma exhibit a rise in intraocular pressure (IOP). Those with rapidly progressive glaucoma (PG) worsening may show a greater increase in optic cup volume (OCV) with elevated IOP. Methods: POAG patients were recruited through glaucoma clinics at the Flinders Medical Centre (n = 60)(24 GS, 24 with stable glaucoma (SG), and 12 PG). Patients underwent IOP measurement and OCV assessment using optical coherence tomography. Two drops of Ibopamine 2% solution was instilled into the study eye of each patient. After 45 minutes, IOP and OCV were re-assessed. Changes from baseline were determined and compared between groups. Results: IOP at baseline was similar between the groups, but following the ibopamine challenge, IOP increased by 1.9 mmHg for GS patients, 4.9 mmHg Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

11 for SG patients (P = 0.003) and 8.3 mmHg for PG patients (P < 0.0001). Compared with baseline measurements, OCV increased by 0.2% for GS patients, 0.6% for SG patients and 5.5% for PG patients. This was not significantly different between GS patients and SG patients (P = 0.75), however it was significantly different between GS patients and PG patients (P < 0.0001), and between SG patients and PG patients (P = 0.001). Conclusion: GS patients may be differentiated from those with manifest glaucoma by their IOP response to an ibopamine challenge. SG may be differentiated from PG patients by their change in OCV following an ibopamine challenge. These promising results need replication and longitudinal follow-up to establish the ability of an ibopamine challenge to predict who might develop glaucoma and who might progress towards blindness.

0404 4. THE RISE OF INTRAOCULAR PRESSURE IN A CAFFEINE TEST VERSUS THE WATER DRINKING TEST IN PATIENTS WITH GLAUCOMA Tuan Tran1, Nuwan Niyaduropola2, Jeremy O’Connor2, Ghee Soon Ang2, Jonathan Crowston2, Dan Nguyen2 1 Sydney Eye Hospital, Sydney, NSW, Australia, 2 Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia Purpose: There is increasing emphasis on the importance of intraocular pressure (IOP) peaks and fluctuation as risk factors for glaucoma progression. It is well recognised that ingesting significant volumes of water as in the water drinking test (WDT) raises IOP and reasonable evidence that caffeine can also raise IOP. The aim of this study is to directly compare the effect of a caffeine test (CT) to that of the WDT on IOP in patients with glaucoma. Methods: Prospective, observer-masked, crossover study of 14 eyes of 14 medically treated patients with primary open angle glaucoma. Patients were initially randomised to either CT or WDT. IOP was measured in both eyes with a Goldmann applanation tonometer at baseline before the test, and after the test, for every 15 minutes for 1 hour by a masked examiner. This was repeated the following week at the same time of day for the other test (the crossover). Peak and fluctuation of IOP were compared between groups using the paired t-test. Results: The maximum IOP obtained by the WDT (19.7 ± 4.1) was greater than the CT (16.7 ± 4.1); and showed greater fluctuation in IOP (4.3 ± 2.7 mmHg [27.7%] p < 0.0001) compared to the CT (1.8 ± 1.9 mmHg [11.7%]); p = 0.004).

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12 Conclusion: The mean rise in IOP was greater with the WDT than the CT. Intake of a 100 mg caffeinated beverage does not appear to provide an alternative for patients unable to tolerate the WDT. 0405 5. ASSESSMENT OF PHOTOGRAPHIC DISC HAEMORRHAGE AND IMPACT ON CLINICAL DIAGNOSIS OF GLAUCOMA Bob Z Wang1,2, Surinder S Pandav2,3, Yu Xiang G Kong1,2, Jessica F Brennan2, Michael A Coote1,2, Jonathan G Crowston1,2 1 Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia, 2Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC, Australia, 3Advanced Eye Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India Purpose: To examine how the presence of a disc haemorrhage on optic disc photographs influences the likelihood of optometrists and glaucoma subspecialists diagnosing glaucoma. Methods: Three disc photographs within the glaucoma optic neuropathy evaluation project were of the same eye, with the difference being the presence of a disc haemorrhage (Disc H), a resolving disc haemorrhage (Disc RH) or a resolved disc haemorrhage (Disc R). Analysis of optometrist and subspecialist responses to nine topographic features and their assessment of glaucoma likelihood were undertaken for the three discs. Results: Twenty-two glaucoma subspecialists and 259 optometrists completed this prospective observational study. There was no statistical difference between optometrists and glaucoma subspecialists in the identification of disc haemorrhage and rim loss for all three discs (P > 0.05), but there were differences in the identification of retinal nerve fibre layer loss for Disc H (P = 0.015) and Disc R (p < 0.001). There were also differences between optometrists and subspecialists in the assessment of glaucoma likelihood for all three discs (P < 0.001). 84.46%, 65.22% and 20.54% of optometrists and 95.45%, 90.91% and 81.82% of subspecialists assessed Discs H, RH and R respectively as being ‘probable’ or ‘certain’ for glaucoma. The reduction in accurate glaucoma diagnosis with disappearance of disc haemorrhage was significant for optometrists but not for glaucoma subspecialists. Conclusion: Although optometrists and glaucoma subspecialists had similar accuracy in the detection of a disc haemorrhage, assimilation of the clinical signs to formulate an accurate diagnosis of glaucoma was substantially lower by optometrists once the disc haemorrhage had resolved.

0406 6. ANTERIOR SEGMENT SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY (OCT) ANALYSIS OF BLEB MORPHOLOGY FOLLOWING DEEP SCLERECTOMY VERSES TRABECULECTOMY J Lam1 (Presenter), Colin I Clement1,2,3 1 Wyong Eye Surgery, Wyong, NSW, 2Sydney Eye Hospital, Sydney NSW 2000, 3Central Clinical School, The University of Sydney, NSW Purpose: To investigate the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy using anterior segment spectral-domain optical coherence tomography (OCT). Methods: Eyes from consecutive patients with glaucoma that underwent primary trabeculectomy (n = 15) or deep sclerectomy (n = 13) between January 2012 and March 2013 by a single surgeon (CC) were prospectively enrolled. At the 3 month post-operative visit, all blebs were graded using the Indiana Bleb Grading Scale (IBGS) and imaged using OCT. Outcome measures on OCT included bleb height, bleb cavity, intra-conjunctival cysts and presence of posterior flow. Results: Three months following surgery, mean IOP reduced from 26.4 +/− 10.4 mmHg to 12.0 +/− 4.8 mmHg following deep sclerectomy and 21.3 +/− 11.9 mmHg to 6.4 +/− 3.9 mmHg following trabeculectomy. Grading using the IBGS revealed deep sclerectomy was associated with shallower (1.3 v 2.0, p < 0.01), narrower (1.77 v 2.53, p < 0.01) and more vascular blebs (2.13 v 1.53, p < 0.01) compared to trabeculectomy. On OCT, deep sclerectomy blebs were shallower (95.3 v 318.4 microns, p < 0.01) and less likely to contain a bleb cavity (p < 0.01), contain intraconjunctival cysts (p < 0.01) or demonstrate posterior flow (p < 0.01). There was a trend towards a thinner conjunctiva/tenon’s membrane following deep sclerectomy (224.6 v 299.1 microns, p = 0.09). Conclusions: Clinical grading and anterior segment OCT shows bleb morphology following deep sclerectomy differs from trabeculectomy.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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Emmanuelle Souzeau , Kathryn Burdon , Bronwyn Ridge1, Andrew Dubowsky2, Jamie Craig1 1 Flinders University, Flinders Medical Centre, Adelaide, Australia, 2SA Pathology, Flinders Medical Centre, Adelaide, Australia Purpose: The Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG) has established a biobank of severe glaucoma cases to identify novel genetic risk factors for the worst glaucoma outcomes, and to establish genetic testing protocols for known glaucoma genes. Methods: Advanced Open-Angle Glaucoma (OAG) cases defined by central visual field loss or severe peripheral vision loss were recruited. Secondary glaucoma cases were also recruited regardless of severity. Cases with advanced glaucoma and Primary Congenital Glaucoma (PCG) were tested in an accredited pathology laboratory by direct DNA sequencing for known glaucoma genes, Myocilin and CYP1B1 respectively, and results were provided back to the participants with the provision of genetic counseling. Cascade genetic testing was made available for relatives of participants with pathogenic mutations in these genes when clinically relevant. Results: 1615 participants with severe OAG and 963 with other glaucoma subtypes have been recruited. Using genome-wide association studies, new glaucoma risk alleles were identified: TMCO1 and CDKN2BAS1. Myocilin mutations were identified in 4.2% of advanced primary OAG individuals, compared with 1.6% in non-advanced individuals. CYP1B1 mutations were found in 18% of PCG cases. Cascade genetic testing has identified highly penetrant Myocilin mutations in as yet asymptomatic individuals. The experience of tested asymptomatic individuals has been evaluated to help health professionals in providing better support to patients. Conclusion: The ANZRAG provides a comprehensive approach to reducing glaucoma blindness by unraveling the genetic complexity of glaucoma, providing accredited genetic testing and genetic counseling, and translating research findings in better clinical care.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Surinder S Pandav1, Craig M Ross2, Dan Q Nguyen2, Yu Q Li2, Jonathan G Crowston2, Michael A Coote2 1 Advanced Eye Center, Postgraduate Institute of Medical Education & Research, India, 2Centre for Eye Research Australia & Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia Purpose: Intraocular Pressure control following a Glaucoma Drainage Device implantation depends on the porosity of the fibrous capsule that forms around the device. We have previously described a method to measure porosity of the capsule in rabbit eyes. Purpose of this paper is to report further improvements in measuring porosity of the capsule using a novel system made of a new implant with two tubes connected to a pressure gaited syringe pump system. Method: The new implant was designed on CAD and printed on a 3D printer. The implant was made of proprietary polyurethane, silicone elastomer. Implant was similar to pediatric Molteno Implant in appearance and dimensions, except that it had two silicone tubes attached to it. The implant was placed in the supero-temporal quadrant under the conjunctiva in 10 New Zealand white rabbit eyes. One of the silicone tubes was inserted in the anterior chamber (AC). The second tube was plugged and kept buried under the conjunctiva in the supero-nasal quadrant. After one week (5 rabbits) and 4 weeks (5 rabbits), the tube connected to AC was ligated with a 6-0 vicryl suture. The second tune was dissected out and connected to a pressure gated syringe pump system to measure the fluid egress per minute through the capsule at a constant pressure of 12 mmHg. For comparison, in another set of 5 rabbits, pediatric Molteno Implant was inserted in the supero-nasal quadrant. The tube was not connected to the AC. Porosity of the capsule was measured at 4 weeks as described above. Results: In the new implant, the mean flow through the capsule was 2.46 +/− 0.8 micro-liters/min at one week following implantation. At 4 weeks the flow significantly reduced to 0.67 +/− 0.16 micro liters/ min (p < 0.01, t-test). The Molteno Implant group had a mean flow of 4.52 +/− 1.16 micro-liters/min. The capsular porosity was significantly reduced in the new implant at one week and 4 weeks as compared to the Molteno implant (p < 0.04, ANOVA) The system worked without any problems and was much easier to implement than the system described previously. Conclusion: The new system functioned well and the measurements were reproducible. It provides a new

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14 model to test the effect of glaucoma drainage devices (new materials/designs) on capsular porosity.

0409 9. GENDER AND INHERITANCE IN ADVANCED GLAUCOMA CASES – AUSTRALIAN & NEW ZEALAND REGISTRY OF ADVANCED GLAUCOMA DATA Jude Fitzgerald, John Law, Bronwyn Ridge, Emmanuelle Souzeau, Jamie Craig Department of Ophthalmology, Flinders University, Adelaide, SA, Australia Purpose: To examine gender differences and maternal/ paternal inheritance in advanced glaucoma patients from ANZRAG – Australian and New Zealand Registry of Advanced Glaucoma. Method: Advanced primary open angle glaucoma patients recruited to ANZRAG, were identified. Gender, presence of family history and lineage of inheritance up to second degree relative were identified. Sub-analysis performed for PXF patients, high tension (HTG) and normal tension (NTG), defining NTG as highest recorded IOP ≤ 21 mmHg. Results: 1275 advanced POAG cases (753 HTG, 522 NTG) and 401 PXF cases were used. No gender difference was seen in advanced glaucoma cases, however nearly two-thirds of PXF patients (63%) were female. The HTG group showed a higher proportion of males, 394 cases (52.3%), whereas the NTG group, showed female cases were predominant, 292 cases (55.9%). 60.3% of cases reported positive family history, with 417 patients able to identify paternal or maternal inheritance. Maternal inheritance was present in 58.8% of cases, and paternal inheritance 41.2%. A similar difference was seen for PXF, NTG and HTG subgroups. In 49 cases where both parent and offspring were enrolled in ANZRAG, the increased inheritance from the maternal side (59.2%) remained. Conclusion: Gender analysis showed an increased prevalence of females in PXF cases and in advanced glaucoma with normal tension, with males more predominant in high tension cases. A difference in maternal/paternal inheritance of similar magnitude across all investigated subtypes of glaucoma was seen, including in a subgroup in which reporting bias is removed by enrolment in ANZRAG of two generations.

0410 10. INCIDENCE OF COMPLICATIONS FROM CHRONIC HYPOTONY FOLLOWING GLAUCOMA SURGERY Steven Yun1, Brian Chua1,2,3, Colin I Clement1,2 Sydney Eye Hospital, Sydney, NSW, Australia, 2 Central Clinical School, The University of Sydney, 3 School of Advanced Medicine, Macquarie University, Sydney


Purpose: Hypotony may be defined as an intraocular pressure (IOP) less than 6 mmHg. It is used as a definition of failure in glaucoma surgical trials and is associated with sight threatening complications such as choroidal effusion and hypotensive maculopathy. However, some eyes maintain an IOP < 6 mmHg without sequelae and with normal vision. Therefore this study aimed to measure the incidence of complications from hypotony following glaucoma surgery. Method: This retrospective case-control study compared 19 eyes with chronic hypotony (IOP < 6 mmHg) to 19 eyes without hypotony (IOP > 5 mmHg) 3 or more months post glaucoma surgery. Cases were identified from a database of 2 surgeons from 2010 to 2013. Outcomes included visual acuity, visual field indices (mean deviation, pattern deviation), refractive change, presence of choroidal effusion, hypotensive maculopathy and cataract progression. Results: Hypotony and control eyes showed no difference in baseline characteristics. Reduced visual acuity (>2 lines from baseline) occurred in 8 hypotony eyes and 3 control eyes (p = 0.074). Choroidal effusion (p = 0.15), maculopathy (p = 0.07) and cataract progression (p = 0.21) occurred more frequently in the hypotony eyes but the difference did not reach statistical significance. Seven of 19 hypotony eyes (36.8%) had no complications. Conclusions: Sight threatening complications including choroidal effusion, maculopathy and cataract progression have a higher incidence in eyes with chronic hypotony following glaucoma surgery. However, not all eyes with chronic hypotony develop sight threatening complications. Hypotony as a definition of glaucoma surgery failure may over estimate failure rates.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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Keith Ong1, Leonard Ong2, Lillian Beatrice Ong3 University of Sydney, Sydney, NSW, Australia, 2 Macquarie University, Sydney, NSW, Australia, 3 University of NSW, Sydney, NSW, Australia


Purpose: Whitish spots are sometimes noted in the corneal endothelium after Selective Laser Trabeculoplasty (SLT). To evaluate the corneal endothelium after SLT, corneal specular microscopy was performed. Method: 142 eyes with open angle glaucoma which had SLT in the period of 9 months (February to November 2012), had corneal specular microscopy before and after SLT. Results: Dark spots in the corneal endothelium on corneal specular microscopy immediately after SLT were evaluated. 71 of the 142 eyes had no significant dark spots or increase in dark spots after SLT. 37 of the 142 eyes showed few dark spots after SLT. 34 of the 142 eyes showed numerous dark spots after SLT on specular microscopy photographs, which resolved by one month. This last group had the greatest decrease in the corneal endothelial cell count at one month postSLT, but this was not statistically significant in this study (P = 0.1). Conclusion: The corneal endothelial abnormalities after SLT shown in this study may be transient, and long term effects are probably negligible in normal corneas or single treatments. However, in corneas with reduced transparency of the endothelium such as compromised corneas and corneas with pigment deposits on the endothelium, there may be a risk of further corneal endothelial compromise especially after repeated SLT. Larger and longer term studies with histopathologic evaluation would be useful. Until further studies are done, it would be wise to minimise the number and energy of SLT laser shots.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Kate Leahy1, Maria Sarris2, Nick Di Girolamo2, Stephanie Watson3, Peter McCluskey3, Andrew White1,3,4 1 Department of Ophthalmology, Westmead Hospital, NSW, Australia, 2School of Medical Sciences, The University of New South Wales, NSW, Australia, 3Save Sight Institute, University of Sydney, NSW, Australia, 4 Westmead Millennium Institute, University of Sydney, NSW, Australia Purpose: Subtle changes in the corneal endothelium have been described immediately post selective laser trabeculoplasty (SLT) treatment. The purpose of this study was to further characterize these changes. Method: Confocal microscopy imaging of human cadaveric donor corneas mounted on an artificial anterior chamber (n = 3) in response to direct application of laser, dilute blood (10%), or a weak peroxide solution (1 mM) was undertaken to mimic potential conditions which describe the clinical finding. Additional cadaveric corneas (n = 4) were mounted in an artificial anterior chamber and were treated with 120 shots 0.9 mJ SLT using a Nd:YAG laser (Ellex Tango, Adelaide) around 360 degrees of the peripheral cornea with a Latina SLT lens or used as controls. Immunofluorescent staining for gap junctions (ZO-1) and cellular morphology staining (H&E) in response to this treatment was carried out. Results: Direct laser produced a circular region of endothelial destruction surrounded by increased endothelial blebs. A different cornea exposed to blood showed increased reflectivity indicative of protein deposition. The cornea exposed to weak peroxide showed widening of intercellular spaces. Immunofluorescent staining was used to identify changes at the level of the endothelial gap junction in response to laser treatment. Conclusion: The endothelial changes we have observed with SLT can be mimicked with a combination of weak blood solution and dilute hydrogen peroxide. We hypothesize that protein deposition and changes in the gap junctions between endothelial cells are responsible for these findings.

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16 1530–1600

Afternoon Tea


CONCURRENT SESSIONS S05: SYMPOSIUM – The Private Practice Life Cycle and Generational Change Venue: Concert Hall Chair: Dr Stephen Best / Dr Brad Horsburgh The Federal RANZCO Board recognise the need for professional practice management education to be incorporated into the Annual Scientific Congress. Ethical practice management education is essential to ophthalmology’s long-term growth and viability in an ever-changing healthcare industry. The recognition of different business imperatives at different stages of an ophthalmologist’s career, is key to enabling private ophthalmology to prosper. At the core, there must be an understanding of the natural private practice life cycle and a tacit understanding of the issues involved in successful succession planning. Dr Brad Horsburgh – The natural life cycle of private practice Summary of ASO practice costs study as they apply to private practice. Presentation of natural life cycle of private practice, including external factors such as divorce, practice breakup, technology paradigms shifts. Dr Christine Younan – “Expectations and aspirations for private practice” Expectations of younger ophthalmologists. Which styles of practice and practice environments are key? Gen Y “Worklife balance” – What does this mean? Dr Ben Fleming – “Starting a new practice” Successes and pitfalls associated with starting an autonomous practice Dr Andrea Vincent – “Joining an established practice” Was it easy to adopt the “culture” of the established practice? Perceived benefits/drawbacks of working with others? Drs Frank Cheok, Frank Bors, Bill Barnett – “Successful succession planning and transition to retirement” What are the characteristics and personality traits of the incoming and incumbent ophthalmologists which made this transition successful? How did we overcome hurdles along the way to enable the new ophthalmologist and retiring incumbent to successfully cooperate? Panel of six speakers with questions from the floor. S06: SYMPOSIUM – Corneal Clinical Update (+ The Green Practice) Venue: Grand Ballroom 1 Moderator: Dr Michael Loughnan Aim: To update general and non-corneal subspecialist ophthalmologists on recent advances in the management of common anterior segment diseases. Format: A series of short presentations over 90 minutes focusing on issues relevant to non-corneal specialists including when to refer, indications for treatment and outcomes. Faculty members would present for 12 minutes each allowing for 3 minutes for questions. Faculty: Anterior segment subspecialists drawn from the RANZCO Corneal SIG Speakers & Topics: Non-graft surgical treatment of keratoconus Dr Dermot Cassidy Lamellar corneal grafts Dr Jacqueline Beltz Treatment protocol for CIN/OSSN A/Prof Richard Mills Treating corneal neovascularisation Dr Con Petsoglou Oral acyclovir for HSK A/Prof Mark Daniell Greening your practice Dr Michael Loughnan Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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S07: TBA S08: RAPID FIRE PAPER SESSION – Retina Venue: Grand Ballroom 3 Chairs: Dr Heather Mack and Dr Anthony Kwan S09: RAPID FIRE PAPER SESSION – Oculoplastics / Neuro-ophthalmology Venue: Chancellor 6 Chairs: Dr Tom Hardy and Dr Simon Dean

0801 1. POST TRANSLATIONALLY MODIFIED COMPLEMENT FACTOR H IN AGE RELATED MACULAR DEGENERATION Matthew Krilis1, Qi Mao2, Michele Madigan1, Jason Wong3, Mahmoud Abulatti2, Robyn Guymer4, Peter McCluskey1, Peng Zhang2, Jian Qi2, Steven Krilis2, Bill Giannakopoulos2 1 Save Sight Institute, University of Sydney, NSW, Australia, 2Department of Immunology and Infectious Diseases, St George Hospital, UNSW, Australia, 3Lowy Medical Research Institute, University of NSW, Australia, 4Centre for Eye Research Australia, University of Melbourne, Australia Purpose: A genetic variant of complement factor H (CFH) tyrosine mutated to a histidine on domain 7 is strongly associated with risk of developing agerelated macular degeneration (AMD). In view of the increased oxidative stress in patients with AMD we hypothesized that post-translational redox modifications to CFH at the tyrosine residues may arise and disrupt CFH’s biologic protective function, thus contributing to AMD pathogenesis. Method: CFH was nitrated in-vitro and a specific ELISA was developed to assay human plasma for nitrated(n)CFH. Nitrated tyrosines were identified using mass spectrometry. Nitrated CFH was assessed in vitro in binding and functional complement assays. The effect of nCFH on the release of IL-8 was assessed in vitro with activated human macrophages. Confocal microscopy with specific antibodies to CFH and nitrated tyrosines were used with human retina from 3 patients with AMD. Results: CFH was nitrated in Domains 7 and 20, the two modules that are critical in binding to oxidised proteins. nCFH did not bind nor inactivate complement. Secretion of IL-8 has been proposed to be important in the inflammation that occurs in AMD. IL-8 secretion was significantly potentiated when nCFH was added to activated human monocytes. Nitrated CFH was present in the plasma and retina of patients with AMD. Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Conclusion: Nitration of CFH abolishes its complement regulatory function. We propose that nitrated CFH is an important risk factor for developing and progressing to late stage AMD. Preventing the formation of nCFH using free radical scavengers may be a possible therapeutic approach in this very important disorder.

0802 2. MAIA MICROPERIMETRY IN RETINAL PRACTICE-EARLY EXPERIENCE Heather G Mack1, Wilson J Heriot1,2 Eye Surgery Associates, Melbourne, VIC, Australia, 2 Centre for Eye Research, University of Melbourne, Melbourne, VIC, Australia


Purpose: To describe early results using microperimetry in retinal practice Method: Retrospective review of records of patients who had microperimetry (Macular Integrity Assessment, MAIA, Center Vue, Padova, Italy) using the ‘expert’ algorithm. Results: Records of 46 eyes of 32 patients who had unexplained visual symptoms or baseline testing of known abnormalities were reviewed. Patients were median age 73 years (range 26–91), and 59% (19) female. Median vision was 75 logMAR letters (6/9.6, range 6/3.8 to 6/48). Four clinical patterns were seen: focal scotomata (3–18 contiguous abnormal points on the interpolated map, 17 eyes); reduced average threshold (0–27 dB) with stable fixation (15 eyes); reduced average threshold (0–27 dB) with relatively unstable or unstable fixation (10 eyes); and normal average threshold (27–36 dB), with stable fixation and normal macular integrity index (4 eyes). Conclusions: Patterns of microperimetry abnormality are useful in understanding unexplained visual symptoms. Microperimetry results are subject to poor test performance. Further studies of MAIA microperimetry in retinal practice, including normal subjects, will be useful.

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Matthew G Crabb, Devaraj Supramaniam, Jodi Glading, Georgia Kaidonis, Miriam Keane, Sudha Cugati, Tim Hsu, Stewart Lake, Niladri Saha, John Landers, Jamie Craig Flinders Hospital, Department of Ophthalmology, Bedford Park, SA, Australia Purpose: Intravitreal injections represent an effective method for delivering anti-vascular endothelial growth factor directly into the posterior segment. Within the literature and at Flinders Medical Centre a range of anaesthetic techniques are employed, with varying quoted efficacy. Method: A single centre, blinded, randomised 12 week prospective study. Patients received either a standardised pledget or sub-conjunctival injection (SCI) anaesthetic. A Visual Analog Scale was utilised immediately after and 24 hours post intravitreal injection to measure pain. Injections were performed by 4 senior ophthalmologists. Results: 112 eyes from 109 patients were included in the study (46% female, 54% male). Patients were treated for ARMD (75%), CRVO (14%), Diabetic disease (8%), and other (3%). 59% of patients received Bevacizumab, 12% Ranibizumab and 29% Aflibercept. The median pain score immediately following intravitreal injection was1.0 (range 0–8.0) for the SCI group and 2.5 (0–8.0) for pledget (Mann-Whitney, U = 1063, z = −2.97, p = 0.003, r = .28). This remained significant after adjustments for sex, previous anaesthetic type, number of previous injections and injector. Median Pain score at 24 hour follow up was 1.0 (0–10) for the SCI group and 0.0 (0–10) for pledget (MannWhitney, U = 1292, z = −1.553 p = 0.12, r = 0.147). This remained non-significant when correcting for the above confounders. Conclusion: Subjective pain immediately after injection was found to be significantly reduced with the use of the SCI anaesthetic technique (medium effect). This was independent of the injector, the number of previous injections and usual anaesthetic. At 24 hours no statistical difference in pain was demonstrated, however it may be as high as 10.

Wijeyanthy Wijeyakumar1,2,3, Thomas Hong1,2, Geoffrey K Broadhead1,2,3, Haitao Li1, Meidong Zhu2,3, Andrew A Chang1,2,3 1 Sydney Retina Clinic & Day Surgery, Sydney, Australia, 2Sydney Institute of Vision Science, Sydney, Australia, 3Save Sight Institute, The University of Sydney, Sydney, Australia Purpose: To assess the impact of intravitreal Aflibercept on vision-related quality of life (VR-QoL) in patients with refractory neovascular age-related macular degeneration (nAMD) over 6 months. Method: 49 patients with refractory nAMD who were previously treated with anti-vascular growth factor therapy were treated with Aflibercept as part of a prospective study over 6 months. Full ophthalmic examination including best corrected visual acuity (BCVA), central macular thickness (CMT) assessed by spectral domain optical coherence tomography (SDOCT), and VR-QoL measured with the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ- 25) were performed at baseline and 6 months. VR-QoL subscales assessed a range of vision function including near and distance activities, mental health, driving, and social functioning. Change in NEI VFQ-25 scores and correlations with BCVA and CMT were analysed. Results: BCVA improved and CMT was reduced significantly with a mean improvement of 6.9 letters and a decrease of 89.4 μm in CMT at 6 month (p < 0.001). Overall NEI-VFQ25 composite scores improved at 6 months compared to baseline (73.45 versus 70.25, p = 0.004). All subscales except for general health showed an improvement after 6 months. Social functioning, mental health, near and distance activities all showed a significant improvement (p < 0.05). No correlations were observed between changes in NEI VFQ25 and changes in BCVA or CMT. Conclusion: Overall vision-related quality of life improved following Aflibercept treatment over 6 months compared to baseline; however this did not correlate with changes in BCVA or CMT.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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Thiran Jayasundera Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA Purpose: To develop a method for quantitative fundus autofluorescence (FAF) image analysis that is capable of selectively measuring changes in AMD while accounting for variable image acquisition conditions such as gain, noise, contrast, and camera movement. Method: Digital files of Heidelberg Spectralis FAF images taken of normal and nonexudative AMD eyes were analyzed (42 FAF images divided into time elapsed sequences of 2 or 3 images).These images showed no disease related change over time, and therefore were meant to be tested as controls for our method. For each pair of images, a region encompassing the macula was defined and divided into a grid of 50 by 50 grid boxes after images were co-registered and pre-processed to eliminate camera variables. Co-registration involved the automatic detection of control points between images and an affine transformation approximated by a Random Sample Consensus (RANSAC) algorithm. Pre-processing involved Gaussian filtering coupled with pixel mapping via linear regression and gamma scaling. A pairwise comparison of 2 regions was performed using a modified difference of squares method. Squared differences between mean pixel values within grid boxes that surpassed thresholds for changes in hyper-fluorescence and hypofluorescence generated a single quantitative value, the macular autofluorescence quantification value (MAQ). Results: Pairwise comparisons of the control FAF images taken of the same subjects at different times yielded an average MAQ score of 141. Visuals showing what the algorithm identified as disease related changes showed very little disease detection. This demonstrated the utility of the method for identifying clinically meaningful changes, with an MAQ of around 150 being a possible baseline. In further studies of images showing actual disease progression over time, average MAQs were found to be in the thousands. Conclusions and Relevance: The MAQ method applied to FAF digital files can quantify changes in AMD and may be useful for selectively identifying AMD progression as distinct from changes due to image acquisition conditions.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Wilson J Heriot1,2, Justine Wilks1, Rachel L McIntosh2, Sophie L Rogers2 1 Eye Surgery Associates, Melbourne, VIC, Australia, 2 Centre for Eye Research Australia, Melbourne, VIC, Australia Purpose: To identify optimal IOL characteristics for combined cataract and vitrectomy patients. We examined whether there was a significant difference between the target refractive outcome and the actual postoperative refractive outcome in 2 patient groups where the IOL power was selected either using standard axial length (AL) readings or following manual AL adjustment for the potential shortening effect from epiretinal membrane and macula thickening. Method: Retrospective audit of patients’ medical charts was undertaken for patients who underwent combined vitrectomy and cataract surgery and did not have the IOL Master AL adjusted. Data was collected for patients where the AL was adjusted for the potential shortening by adding OCT measured macular thickness beyond the normal ∼200 u. Variables of interest were assessed for normality and nonparametric statistics were undertaken as needed. Target DS and postsurgical DS were compared using the Wilcoxon matched-pairs signed-ranks test for equality. Magnitude and direction of any differences was quantified using the mean (95%CI) or median (interquartile range – IQR) of the difference, as appropriate. Results: Data was collected for 161 eyes undergoing combined vitrectomy and phacoemulsificationintraocular lens insertion and no adjustment for AL and for an additional 47 eyes where the axial length was manually adjusted based on macular thickness on OCT. There was no significant difference between target spherical refractive outcome and actual post-op spherical refractive outcome after manual AL adjustment with the mean difference between target and postop spherical component being +0.05 DS (p = 0.593). Target refraction and actual post-op refraction however, differed significantly in the non-adjusted eyes with a mean difference of −0.17 DS (p =< 0.001) and a significant difference was also seen between the two groups (p = 0.013). The target spherical refraction using the lens selected after manual AL adjustment and the target spherical refraction using the lens selected prior to AL also differed significantly (p = 0.0002) with a median difference of +0.12 DS (IQR +0.03 to +0.42).

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20 Conclusion: Optimising visual rehabilitation in patients undergoing vitreoretinal surgery almost universally involves cataract surgery. Combining small incision phacoemulsification and foldable intraocular lens insertion with vitrectomy secures excellent visibility and prevents subsequent surgery. Achieving a contemporary standard of care for the refractive outcome is potentially compromised by axial length (AL) aberrations from abnormal reflectivity from surface membranes. Manual AL adjustment according to OCT measured macular thickness offers a post-op refractive outcome more closely aligned to target refraction. This audit has demonstrated a superior refractive outcome after manual AL adjustment compared with the standard IOL power used for cataract surgery alone with fewer outliers. 0807 7. RETINAL ABNORMALITIES IN MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS TYPE II (‘DENSE DEPOSIT DISEASE’): A HIGH RISK OF VISUAL LOSS, CLUE TO THE DIAGNOSIS AND PATHOGENESIS AND MONITORING Deb Colville1, Heather G Mack2, Andrew Symons3, Liv Amos4, Judy Savige1 1 The University of Melbourne Department of Medicine, Melbourne Health and Northern Health, 2 Eye Surgery Associates, East Melbourne 3002, 3 Monash Medical Centre Department of Nephrology, 4 Royal Melbourne Hospital, Parkville, VIC 3050, AUSTRALIA Purpose: Dense deposit disease (DDD) is an inherited disease characterised by progressive renal failure, dense deposits in the GBM, partial lipodystrophy, and retinal drusen. Some patients have homozygous or compound heterozygous mutations in the Complement Factor H (CFH) gene, as well as C3NeF and low C3 levels. Other genes are not known. We describe here clinical features in 6 patients from a single centre with DDD who were examined by an ophthalmologist and underwent retinal imaging. Method: The patients were 3 males and 3 females, with a median age of 49 years (range 38 to 79), from 5 families. (One male and one female were brother and sister.) The average age at renal diagnosis was 26 years (range14 – 45). All individuals had hypertension. Four patients had renal transplants, and two still had normal renal function. At least 4 had lipodystrophy. Two patients underwent extensive investigations including ERG and EOG and one had a fluorescein angiogram. Five had OCT. Results: All 6 patients had bilateral retinal drusen. These were small and punctate in one individual and

mainly large and soft in the other 5. They were bilateral and extended from the macula to the periphery. They were brighter on autofluorescence and fluorescein angiography. All but one of the patients had some impaired night vision on close questioning, and some had retinal atrophy on funduscopy, retinal images or OCT. Retinal imaging and OCT demonstrated local areas of retinal atrophy in all patients. One patient (the 79 year old) (Sylvestri et al 2009 Grade 6) had severe vision loss with extensive geographic atrophy and retinal haemorrhage, a subretinal neovascular membrane, and subretinal serous exudation. One milder patient had previously undiagnosed keratoconus. Conclusion: Dense deposit disease affects the retina in all patients, and patients are symptomatic with loss of night vision from early on. They all have drusen and with time retinal atrophy develops together with further retinal complications. Patients should be assessed ophthalmologically from renal presentation and consideration be given to being monitored yearly after this, in order to prevent complications. Patients should be advised to re-present if they have central distortion of vision or notice any blindspots. Although the drusen in DDD resemble those in macular degeneration, retinal disease in DDD is much more extensive, severe and more likely to result in complications. 0808 8. AUTOFLUORESCENCE AND SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN NON-NEOPLASTIC AUTOIMMUNE RETINOPATHY Ming-Lee Lin, Pearse A Keane, Adnan Tufail, Carlos Pavesio Moorfields Eye Hospital, London, United Kingdom Purpose: To report the imaging characteristics of non-neoplastic autoimmune retinopathy. Method: Retrospective observational case-series of patients diagnosed with autoimmune retinopathy confirmed with serological testing. Colour fundus photographs, autofluorescence images and spectral domain optical coherence tomograms (SD-OCT) were reviewed. Results: Four patients were identified. Their ages ranged from 21 to 84 years. Patients were extensively investigated for an underlying systemic malignancy and this was excluded in all patients. Retinal autoantibody testing was positive against a 40 kDa protein most likely to represent Rhodopsin in two patients, and a 47 kDa protein thought to be alpha-enolase in the remaining two patients. SD-OCT showed outer retinal loss with paracentral areas of abnormal hyperautofluorescence in 3 of 4 patients. 3-year follow-up was obtained in one patient which showed Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Sunday 3rd November progressive enlargement of this hyperautofluorescent area correlating with photoreceptor loss and retinal atrophy. Interestingly, one patient retained a relatively normal outer retinal architecture despite severe progressive visual loss. Conclusion: SD-OCT and fundus autofluorescence may aid in the diagnosis of non-neoplastic autoimmune retinopathy and may serve as an important noninvasive tool for monitoring this rare disorder. 0809 9. DIAGNOSIS OF RETINITIS PIGMENTOSA PATIENTS IN METROPOLITAN SYDNEY REGION – A 35-YEAR RETROSPECTIVE ANALYSIS Tony Shang-Chuan Chen1,2,4, John Grigg1,2, Robyn Jamieson3, Peter McCluskey1,2 1 Sydney Hospital and Sydney Eye Hospital, Sydney, NSW, Australia, 2Save Sight Institute, Discipline of Clinical Ophthalmology, University of Sydney, NSW, Australia, 3Department of Clinical Genetics, The Children’s Hospital at Westmead, Sydney, NSW, Australia, 4University of New South Wales, Sydney, NSW, Australia Purpose: Save Sight Institute (SSI) is a major university specialist centre delivering research, teaching and specialist clinical services to patients with retinitis pigmentosa (RP) in metropolitan Sydney. All SSI patients suspected of possible RP were analysed and tracked of their progress and diagnosis. Method: A retrospective, chart-based, cohort study of suspected RP patients at SSI. The study period was from 1977 to 31st December, 2012, inclusive. The patient cohort was obtained from SSI RP and rod cone dystrophy database, which was created by searching the keyword “retinitis pigmentosa”, “RP” or “rod cone dystrophy” in the patients’ medical records. Results: 172 patients were identified. 88 patients were assessed and diagnosed with non-syndromic RP. 51 patients were diagnosed with cone-rod dystrophy. A further nine patients had syndromic RP, with five patients diagnosed with Usher’s syndrome, and one case each of Alagille syndrome, Cohen syndrome, Enhanced S cone syndrome and Spinocerebellar ataxia type 7. Eight patients had other unrelated diagnoses, including three cases of Stargardt disease. The remaining 16 patients were assessed over time and had an unspecified retinal dystrophy. Conclusion: As time progressed, the diagnosis of RP was subsequently confirmed in just over half (51.2%) of these patients. In addition, nearly 10% of the total database patients still had an unspecified retinal dystrophy, which further stresses the challenge and difficulty in diagnosing RP and other hereditary retinal disorders. Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

21 0810 10. TRACTIONAL MACULOPATHY: CORRELATION OF ANATOMIC MORPHOLOGY WITH MACULAR MICROPERIMETRY Adil R Syed1,2, Andrew A Chang1,2,3 Sydney Institute of Vision Science, Sydney, Australia, 2 Sydney Retina Clinic & Day Surgery, Sydney, Australia, 3Save Sight Institute, The University of Sydney, Sydney, Australia


Purpose: To describe macular microperimetry (MAIA) threshold changes associated with structural pathology seen on spectral domain ocular coherence tomography (SD-OCT) in patients with tractional maculopathies. Methods: 10 eyes with full thickness macular hole (FTMH), 10 eyes with diffuse tractional maculopathy (DTM), and 10 eyes with lamellar macular hole (LMH) underwent SD-OCT and MAIA testing. Individual MAIA threshold points were located relative to pathology by superimposing MAIA maps over OCT scans using Adobe Photoshop software. Minimum of ten vascular features (at least two from each retinal quadrant) were used for scan alignment. Average intralesional sensitivity (AILS) was compared with average overall sensitivities of the affected eyes (ASAE) and fellow eyes (ASFE). AILS for DTM was a single threshold overlying area of greatest traction. Results: FTMH: AILS was 15.4 dB (normal range for all thresholds ≥25 dB), a 28.5% reduction vs. ASAE (21.5 dB) and 39.4% reduction vs. ASFE (25.5 dB). ASAE vs. ASFE showed 15.2% reduction. DTM: AILS was 21.6 dB, a 9.7% reduction vs. ASAE (23.8 dB) and 13.3% reduction vs. ASFE (25.2 dB). ASAE vs. ASFE reduction was 4.3%. LMH: All eyes in our cohort had LMH extension to outer nuclear layer (ONL) level. No significant differences between AILS, ASAE or AFAE were noted. Conclusions: FTMH causes most significant AILS and ASAE vs. ASFE reductions. Comparing AILS with ASAE appears to be inconclusive in DTM. AILS vs. ASFE may be a more sensitive measure in evaluating DTM. LMH with only inner retinal layer disruption may not significantly compromise AILS. Further investigation correlating MAIA results with morphology changes is warranted.

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LHN Sheck1, E Tan2, FPY Lin3, NJ Mortimer2, PJ Salmon2, SGJ Ng1 1 Eye Department, Waikato Hospital, Hamilton, New Zealand, 2Skin Cancer Institute, Dermatologic Surgical Unit, Tauranga, New Zealand, 3Department of Medicine, Waikato Hospital, Hamilton, New Zealand, and Centre for Health Informatics, University of New South Wales, Sydney, Australia

Zelda S Pick1, Jennifer S Tan1, Priscilla EZ Tan2, Adam D Gajdatsy2,3, Brett A O’Donnell4, Daniel D Athavale4, Khami Satchi1, Alan A McNab1, Jwu J Khong1 1 Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia, 2Sir Charles Gairdner Hospital, Perth, WA, Australia, 3University of Western Australia, Perth, WA, Australia, 4Royal North Shore Hospital, Sydney, NSW, Australia

Aim: To investigate the growth of periocular basal cell carcinomas (pBCC) while awaiting excision. Methods: A prospective cohort study of patients with pBCC during a 24 month period at a public hospital and a private clinic. All patients underwent tumour excision by Mohs micrographic surgery and reconstruction. Demographic data, clinical photographs, tumour size at initial visit and at time of excision, histological subtype, resulting defect size, and reconstruction technique were recorded. Results: 112 consecutive patients were recruited. The mean age was 73 years, with 54% male. 63% were treated in the public hospital. There was a significant difference in waiting time for surgery between public and private patients (median 143.5 days public, 62 days private, p < 0.005). In all patients, there was a significant difference in tumour size between their initial assessment and at the time of excision. (37.7 mm2 at the initial assessment versus 51.8 mm2 at time of excision, p < 0.001), but there was no statistically significant difference between the public and private patients. The median growth rate of the pBCC was 2.92 mm2 per 30 days. The risk factors for faster growth were male sex (OR 2.99, p = 0.018) and recurrent tumours (OR 3.56, p = 0.037). The effect of histological subtype of the pBCC and the technique used for lid reconstruction were analysed. Conclusions: In these patients, there was a significant increase in the size of pBCC while awaiting treatment. Due to the faster pBCC growth rates in men & recurrent tumours, delays in excision in these cases should be minimised.

Purpose: To describe a large series of orbital cellulitis caused by dacryocystitis. Method: Retrospective case series collating presentation, clinical and radiological findings, bacteriology, treatment and treatment outcome. Results: Nine cases are described, representing the largest case series in the literature to date. Six females and three males, aged 39 to 81 years, developed orbital cellulitis from dacryocystitis. Eight cases had radiological evidence of extraconal orbital fat stranding, and one had an extraconal orbital abscess. The pathogens included methicillin sensitive Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus constellatus and actinomyces. Six patients underwent surgical drainage of the lacrimal sac within 24 hours of presentation, two of whom had formal urgent dacryocystorhinostomies (one endoscopic and one external), with subsequent resolution of orbital cellulitis. Five patients have to date undergone elective dacryocystorhinostomies, after medical treatment and resolution of infection. Conclusion: Acute dacryocystitis is usually associated with preseptal cellulitis, as the orbital septum inserts into the posterior lacrimal crest, forming an effective barrier to infection. Orbital cellulitis, although unusual, may result from dacryocystitis and is a visionand life-threatening complication.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

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Daniel Narayan1, Edwin Figueira2,3, Adnan Phirbai2, John Crompton1,2,3, Ghislaine Traber-Hoffmann4, Klara Landau4, Dinesh Selva1,2,3 1 University of Adelaide, Adelaide, South Australia, Australia, 2SAIO, Adelaide, South Australia, Australia, 3 Royal Adelaide Hospital, Adelaide, South Australia, Australia, 4University Hospital Zurich, Zurich, Switzerland Purpose: To study the natural history and clinicoradiological characteristics of primary paediatric optic nerve sheath meningioma (PPONSM). Method: Clinical retrospective non-comparative multi-centre case series involving 8 patients under 17 years of age who presented between 1994 and 2011 to the University Hospital Zurich, Switzerland and the Royal Adelaide Hospital, Australia. The diagnosis of PPONSM was made using radiographic findings. Patients were excluded if the diagnosis was uncertain. Clinical records and imaging studies were reviewed. Results: All patients (8/8) presented with visual impairment. 4/8 patients presented with proptosis and 6/8 had restriction of extraocular movements. Optic disc oedema was found in 4/8 patients, disc atrophy in 3/8 patients, and optociliary shunt vessels in 1/8 patients. Magnetic resonance imaging showed the tumour had a fusiform appearance in 6/8 cases, tubular appearance in 1/8 cases and globular appearance in 1/8 cases. 4/8 (50%) tumours had associated calcification. Patients were followed up for 9.0 ± 5.5 years (mean ± SD). Tumour growth was observed in 4/8 (50%) patients. Intracranial extension was seen in 2/8 (25%) patients at presentation and developed in 1/8 (13%) patients during follow-up. All patients (8/8) experienced decreased visual acuity after followup. All patients (8/8) were alive with disease after follow-up. Conclusion: Much of the past medical literature supports early treatment for PPONSM. Treatment has evolved from surgical resection to irradiation. The application of irradiation in children has not been studied thoroughly. We found that a subset of tumours show indolent growth and may be managed using observation.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Nicholas Andrew1, Nicole Sladden2, Daniel Kearney2, Dinesh Selva1 1 South Australian Institute of Ophthalmology and Department of Ophthalmology and Visual Sciences, University of Adelaide, South Australia, 2Institute of Medical and Veterinary Science, Department of Surgical Pathology, Adelaide, Australia Purpose: The primary aim was to retrospectively determine the proportion of benign lymphoid hyperplasias (BLH) and idiopathic orbital inflammations (IOI) accounted for by IgG4-related orbital disease (IgG4-ROD). Secondary aims were to compare the pathological and clinical features of the IgG4-ROD and non-IgG4-ROD groups. Method: Retrospective histopathology assessment and clinical case series. Benign orbital inflammations were retrieved from the specimen archive of the Institute of Medical and Veterinary Science, South Australia. 10 consecutive cases of benign lymphoid hyperplasia (BLH) and 55 consecutive cases of idiopathic orbital inflammation (IOI) were included in this study. All cases were retrospectively stained for IgG and IgG4. Cases with >10 IgG4+ cells per high power field (hpf) and an IgG4+/IgG+ ratio >0.4 were diagnosed as IgG4-ROD, as per the comprehensive diagnostic criteria by Umehara et al. The intensity of sclerosis, lymphoplasmacytic infiltration, and eosinophilic infiltration was graded from 0 to 3+. The grading system was standardised by defining the features indicative of each score and by using a series of reference photomicrographs against which cases were judged. Results: 18 orbital biopsies from 17 patients fulfilled the comprehensive diagnostic criteria for ‘definite’ or ‘probable’ IgG4-ROD. 50% of cases originally diagnosed as BLH were IgG4-ROD. 23.6% of cases originally diagnosed as IOI were IgG4-ROD. Compared with the non IgG4-ROD group, IgG4-ROD cases had significantly more lymphoplasmacytic infiltration (P = 0.006), eosinophilic infiltration (P = 0.0001), and sclerosis (P = 0.008). Significantly more IgG4-ROD patients had a blood eosinophilia at the time of orbital biopsy (P = 0.03). There was no statistically significant difference between IgG4-ROD and non-IgG4-ROD cases in terms of the presenting clinical features, presenting radiological features, response to corticosteroid treatment, or incidence of lymphoma. IgG4-ROD cases affected males and females equally (9:8), had a mean age of 47.7 years, were bilateral in 50% of cases, and

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24 showed a mean of 110 IgG4+ cells per hpf. Presenting features of IgG4-ROD cases included eyelid or periocular swelling (77.8%), proptosis (55.6%), dystopia (33.3%), conjunctival or eyelid erythema (25.0%), pain (33.3%), diplopia (33.3%), and tenderness (35.7%). Orbital structures involved by IgG4-ROD on imaging included lacrimal gland(s) (76.5%), orbital fat (47.0%), extraocular muscle(s) (35.3%), orbital nerves (11.8%), and sclera (5.9%). Non-IgG4-ROD cases had a female predominance (2:1), a mean age of 52.6 years, and a mean of 6.4 IgG4+ cells per hpf. Conclusions: IgG4-ROD accounts for a significant proportion of non-specific orbital inflammations. This study identified numerous pathological differences but no clinical differences between IgG4-ROD and non IgG4-ROD cases.

obstruction (ANLDO) (15.5%). Previous interventions included probing 75.9% (88/116), massaging 43.1% (50/116) and intubation 39.7% (46/116). There were no intraoperative complications. There was 1 case of postoperative pyogenic granuloma. There were no cases of postoperative infection and postoperative haemorrhage. 90% of procedures were considered successful. Complete symptom resolution was observed in 78% (90/116), significant improvement in 12% (14/116), partial improvement in 2% (2/116) and no improvements in 8% (9/116). Conclusions: In our series, we demonstrated that endonasal DCR is a safe operation and has an overall success rate of 90% for paediatric NLDO.

0906 0905 5. PAEDIATRIC ENDONASAL DACRYOCYSTORHINOSTOMY – A MULTICENTRE SERIES OF 116 CASES WengOnn Chan1,2, Geoff Wilscek3, Raf Ghabrial3, Robert Alan Goldberg4, Peter Dolman5, Dinesh Selva1,2, Raman Malhotra6 1 South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia, 2Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, Australia, 3Sydney Eye Hospital, Sydney, New South Wales, Australia, 4Ronald Reagan UCLA Medical Center, Los Angeles, California, United States, 5University of British Columbia, Department of Ophthalmology and Visual Sciences, Eye Care Centre, Vancouver, Canada, 6Corneoplastic Unit, Queen Victoria Hospital, West Sussex, United Kingdom Purpose: To report our experience with paediatric endonasal DCR Methods: Multicentre, retrospective, non-comparative study. Cases of paediatric endonasal DCR from 2006– 2011 were included from 6 oculoplastic units. Patients over the age of 16 were excluded. The main outcome measures were: indication for surgery, demographics, previous interventions, intraoperative or postoperative complications, follow-up duration and success rate (defined as significant improvement of epiphora). Results: A total of 116 endonasal DCRs were performed for 103 patients. The mean follow-up period was 8 months (range 3 months-to-4 years), with 1 patient lost to follow-up. There were 48 males (mean age 5 years and 9 months) and 50 females (range of 4 months-to-16 years) with a total of 98 cases of congenital nasolacrimal duct obstruction (CNLDO) (84.5%) and 18 cases of acquired nasolacrimal duct

6. SIMULTANEOUS NASAL PROCEDURES IN ENDOSCOPIC DACRYOCYSTORHINOSTOMY Edwin Figueira1,3, Zaid Al Abbadi2, Raman Malhotra2, Geoffrey Wilcsek1, Dinesh Selva3 1 Oculoplastic Unit, Prince of Wales Hospital, Department of Ophthalmology, Prince of Wales Hospital, Randwick, NSW. Australia, 2Corneoplastic unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, RH19 3DZ, 3South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences, University of Adelaide, South Australia Purpose: To assess the frequency of simultaneous nasal procedures in powered endoscopic dacryocystorhinostomy (endoDCR) performed by oculoplastic surgeons. Methods: In a retrospective, multicenter study, demographic, clinical and surgical data of consecutive endoDCR cases at three oculoplastic centres, over periods of 6, 4 and 2.2 years respectively, were reviewed. The rates of simultaneous nasal procedures were studied. Complication rates in the patients who had simultaneous endonasal procedures were also analysed. Results: 576 cases [mean age: 63.2 years (16.2–94 years), male: female: 32.7%:67.3%] were included. 14.06 % of the total cohort of patients required a simultaneous endonasal procedure during endoDCR. 11.9 % required septoplasty, 1.5% required middle turbinate surgery and 0.34% required polypectomy during endoDCR. The septoplasty rate varied from 5.2 to 15% between surgeons from the three centres. Of the 81 patients with concomitant procedures, 1 had postoperative epistaxis and 1 had an asymptomatic septal adhesion. Conclusions: A significant proportion of patients undergoing endoDCR may require concomitant Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Sunday 3rd November endonasal procedures. Therefore, endonasal lacrimal surgeons utilising techniques that aim to marsupialise the entire lacrimal sac may benefit from expertise in the surgical management of concomitant nasal pathology.

0907 7. ORBITAL IMPLANT EXPOSURE: VERSATILITY OF THE TEMPOROPARIETAL FASCIAL GRAFT Liam Turner, Anjana Haridas, Timothy Sullivan Royal Brisbane Hospital, Brisbane, Australia Purpose: Orbital implant exposure is the most common complication arising from socket surgery with rates varying from 3.2% to 34%. The purpose of this study was to report the use of the temporoparietal fascial graft (TPFG) to correct orbital implant exposures in a variety of different clinical situations. Method: A retrospective, non-comparative, interventional case series was undertaken of a single surgeon’s experience (T.S) with temporoparietal fascial grafts within Brisbane, Australia from 2005–2012. Results: Twelve patients were identified, who contributed a total of 13 grafts. The case series consisted of 7 males and 5 females with a mean age of 36.08 (SD = 14.09, Range = 10–52 years). Two grafts were performed in paediatric patients. Implant types varied with a total of 5 hydroxyapatite, 4 porous polyethylene, 2 bioceramic and 1 acrylic implant. Grafts were performed for the exposure on average at 3.77 months post -identification (SD = 3.31, Range 1–11 months). Of the 13 grafts performed, two grafts failed during the follow-up period, equating to a failure rate of 15.38%. Conclusion: We demonstrate the versatility of the temporoparietal fascial graft, with respect to: (1) the ability to use it successively; (2) the effectiveness for both short- and long-duration orbital implant exposure; (3) the use in exposure secondary to varying implant types (i.e. hydroxyapatite, porous polyethylene, bioceramic and acrylic); and (4) its use within paediatric orbital implant exposures.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

25 0908 8. PREVALENCE OF DERMATOCHALASIS IN HEALTHY YOUNG ADULTS: THE RAINE EYE HEALTH STUDY Charlotte M McKnight1,2, Justin C Sherwin2,3, Seyhan Yazar1,2, Hannah Forward1,2, Alex X Tan1,2, Jenny Mountain4, Adam D Gajdatsy1,2,5, Jean-Louis de Sousa2,6, Alex W Hewitt7, David A Mackey1,2 1 Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia, 2 Lions Eye Institute, Perth, WA, Australia, 3 Department of Public Health and Primary Care, University of Cambridge, UK, 4Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia, 5Sir Charles Gairdner Hospital, Nedlands, WA, Australia, 6Royal Perth Hospital, Perth, WA, Australia, 7Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Vic, Australia Purpose: Upper eyelid blepharoplasty is the most common oculoplastic procedure performed in Australia, however there is little evidence regarding the baseline prevalence of dermatochalasis (the major indication for blepharoplasty) in the medical literature. Establishing prevalence of disease is important to assess existing treatment coverage and plan future health services. Few population-based studies report prevalence in older adults, and to our knowledge there are none in young adults. Method: Participants in the Raine Eye Health Study (n = 1329, age 19–22 years) were assessed for presence of dermatochalasis using standardised photographs. Right and left eyelids were graded individually. Dermatochalasis was defined as upper eyelid skin extending beyond the eyelid margin. Participants with inadequate quality photographs (n = 15) and those with Asian eyelid structure (n = 42) were excluded. Results: Dermatochalasis affecting one or both eyes was present in 7.2% of participants. There was a significant difference between males and females (11.4% vs 2.8%, p < 0.001). Bilateral dermatochalasis occurred in 3.7% of participants (5.6% males vs 1.7% females). No clinically significant BMI association was found. When a less strict definition of dermatochalasis was applied (upper eyelid skin reaching eyelashes), prevalence of dermatochalasis affecting one or both eyes was higher at 32.1% in males and 16.3% in females. Conclusion: A significant number of healthy young adults meet photographic criteria for dermatochalasis, defined as upper eyelid skin extending beyond the eyelid margin. It should be emphasised that no assessment of cosmesis or functional impairment was made. As

45th Annual Scientific Congress

26 dermatochalasis increases with age, it is expected that values would be higher in the general adult population. 0909 9. HISTOLOGICAL SUBTYPES OF PERIOCULAR BASAL CELL CARCINOMA Albert Wu1, Michelle T Sun1, Shyamala C Huilgol2, Simon Madge1,3, Dinesh Selva1 1 South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, 2 Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, 3Department of Ophthalmology, Hereford County Hospital, Hereford, UK Purpose: To determine the proportion of different subtypes of periocular BCC in South Australia. Methods: Histological analysis of consecutive periocular BCC specimens. Results: From 2006 to 2013, a total of 1915 consecutive periocular BCC specimens were analysed. The mean age at resection was 68.8 years (median: 71, range: 21–101). Most specimens (56.6%) were removed from male patients. 51.8% involved the lower eyelid, 29.4% the medial canthus, 11.2% the lateral canthus and 7.6% the upper eyelid. The main histological subtypes identified were nodular (65.1%), infiltrative (17.6%), superficial (12.9%) and micronodular (4.3%). There were 419 (24.9%) specimens with more than one subtype. The most common subtype combinations were nodular with infiltrative (49.6%), and nodular with superficial (25.8%). Conclusions: The majority of periocular BCC were located on the lower lid and classified histologically as nodular. Infiltrative BCC occurred more frequently than the superficial subtype. As the proportion of mixed BCC containing aggressive subtypes is high, surgical excision with margin control should be considered for periocular BCC. 0910 10. PATTERNS AND SEVERITY OF VISUAL FIELD LOSS AT PRESENTATION IN PATIENTS WITH PITUITARY ADENOMA Siddharth Ogra1, Andrew Nichols2, Andrew Kaye2, Peter J Savino3, Helen Danesh-Meyer1 1 Department of Ophthalmology, University of Auckland, Auckland, New Zealand, 2Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia, 3Neuro-ophthalmology Service, Shiley Eye Centre, San Diego, California, USA Purpose: To analyse the pattern of visual field defects in patients with pituitary adenoma on first presentation.

Method: 103 consecutive patients (206 eyes) presenting to the neurosurgical department over a three year period at the Royal Melbourne Hospital were recruited. Ophthalmological examination and standard automated perimetry (Humphrey, 24-2 threshold) was performed. Pattern of visual field defects and severity of were assessed. Results: The mean population age was 53.93 (SD = 15). Visual loss was the most common reason for presentation (39%) followed by endocrine abnormality (21%) and headache (15%). Out of 54 patients with visual field 18 (33%)had unilateral involvement. Bitemporal defects were the most prevalent pattern (n = 22 patients, 41%) followed by homonymous defects (n = 7, 13%). The mean visual acuity in those with bitemporal defects was 6/7.5 with half of patients having visual acuity greater than this in both eyes. Patients with unilateral defects all showed reduction in the mean visual acuity in addition to the visual field defect of the affected eye compared to the unaffected eye. Eyes with central field defects had the worst mean visual acuity (6/12). Conclusion: Patients with pituitary adenoma frequently present with visual loss and visual field defects on examination. Bitemporal defects are the most common pattern, however a significant proportion of patients may have only unilateral involvement. Patients with bitemporal defects often have preserved visual acuity. Visual field testing is essential for complete evaluation, as visual acuity is not sufficient to rule out intracranial pathology. 0911 11. MODELING ISOPTER-BASED VISUAL FIELD CONSTRICTION IN OPEN ANGLE GLAUCOMA Aditya Hernowo, Janalia Sjarif, Haryo Yudono, Retno Ekantini, Hartono Hartono Gadjah Mada University, Yogyakarta, Indonesia Purpose: This study aims at modeling the radius of the extramacular isopters based on the radius of the macular (central) isopter. Methods: This was a cross sectional study involving 50 participants (25 males). Inclusion criteria were: (1) diagnoses of open-angle glaucoma; (2) no previous glaucoma treatment; (3) age ≥18 years. The exclusion criterion was: comorbidity with other intraocular or visual pathway affecting conditions. The visual fields with isopters I1e, I2e, I3e, and I4e were mapped with Goldmann kinetic perimetry. Outcome measure of isopter radii were stated in degree unit. For each quadrant, the radius was measured from the fixation point, at 45° distance from the horizontal meridian, to the desired isopter (line). Linear regressions were performed with the ratio of the I1e radius to the other Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

Sunday 3rd November isopters as the dependent variable and the quadrantic radius of isopter I1e as the predictor. Results: The relationship between the radius of isopter I1e to the outer isopters were relatively constant. The relationship between the central-to-outer radii ratio to the central radii were linear (R2 = 0.77– 0.99; p < 10−12). The radii of the isopters I3e and I4e were more confidently estimated by the radius of the isopter I1e (R2 = 0.95–0.99; p < 10−12). Conclusion: The radius of central isopters (I1e) in open-angle glaucoma can be used to reliably estimate the extramacular isopters radii (I2e, I3e, and I4e). 0912 12. MERKEL CELL CARCINOMA OF THE EYELID: MANAGEMENT AND PROGNOSIS Helen M Herbert HM1, Michelle T Sun2, Dinesh Selva2, Bertie Fernando3, George M Saleh1,4,5, Michele Beaconsfield1, Richard Collin1, Brian Leatherbarrow3, Chris J Mclean5, Shyamala C Huilgol6, Garry Davis2, Timothy J Sullivan7 1 Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK, 2South Australian Institute of Ophthalmology, University of Adelaide, South Australia 5000, 3Manchester Royal Eye Hospital, Manchester, Oxford Road, Manchester, England, M13 9WH UK, 4NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 5Department of Ophthalmology, The Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU7 5XX, England, UK, 6Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia 5000, 7 Department of Ophthalmology, Royal Brisbane Hospital Herston, Queensland 4029, Australia Purpose: To analyze the TNM stage, management and outcomes of patients with Merkel cell carcinoma (MCC) of the eyelid.

Clinical and Experimental Ophthalmology 2013; 41 (Suppl 1): 7–27 © 2013 Royal Australian and New Zealand College of Ophthalmologists

27 Method: Retrospective case series of 21 patients from five tertiary referral centres in the United Kingdom and Australia. Tumors were staged according to The American Joint Committee on Cancer 7th edition TNM criteria for eyelid carcinoma and MCC. Results: Eyelid carcinoma TNM stages were: T2aN0M0, 5 patients; T2bN0M0, 7 patients; T3aN0M0, 4 patients; T3bN0M0, 3 patients; T2bN1M0, 1 patient; T3aN1M0, 1 patient. Merkel cell carcinoma TNM stages were: T1N0M0, 12 patients; T2N0M0, 7 patients; T1N1M0, 1 patient; T2N1M0, 1 patient. One patient underwent sentinel lymph node biopsy and 8 had head/neck imaging. Eighteen patients underwent wide local excision; 12 with paraffin section and 6 with frozen section. Two patients had Mohs surgery and one required an orbital exenteration. Adjuvant radiotherapy was used in 57% and two received chemotherapy. Median follow up was 54 months with local, regional nodal and distant metastatic recurrence rates of 10%, 10% and 19% respectively. The lowest T-category tumor metastasizing to both regional nodes and distant locations was a T2a (Eyelid TNM)/T1 (Merkel TNM) tumor measuring 8 mm. Two patients with T3a (Eyelid TNM)/T2 (Merkel TNM) tumors died due to metastatic Merkel cell carcinoma. Conclusions: Tumors with a low T-stage are associated with regional nodal and distant metastatic disease. It may be reasonable to consider sentinel lymph node biopsy or strict regional lymph node surveillance for all eyelid MCC regardless of T-stage or size.

Abstracts of the Royal Australian and New Zealand College of Ophthalmologists 45th Annual Scientific Congress. November 2-6, 2013. Hobart, Tasmania.

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