Sarah Coupland

• Session I: From Inflammation to Innovation: Exploring Mechanisms and Modeling in Retinal Disease?
  許淑娟 Shwu-Jiuan SheuTaiwan Moderator Risk factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patientsPurpose: This study aims to examine factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patients. Specifically, we focus on the initial HbA1C at diagnosis, its change at ophthalmologic visit and medication adherence (MR). Research Design and Methods: A prospective study involving 300 type II DM patients (≥20 years) was conducted from July 2022 to January 2024. MR was assessed using the Taiwanese version of the Morisky Medication Adherence Scale-8 (MMAS-8). DR progression was evaluated through a defined clinical scoring system. Statistical analyses included chi-square tests and logistic regression to examine the factors associated with STDR severity and progression. Results: After excluding 122 patients for missing data, 178 participants were analyzed. Changes in HbA1c were strongly associated with STDR. Both improvements and deteriorations or sustained high in HbA1c levels were linked to an increased likelihood of advanced DR scores compared to sustained low group. Those with sustained high HbA1c had the most impact. High initial HbA1c had a greater impact on females, age <65, patients lacking exercise or diet control. Patients with low or moderate MR showed significantly higher HbA1c level at ophthalmologic visit, and increased risk developing STDR. Age ≥65 years was a protective factor against higher DR scores. Conclusions: This study highlights the relationship between initial blood glucose levels at diabetes diagnosis, and subsequent HbA1c change during ophthalmology visits concerning DR severity and progression. High initial HbA1c might indicate the need for frequent ophthalmic visit.

  許聖民 Sheng-Min HsuTaiwan Moderator Pseudophakic Macular Edema: Stopping Vision Loss Before It StartsPseudophakic macular edema (Ervine-Gass syndrome) remains the most common cause of decreased visual acuity after uneventful cataract surgery. Previous study reported that 26.8% of eyes with pseudophakic macular edema did not recover 6/6 vision. Clinically significant pseudophakic macular edema impairing patients' vision is found in 1-2% of patients with its peak 6 weeks following surgery, but subclinical macular edema can be seen in about 30% of patients in FA and up to 40% in OCT. To date, there are no uniform recommendations for the treatment of pseudophakic macular edema. Therefore, I will present two cases of pseudophakic macular edema here and discuss the strategies for treatment.
• Leveraging AI and in Silico Modeling in Uveitis
  Marion MunkSwitzerland Speaker Leveraging AI and in silico modeling in uveitsArtificial intelligence (AI) and in silico modeling hold growing potential in improving our understanding and clinical management of uveitis. This work highlights two complementary approaches: the use of AI to identify imaging-based risk factors for disease progression, and the application of computational biology to investigate potential immunological mechanisms such as molecular mimicry. Based on longitudinal clinical imaging data, machine learning tools were applied to extract and analyze relevant biomarkers with the aim of predicting inflammatory complications. In parallel, bioinformatic methods were used to explore structural and functional similarities between microbial and ocular proteins, supporting hypotheses around immune-mediated tissue damage. Together, these approaches demonstrate how AI-driven analysis and in silico tools can contribute to both individualized disease monitoring and a deeper insight into uveitis pathophysiologyLeveraging Bioinformatics to Identify Targetable Mechanisms in Diabetic Retinal DiseaseThis presentation highlights a bioinformatics-driven approach to understanding how different retinal cells respond to diabetic conditions, with the goal of identifying novel pathways relevant to disease progression and potential therapeutic intervention. By analyzing large-scale transcriptomic datasets from retinal tissue, gene expression changes specific to retinal cells can be mapped to key metabolic and inflammatory signaling networks. This method enables the discovery of altered pathways that may not be apparent through conventional analysis, providing deeper insight into the cellular mechanisms driving diabetic retinopathy. Focusing on pathway-level changes—such as those related to lipid metabolism, cytokine signaling, and cellular stress—this approach offers a powerful tool to uncover molecular targets that could be leveraged for future drug development. The integration of computational biology with retinal cell-specific data opens new avenues for precision medicine and the development of targeted therapies in diabetic retinal disease.
• Discussion
• Leveraging Bioinformatics to Identify Targetable Mechanisms in Diabetic Retinal Disease
  Marion MunkSwitzerland Speaker Leveraging AI and in silico modeling in uveitsArtificial intelligence (AI) and in silico modeling hold growing potential in improving our understanding and clinical management of uveitis. This work highlights two complementary approaches: the use of AI to identify imaging-based risk factors for disease progression, and the application of computational biology to investigate potential immunological mechanisms such as molecular mimicry. Based on longitudinal clinical imaging data, machine learning tools were applied to extract and analyze relevant biomarkers with the aim of predicting inflammatory complications. In parallel, bioinformatic methods were used to explore structural and functional similarities between microbial and ocular proteins, supporting hypotheses around immune-mediated tissue damage. Together, these approaches demonstrate how AI-driven analysis and in silico tools can contribute to both individualized disease monitoring and a deeper insight into uveitis pathophysiologyLeveraging Bioinformatics to Identify Targetable Mechanisms in Diabetic Retinal DiseaseThis presentation highlights a bioinformatics-driven approach to understanding how different retinal cells respond to diabetic conditions, with the goal of identifying novel pathways relevant to disease progression and potential therapeutic intervention. By analyzing large-scale transcriptomic datasets from retinal tissue, gene expression changes specific to retinal cells can be mapped to key metabolic and inflammatory signaling networks. This method enables the discovery of altered pathways that may not be apparent through conventional analysis, providing deeper insight into the cellular mechanisms driving diabetic retinopathy. Focusing on pathway-level changes—such as those related to lipid metabolism, cytokine signaling, and cellular stress—this approach offers a powerful tool to uncover molecular targets that could be leveraged for future drug development. The integration of computational biology with retinal cell-specific data opens new avenues for precision medicine and the development of targeted therapies in diabetic retinal disease.
• Discussion
• What Else Behind Diabetic Retinopathy Beside Anti-VEGF?
  賴佐庭 Tso-Ting LaiTaiwan Speaker ROP: Consensus of Pediatric Retina GroupOBJECTIVE: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness, particularly in preterm infants. In Taiwan, the absence of national guidelines and the variability in clinical practice have highlighted the need for locally adapted consensus recommendations. METHODS: An expert panel of eleven ophthalmologists from eight tertiary centers in Taiwan convened to develop a consensus on ROP management. Through a structured process that included key question formulation, systematic literature review, iterative discussion, and voting, the panel established consensus statements. Agreement was defined as >/=75% of panelists voting "agree" or "strongly agree" using a five-point Likert scale. RESULTS: Consensus recommendations were developed across three major domains: screening, treatment, and follow-up. For screening, the panel endorsed criteria commonly used in Taiwan-gestational age <32 weeks or birth weight <1500 g-but emphasized the need for population-based validation. Both anti-vascular endothelial growth factor (VEGF) agents and laser photocoagulation were recognized as acceptable first-line treatments for type 1 ROP, with individualized treatment decisions based on disease characteristics, anesthesia risk, and follow-up capacity. Guidelines were also established for the management of ROP reactivation, procedural protocols, and agent selection. For follow-up, the panel recommended extended surveillance after anti-VEGF therapy and outlined the criteria for identifying and monitoring persistent avascular retina. Follow-up schedules were proposed to detect long-term ocular and neurodevelopmental complications. CONCLUSIONS: This consensus provides updated evidence-based guidance for ROP care in Taiwan, addressing both traditional and emerging clinical challenges. These recommendations aim to standardize care practices while remaining adaptable to future research and evolving clinical needs.What Else Behind Diabetic Retinopathy Beside Anti-VEGF?Diabetic retinopathy (DR) has long been characterized as a microvascular disease, and anti-VEGF therapy remains one of the standard treatments for its sight-threatening complications. However, accumulating evidence demonstrates that DR is a complex neurovascular disorder in which neurodegeneration, oxidative stress, chronic inflammation, dysregulated cell death pathways, and impaired autophagy play central roles. Preclinical studies highlight early retinal neurodegeneration, glial dysfunction, and microglia-mediated inflammation as substantial contributors to DR development and progression, which might precede clinically visible vascular changes. Oxidative stress is another major driver, triggering mitochondrial injury, endothelial dysfunction, and aberrant programmed cell death—including apoptosis, pyroptosis, and necroptosis—which further accelerates neurovascular impairment. A growing body of experimental work has explored therapeutic strategies beyond VEGF suppression. Antioxidants such as astaxanthin have been shown to restore autophagy and enhance Nrf2-mediated defense mechanisms in photoreceptors under high-glucose stress—findings demonstrated in our own studies. Similarly, targeting inflammatory pathways with agents such as fenofibrate or cilostazol has been shown to reduce inflammatory mediators, oxidative damage, and retinal apoptosis in diabetic models. Additional approaches, including fibroblast growth factor 1 treatment and interventions aimed at preventing high-glucose-induced cellular senescence, further underscore the multifaceted nature of DR pathophysiology. Together, these insights suggest that DR extends far beyond vascular endothelial dysfunction, and effective long-term management may require therapies targeting oxidative stress, inflammation, neuroprotection, autophagy regulation, and metabolic resilience. This talk will review these emerging mechanisms and discuss future therapeutic perspectives that complement, rather than replace, anti-VEGF therapy.
• Discussion
• Break
• Session II: Regional Challenges in Uveitis Management across Asia
  林昌平 Chang-Ping LinTaiwan Moderator

  郭錫恭 Hsi-Kung KuoTaiwan Moderator
• Revisiting Tuberculosis in Uveitis: Immunopathogenesis and the Role of Antitubercular Therapy
  Rina La Distia NoraIndonesia Speaker Revisiting Tuberculosis in Uveitis: Immunopathogenesis and the Role of Antitubercular Therapy.Tuberculosis-associated uveitis (TB-uveitis) remains a major cause of intraocular inflammation in TBendemic countries. Its immunopathogenesis involves both direct ocular infection by Mycobacterium tuberculosis and immune-mediated responses to mycobacterial antigens. The overlapping clinical features and absence of systemic TB in many cases make diagnosis and treatment particularly challenging. This presentation revisits the current understanding of TB-uveitis, focusing on the immune mechanisms involved and their clinical implications. We discuss how latent TB infection may act as a trigger for ocular inflammation and explore the limitations of existing diagnostic criteria. To address the uncertainty surrounding treatment decisions, we conducted a randomized controlled trial in Indonesia involving patients with uveitis of undetermined cause who tested positive for QuantiFERONTB Gold Plus. All participants received immunosuppressive therapy, with half receiving additional antitubercular therapy (ATT). At six months, the ATT group had significantly higher rates of complete uveitis resolution and fewer relapses during extended follow-up. We also conducted a translational study evaluating peripheral blood expression of interferon-inducible genes. A higher baseline gene expression score was associated with favorable treatment outcomes, suggesting a potential role for immune biomarkers in guiding therapy. This talk integrates clinical and translational findings to offer a more personalized and evidence-based approach to managing TB-uveitis. The goal is to move beyond empirical ATT toward tailored treatment strategies informed by immunologic profiles and regional disease patterns.
• Discussion
• Pattern and Distribution of Uveitis Etiologies in Taiwan: A Multi-Center Perspective
  許詠瑞 Yung-Ray HsuTaiwan Speaker Loose Zonules, Steady Hands: Saving the Unstable LensZonular dehiscence with vitreous prolapse represents one of the most challenging scenarios in cataract surgery. This case involves a 65-year-old female referred intraoperatively for severe temporal zonular dialysis extending 120° with vitreous prolapse into the anterior chamber. In such situations, initial management options depend on the degree of capsular support and the surgeon’s familiarity with the anterior or posterior segment approaches. Possible options include: (1) primary pars plana lensectomy and vitrectomy (PPLV) with Yamane double-needle intrascleral fixation of an IOL; (2) anterior vitrectomy with in-the-bag or supplemental scleral fixation of a one-piece IOL using sutures; (3) pars plana vitreous levitation–assisted phacoemulsification; or (4) use of hooks or rings to preserve capsular support for in-the-bag implantation. In this case, I stabilized the anterior capsule using iris retractors, performed a careful anterior vitrectomy, and completed a slow-motion phacoemulsification to minimize zonular stress. Following cortical cleanup, both an in-the-bag IOL and capsular tension ring (CTR) were successfully implanted. The patients visual acuity on postoperative day 1 was 0.9. This surgical video illustrates a practical surgical maneuver with controlled movements, vitreous management, and structural stabilization techniques that allow safe phacoemulsification even in the setting of profound zonular loss.Pattern and Distribution of Uveitis Etiologies in Taiwan: A Multi-Center Perspective Uveitis is a heterogeneous group of intraocular inflammatory disorders with diverse etiologies and variable regional patterns. To delineate the current epidemiologic landscape of uveitis in Taiwan, a nationwide multicenter retrospective study was conducted collaboratively by the Taiwan Ocular Inflammation Society. Newly diagnosed uveitis cases from July 2022 to June 2023 were collected from 15 tertiary referral centers across northern, central, southern, and eastern Taiwan. A total of 1,654 cases were analyzed. The mean age at onset was 49.5 ± 18.3 years, with nearly equal sex distribution (50.6% male). Anatomical classification includes anterior uveitis (64.3%), followed by panuveitis (22.4%), posterior uveitis (11.0%), and intermediate uveitis (2.3%). Etiologically, 43.6% were non-infectious, 23.5% infectious, and 32.9% undifferentiated. The leading non-infectious entities were HLA-B27/ankylosing spondylitis–related uveitis (15.4%), glaucomatocyclitic crisis (5.0%), and Vogt-Koyanagi-Harada syndrome (3.3%). Among infectious causes, herpetic anterior uveitis (7.7%), cytomegalovirus anterior uveitis (5.1%), and endogenous bacterial endophthalmitis (3.9%) predominated. This large-scale multicenter study represents the most comprehensive epidemiological overview of uveitis in Taiwan to date. The unique disease pattern and relevant diagnostic challenges will be analyzed in this talk.
• Discussion
• Infectious Uveitis in Asia: Warning Scenarios Not to Be Missed
  黃謙傑 Jerry HuangTaiwan Speaker Infectious Uveitis in Asia: Warning Scenarios Not to Be MissedInfectious uveitis remains a significant cause of visual morbidity in Asia, demanding prompt diagnosis and management. This review highlights critical warning scenarios that clinicians must not overlook, including differentiating acute anterior uveitis from bacterial endophthalmitis, and distinguishing tuberculous retinal vasculitis from Eale's disease. Additionally, it emphasizes the importance of recognizing sarcoidosis versus fungal endophthalmitis to avoid misdiagnosis and delayed treatment. Comparative analysis underlines key clinical features, auxiliary investigations, and response to therapy, guiding accurate diagnosis in resource-limited settings. Awareness of these differing presentations and potential pitfalls is essential to prevent irreversible visual loss and to optimize patient outcomes.
• Discussion
• Break
• Session III: Sarcoidosis vs. TB
  黃奕修 Yih-Shiou HwangTaiwan Moderator

  蔡明霖 Bright TsaiTaiwan Moderator

  詹維鈞 Wei-Chun ChanTaiwan Moderator
• Clinical Features and Treatments of Severe Ocular Sarcoidosis
  Kenichi NambaJapan Speaker Clinical feature and treatments of severe ocular sarcoidosisThe most common cause of uveitis in Japan is ocular sarcoidosis. Only cases meeting the diagnostic criteria qualify as ocular sarcoidosis, but the total number of suspected cases that do not meet the criteria is also significant. Ocular sarcoidosis presents with a wide range of ocular findings, affecting areas from the anterior to the posterior segment, and shows considerable individual variation. It often presents with little anterior chamber inflammation or vitreous opacity, frequently arising from elevated intraocular pressure due to gonio nodules, sometimes leading to misdiagnosis as primary open-angle glaucoma. Conversely, it can also present with severe findings, including marked vitreous haze, retinal vascular sheathing, retinal exudates, and cystoid macular edema, potentially leading to permanent visual impairment. The clinical course also varies significantly between individuals. Some cases resolve with a single treatment, remain stable without recurrence, and have a favorable visual prognosis. However, other cases involve prolonged inflammation necessitating long-term treatment. In such protracted cases, complications such as concomitant cataracts, secondary glaucoma, and macular degeneration frequently lead to visual impairment. Sarcoidosis is a disease relatively responsive to steroid therapy. Treatment primarily involves steroid eye drops along with mydriatic eye drops. If eye drops do not respond, oral steroids or periocular steroid injections are used. Oral methotrexate or oral adalimumab may sometimes be necessary. However, ocular sarcoidosis is a disease manifesting in waves of symptoms, and often resolves spontaneously. I will present actual cases and discuss the above points accordingly.
• Discussion
• Tackling Chronic Uveitis: Lessons from the Clinic and the Lab
  Soumyava BasuIndia Speaker Chronic uveitis: lessons from the clinic and the labChronic, recurrent inflammation is the primary cause of vision loss and structural complications (photoreceptor loss, cataract, glaucoma, and others) in uveitis. To understand if local factors drive chronic inflammation, we investigated the clinical patterns of recurrent inflammation, and the immunological landscape of vitreous samples, in non-infectious uveitis. In the clinical studies, we retrospectively analyzed HLA-B27 acute anterior uveitis (AAU) patients with documented 2 recurrences for the laterality patterns of recurrent inflammation. Recurrence patterns were classified as ipsilateral (group A) and contralateral (group B) based on the laterality of the second episode. We found that ipsilateral recurrences are more common and severe in HLA-B27 AAU, regardless of the presence of systemic disease or therapy. Similar results were also noted for recurrent inflammation in Behcet’s uveitis, supporting the hypothesis that an eye-specific immune memory exists in non-infectious uveitis. To further characterize the eye-specific immune-memory, we investigated the immune phenotypes and functional attributes of eye-infiltrating immune cells in the vitreous fluids of uveitis patients. Among the various memory T-cell populations in the vitreous, we found CD69+CD103+ tissue resident memory (TRM) T-cell populations. Although the primary function of these cells is long-term immune protection, these TRM cells have also been linked to chronic and recurrent inflammation in numerous autoimmune diseases affecting various organs. Our studies revealed that eye-infiltrating CD4 and CD8 TRMs are functionally distinct, antigen-responsive, and associated with disease prognosis in uveitis, underscoring their potential as biomarkers and possible therapeutic targets.
• Discussion
• Session IV: Local Perspectives of Uveitis Management in Taiwan
  葉伯廷 Po-Ting YehTaiwan Moderator

  張祐誠 Yo-Chen ChangTaiwan Moderator

  陳怡杏 Chen Yi-HsingTaiwan Moderator
• Decoding Intraocular Masquerade
  Sarah CouplandUnited Kingdom Speaker Uveal melanoma prognostication: beyond chromosome 3Prognosis for uveal melanoma (UM) is determined by a combination of clinical, histopathological, and molecular factors. Clinical markers include tumour size and location, while histopathological factors include cell type and mitotic activity. The Liverpool Ocular Oncology Centre has a long track record in UM prognostication, and has devised an algorithm (LUMPO3) for more precise risk stratification and identifying patients at high risk for metastasis. It is a multiparametric model, which also included genetic data, particularly chromosome 3 and 8. It has been demonstrated that BAP1 immunohistochemistry is a very close surrogate for the status of the BAP1 gene, which if mutated is associated with a poor prognosis in UM. Our recent work has investigated the inclusion of BAP1 immunohistochemistry in LUMPO3, in labs where chromosomal analysis is not available. Early detection of metastatic UM is critical, as the prognosis is poor once widespread metastases develop. If detected earlier, surgical and newer immunotherapy options have been demonstrated to prolong survival.Decoding intraocular masqueradeIntraocular lymphomas can be divided into 3 main subtypes: primary vitreoretinal lymphoma (VRL), primary choroidal lymphoma, and secondary intraocular lymphoma. VRL is a rare but aggressive form of non-Hodgkin lymphoma that affects the eye. The most common subtype is a Diffuse large cell B-cell lymphoma (DLBCL), and displays a similar morphology, immuno- and genetic profile to the primary CNS lymphomas. Indeed, VRL can relapse in the CNS, and similarly CNSL can involve the eye. VRL often "masquerades" as chronic uveitis, making early and accurate diagnosis challenging but crucial for effective treatment and improved prognosis. In contrast, primary choroidal lymphoma is an indolent non-Hodgkin lymphoma similar to the Marginal Zone B-cell lymphomas of the ocular adnexa, and do not spread to the CNS. This lecture will provide an update about the biology, diagnostics and treatment of VRL and choroidal lymphomas. It will also provide examples of differential diagnoses to consider in vitrectomy specimens.Update of Ocular Adnexal LymphomasOcular adnexal lymphomas are most commonly non-Hodgkin lymphomas (NHL) that develop in the conjunctiva, eyelid, lacrimal gland, and orbit. The most common subtype is an extranodal marginal zone lymphoma (EMZL), which often presents as a painless, salmon-coloured lesion on the conjunctiva or as a mass causing symptoms like proptosis, double vision, or swelling in the orbit. Other common NHL of the ocular adnexa include follicular lymphomas, diffuse large cell B-cell lymphomas and mantle cell lymphomas. Treatment varies as per lymphoma subtype and requires joined-up assessment with the haematologists and radiologists. Typically treatment is local with low-dose radiation therapy being a standard option for localised disease, while systemic treatment may be used for more advanced cases. This lecture will provide an update about the biology, diagnostics and treatment of ocular adnexal lymphomas.
• Ocular Complications and Long-Term Care in Immunocompromised Pediatric Patients
  賴勇仁 Yung-Jen LaiTaiwan Speaker Ocular Complications and Long-Term Care in Immunocompromised Pediatric PatientsThis presentation provides a comprehensive overview of ocular complications in immunocompromised pediatric patients, drawing on the clinical experience of a tertiary referral center. We will outline the classification, diagnosis, and treatment protocols for opportunistic infections, with a specific focus on cytomegalovirus (CMV) retinitis and fungal chorioretinitis in children. Beyond acute infection control, we will discuss the critical management of long-term sequelae, including recurrences, tractional retinal detachment (TRD), and cataract formation. This session highlights the necessity of a systematic, multidisciplinary approach to preserve vision in this high-risk pediatric population.
• Inherited Retinal Disease-Associated Uveitis
  李岳章 Yueh-Chang LeeTaiwan Speaker Inherited Retinal Disease-Associated UveitisInherited retinal diseases (IRDs) are traditionally regarded as non-inflammatory disorders characterized by progressive photoreceptor degeneration. However, uveitis may occasionally occur in patients with IRDs, creating diagnostic challenges and influencing therapeutic decisions. This presentation highlights two clinically important scenarios illustrating this overlap: retinal pigmentary changes mimicking retinitis pigmentosa (RP) as a manifestation of advanced uveitis, and recurrent macular edema in advanced RP that responds to intravitreal anti-VEGF therapy. Chronic or recurrent posterior uveitis can produce pigmentary alterations resembling the bone-spicule pattern seen in RP, potentially leading to misdiagnosis of a primary inherited dystrophy. Correctly identifying inflammation-induced pigmentary change is essential, as addressing the underlying uveitis may alter disease course. Conversely, in patients with genetically confirmed RP, macular edema—often persistent or recurrent—may show meaningful improvement after anti-VEGF treatment, suggesting that secondary vascular leakage and inflammatory activity contribute to visual decline in these eyes. Emerging genetic and mechanistic reports suggest that inflammation may play a role in selected IRDs. Variants in genes such as CRB1, ALPK1, CAPN5, and VCAN1 have been associated with impaired retinal barrier function, activation of proinflammatory pathways, altered immune regulation, or abnormal vitreous architecture, each of which may increase susceptibility to inflammatory manifestations. While these findings are not universal across all IRDs, they provide potential explanations for cases in which uveitis precedes, accompanies, or complicates retinal degeneration. Recognizing these overlapping presentations is important for accurate interpretation of retinal findings, appropriate use of imaging and genetic testing, and individualized therapeutic planning, particularly in patients presenting with atypical features or unexplained inflammation.
• Discussion

• 眼瞼及眼窩專題演講會 Eyelid and Orbital Symposium
  蔡悅如 Yueh-Ju TsaiTaiwan Moderator Transcanalicular Diode Laser Assisted DacryocystorhinostomyTranscanalicular laser dacryocystorhinostomy is a minimally invasive surgical intervention for nasolacrimal duct obstruction. The procedure involves creating a direct osteotomy by advancing a laser fiber through the canaliculus to ablate the bone and soft tissue separating the lacrimal sac from the nasal cavity. This approach offers distinct advantages, including the absence of cutaneous scarring, superior hemostasis, and preservation of the physiological lacrimal pump mechanism; it also serves as an effective salvage technique for failed DCRs. We utilized an 810-nm diode laser, and a video demonstration of the intraoperative technique will be presented. Due to the reduced operative time and minimal bleeding, this procedure is well-suited for local anesthesia, making it particularly advantageous for elderly patients.

  蘇姵元 Pei-Yuan SuTaiwan Moderator

  許紋銘 Wen-Ming HsuTaiwan Moderator
• Nonspecific Idiopathic Orbital Inflammation Update
  胡佩欣 Pei-Shin HuTaiwan Speaker Nonspecific Orbital Inflammation UpdateNonspecific orbital inflammation (NSOI) remains one of the most challenging diagnostic entities in orbital disease due to its heterogeneous presentation and overlap with infectious, autoimmune, and neoplastic conditions. Traditionally considered a diagnosis of exclusion, NSOI now benefits from emerging imaging criteria, structured diagnostic algorithms, and increasing evidence supporting individualized management. This presentation integrates data from recent guideline development and a large evidence-based clinical cohort to provide a concise and practical framework for clinicians. Key components include updated classification systems, the role of MRI with diffusion-weighted imaging in differentiating NSOI from lymphoma or IgG4-related disease, and indications for biopsy when clinical or radiologic features are atypical or treatment response is inconsistent. Treatment strategies emphasize corticosteroid response patterns, recurrence predictors, and escalation pathways incorporating immunosuppressants, biologics such as rituximab, and selective radiotherapy. By combining high-level evidence with annotated imaging examples and treatment algorithms, this lecture aims to support accurate diagnosis, avoid misclassification, and improve long-term outcomes in patients with NSOI, especially those with recurrent or steroid-dependent disease.
• Endoscopic Removal of Orbital Apex Mass
  涂云海 Yunhai TuChina Speaker Endoscopic removal of orbital apex massThe orbital apex mass has always been a difficult point in orbital surgery. The anatomical space of the orbital apex is narrow, and transorbital surgery often leads to serious complications, even blindness. We have been committed to minimally invasive ophthalmic endoscopic surgery. Endoscopic transnasal surgery has opened up a new world for the removal of orbital apex tumors, and we gradually mastered the operation of dual instruments with both hands under endoscopy by one doctor. However, there is still no solution for the orbital apex mass upper lateral of the optic nerve . We designed a surgical approach combining endoscopic transnasal and transperiosteal space surgery. Starting from the foreign body in the orbital apex, continuous practice has been carried out to successfully remove the orbital apex mass upper lateral of the optic nerve. Thus, we have achieved a complete surgical system for endoscopic removal of orbital apex mass
• Computer-Assisted Navigation in Orbital Surgery
  蔡傑智 Chieh-Chih TsaiTaiwan Speaker Computer-Assisted Navigation in Orbital SurgeryOrbital surgery presents unique challenges due to the complex anatomy of the orbit and the close proximity of vital structures such as the optic nerve and extraocular muscles. Traditional freehand approaches rely heavily on surgical experience and anatomical estimation, which can limit precision in complex orbital surgery. Computer-assisted navigation (CAN) has emerged as a transformative tool to enhance surgical accuracy, safety, and predictability. This lecture will explore the principles and clinical applications of computer-assisted navigation in orbital surgery. Topics include image acquisition and 3D reconstruction, preoperative virtual planning, and real-time intraoperative guidance. Case examples will illustrate its use in orbital fracture repair, decompression for thyroid eye disease, and tumor excision. Patient-specific implants designed through advanced three-dimensional (3D) imaging, computer-aided design and computer-aided manufacturing will also be presented. In conclusion CAN has bridged radiologic imaging and operative execution, providing a safer and more precise approach to orbital surgery.
• Transforming TED Management: The Rise of Targeted Therapies and What the Evidence Tells Us
  魏以宣 Yi-Hsuan WeiTaiwan Speaker Transforming TED Management: The Rise of Targeted Therapies and What the Evidence Tells UsTreatment for thyroid eye disease (TED) has changed greatly with the development of new targeted biologic therapies. Research on IGF-1R, IL-6, and other potential targets for biologic therapy has been extensive in recent years. This talk will review how these therapies work, summarize key clinical findings, and share real-world experience. By combining current evidence and clinical insights, we will explore how targeted treatments are improving outcomes and transforming the management of TED.
• Update of Ocular Adnexal Lymphomas
  Sarah CouplandUnited Kingdom Speaker Uveal melanoma prognostication: beyond chromosome 3Prognosis for uveal melanoma (UM) is determined by a combination of clinical, histopathological, and molecular factors. Clinical markers include tumour size and location, while histopathological factors include cell type and mitotic activity. The Liverpool Ocular Oncology Centre has a long track record in UM prognostication, and has devised an algorithm (LUMPO3) for more precise risk stratification and identifying patients at high risk for metastasis. It is a multiparametric model, which also included genetic data, particularly chromosome 3 and 8. It has been demonstrated that BAP1 immunohistochemistry is a very close surrogate for the status of the BAP1 gene, which if mutated is associated with a poor prognosis in UM. Our recent work has investigated the inclusion of BAP1 immunohistochemistry in LUMPO3, in labs where chromosomal analysis is not available. Early detection of metastatic UM is critical, as the prognosis is poor once widespread metastases develop. If detected earlier, surgical and newer immunotherapy options have been demonstrated to prolong survival.Decoding intraocular masqueradeIntraocular lymphomas can be divided into 3 main subtypes: primary vitreoretinal lymphoma (VRL), primary choroidal lymphoma, and secondary intraocular lymphoma. VRL is a rare but aggressive form of non-Hodgkin lymphoma that affects the eye. The most common subtype is a Diffuse large cell B-cell lymphoma (DLBCL), and displays a similar morphology, immuno- and genetic profile to the primary CNS lymphomas. Indeed, VRL can relapse in the CNS, and similarly CNSL can involve the eye. VRL often "masquerades" as chronic uveitis, making early and accurate diagnosis challenging but crucial for effective treatment and improved prognosis. In contrast, primary choroidal lymphoma is an indolent non-Hodgkin lymphoma similar to the Marginal Zone B-cell lymphomas of the ocular adnexa, and do not spread to the CNS. This lecture will provide an update about the biology, diagnostics and treatment of VRL and choroidal lymphomas. It will also provide examples of differential diagnoses to consider in vitrectomy specimens.Update of Ocular Adnexal LymphomasOcular adnexal lymphomas are most commonly non-Hodgkin lymphomas (NHL) that develop in the conjunctiva, eyelid, lacrimal gland, and orbit. The most common subtype is an extranodal marginal zone lymphoma (EMZL), which often presents as a painless, salmon-coloured lesion on the conjunctiva or as a mass causing symptoms like proptosis, double vision, or swelling in the orbit. Other common NHL of the ocular adnexa include follicular lymphomas, diffuse large cell B-cell lymphomas and mantle cell lymphomas. Treatment varies as per lymphoma subtype and requires joined-up assessment with the haematologists and radiologists. Typically treatment is local with low-dose radiation therapy being a standard option for localised disease, while systemic treatment may be used for more advanced cases. This lecture will provide an update about the biology, diagnostics and treatment of ocular adnexal lymphomas.
• Precise Repair of Complex Orbital Fractures (Pre-recorded Video)
  盧葦 Wei LuChina Speaker Precise Repair of Complex Orbital FracturesZygomatic-orbito-maxillary fracture is a kind of complex orbital fracture with high morbidity, which can lead to severe physical dysfunction and deformity. The orbital mechanical environment has great influence on the fracture repair and reconstruction. If the internal fixation is not consistent with the mechanical environment after the reconstruction, it is easy to lead to complications such as poor fracture healing, implant deformation, malposition and even breakage, which not only bring trouble to patients, but also increase financial burden. This study developed finite element models of absorbable material and titanium material for repair and fixation, respectively. By applying a force of 120 N to the model to simulate the masseter muscle strength, the maximum stress and displacement of the repair materials and the fracture ends were measured. In discussing various models, the maximum stress values of absorbable and titanium materials are less than their yield strength, and the maximum displacement values of the titanium material and fracture end were less than 0.1 mm and 0.2 mm. The maximum displacement values of absorbable material and fracture end in incomplete zygomatic fracture and dislocation were less than 0.1 mm and 0.2 mm. While in the zygomatic complex complete fractures and dislocation, the maximum displacement values of the absorbable material and the fracture end exceeded 0.1 mm and 0.2 mm. In this study, the finite element biomechanical analysis method improved the operative success ratio of zygomatic-orbito-maxillary fracture and reduced postoperative complications, which provided a new research method and objective quantitative basis for the accurate treatment.
• Discussion
• 眼瞼及眼窩專題演講會 Eyelid and Orbital Symposium
  張丞賢 Cheng-Hsien ChangTaiwan Moderator

  廖述朗 Shu-Lang LiaoTaiwan Moderator

  褚晏彰 Yen-Chang ChuTaiwan Moderator
• Anatomical Nuances and Surgical Finesse in Asian Upper Blepharoplasty
  Kyung In Woo Speaker Anatomical Nuances and Surgical Finesse in Asian Upper BlepharoplastyAsian upper blepharoplasty, in our experience, benefits significantly from a profound understanding of the unique anatomical characteristics that distinctly differ from those of Caucasian eyelids. This lecture will focus on the subtle anatomical variations in the Asian eyelid, emphasizing the critical role of meticulous preoperative analysis and planning in achieving successful and natural-looking results. We will delve into key anatomical elements, including hidden ptosis, variations in eyelid heaviness, and epicanthus. Throughout this presentation, we aim to explore various surgical techniques specifically designed to meet the aesthetic expectations of Asian patients while maintaining functional stability. Furthermore, we will share some refined surgical finesse and considerations aimed at minimizing complications and maximizing natural outcomes. We will also share the practical strategies and techniques for addressing complications that can result from blepharoplasty. This lecture is designed to provide insights for ophthalmologists seeking to enhance their anatomical knowledge and surgical proficiency in Asian upper blepharoplasty.
• Transcanalicular Diode Laser Assisted Dacryocystorhinostomy
  蔡悅如 Yueh-Ju TsaiTaiwan Speaker Transcanalicular Diode Laser Assisted DacryocystorhinostomyTranscanalicular laser dacryocystorhinostomy is a minimally invasive surgical intervention for nasolacrimal duct obstruction. The procedure involves creating a direct osteotomy by advancing a laser fiber through the canaliculus to ablate the bone and soft tissue separating the lacrimal sac from the nasal cavity. This approach offers distinct advantages, including the absence of cutaneous scarring, superior hemostasis, and preservation of the physiological lacrimal pump mechanism; it also serves as an effective salvage technique for failed DCRs. We utilized an 810-nm diode laser, and a video demonstration of the intraoperative technique will be presented. Due to the reduced operative time and minimal bleeding, this procedure is well-suited for local anesthesia, making it particularly advantageous for elderly patients.
• From Injections to the Operating Table: Surgical Management of Blepharospasm or Hemifacial Spasm
  吳淑雅 Shu-Ya WuTaiwan Speaker From Injections to the Operating Table: Surgical Management of Benign Essential Blepharospasm Benign essential blepharospasm (BEB) is an adult-onset focal dystonia characterized by involuntary spasms of the periocular muscles, resulting in forced eyelid closure. Because the pathogenesis of BEB remains unclear, current management primarily aims at symptomatic relief. Botulinum toxin injection remains the first-line therapy, while surgical intervention is considered for patients with poor response to injections, or for those with eyelid deformities secondary to blepharospasm. Protractor myectomy can be performed as either a full or limited procedure. Currently, limited myectomy is preferred due to its superior cosmetic outcomes and lower complication rates. In addition, combining limited myectomy or eyelid corrective surgery with botulinum toxin injections can further optimize clinical outcomes. Apraxia of eyelid opening (AEO) is characterized by the paradoxical co-contraction of the orbicularis oculi and levator palpebrae muscles, often necessitating surgical management. Surgical strategies may involve either a single-stage or a two-stage approach. I personally favor the two-stage approach, as performing all procedures simultaneously can be technically challenging due to a higher risk of bleeding and hematoma formation. Staging the procedures allows for adequate assessment of the initial surgical results and more precise planning of subsequent interventions.
• Spatial Computing and Augmented Reality in Oculoplastic Surgery: Reimagining the Surgical Field
  Bobby S. KornUnited States Speaker Spatial Computing and Augmented Reality in Oculoplastic Surgery: Reimagining the Surgical FieldThe emergence of spatial computing headsets like the Apple Vision Pro is reshaping surgical visualization and education. In oculoplastic surgery, where precision and anatomical complexity are paramount, these tools offer immersive, real-time access to imaging and anatomical overlays without disrupting surgical flow.
• Principles for Natural, Symmetric, and Reliable Double Eyelid Surgery
  林宣君 Shan-Jiun LinTaiwan Speaker Principles for Natural, Symmetric, and Reliable Double Eyelid SurgeryThe fundamental principle for a natural result is the replication of the native anatomical connection between the anterior and posterior lamellae. Common issues that can produce an unnatural appearance include direct skin-to-posterior lamella fixation after orbicularis oculi muscle (OOM) disruption. Achieving symmetry extends beyond basic consistency in width and suture tension; it requires advanced adjustments based on individual patient anatomy, including levator function, eyelid thickness, and globe position (e.g., enophthalmos or proptosis). Reliability is secured by creating a stable, non-shallow fold, ensuring appropriate skin tightness, and maintaining a clear anatomical view of structures like orbital fat and the levator muscle during the procedure. The presentation also addresses common challenges and pitfalls, including the difficulty of precise measurement on aging or lax skin, the importance of patient marking in a seated position to account for gravity, and the cautious preservation of functional tissues, such as the orbicularis oculi muscle (OOM) and orbital septum, to prevent complications like lagophthalmos and facilitate potential future revisions.
• Discussion

• 視網膜專題演講會 Retina Symposium
  鄭成國 Cheng-Kuo ChengTaiwan Moderator Full Thickness Macular Hole: TRS Consensus of Surgical ManagementTo establish a consensus for surgical management of full-thickness macular hole (FTMH) and macular hole retinal detachment (MHRD). The Taiwan Retina Society (TRS) invited nine experienced vitreoretinal surgeons from Taiwan to participate in questionnaire for surgical management of FTMH and MHRD based on Delphi methodology. Among the 49 items, 30 items (61.2%) reached strong consensus after 2 rounds. For FTMH, strong consensus included routine internal limiting membrane (ILM) peeling in all stages of FTMH, ILM flap in large holes ≥ 400 μm, ILM flap covering technique, small peeling area < 5 mm diameter, preservation of adherent epiretinal membrane in the flap if it cannot be separated from ILM, C3F8 as preferred tamponade for ILM peeling alone but not in the presence of ILM flap, post-operative facedown position, simple intravitreal gas injection for early persistent holes, use of pedicle flap or SWIFT for persistent holes in previously small area-peeled macula. For MHRD, strong consensus included the use of ILM flap, ILM flap covering technique, preservation of adherent epiretinal membrane if it cannot be separated from ILM, C3F8 as preferred tamponade, post-operative ace down position, no intentional subretinal fluid drainage during air-fluid exchange in small RD area within arcade, intraoperative use of adjuvants. Strong consensus achieved in a significant portion of key questions frequently encountered in the management of FTMH and MHRD. Recommendations from this Delphi study helps in decision making for clinical practice.

  陳世真 Shih-Jen ChenTaiwan Moderator

  吳佩昌 Pei-Chang WuTaiwan Moderator
• ERM: TRS Consensus of Surgical Indication and Surgical Management
  黃德光 De-Kuang HwangTaiwan Speaker ERM: TRS Consensus of Surgical Indication and Surgical ManagementEpiretinal membrane (ERM) is common, yet the optimal timing and technique for surgery remain variably practiced. The Taiwan Retinal Society (TRS) convened a panel of experienced vitreoretinal surgeons to synthesize evidence and expert experience into practical consensus statements on surgical indications and management. The suggested clinical classification, evaluation, and surgical management (including timepoint and methods) were discussed during the meeting. All results and consensus will be showed in this presentation.
• Full Thickness Macular Hole: TRS Consensus of Surgical Management
  鄭成國 Cheng-Kuo ChengTaiwan Speaker Full Thickness Macular Hole: TRS Consensus of Surgical ManagementTo establish a consensus for surgical management of full-thickness macular hole (FTMH) and macular hole retinal detachment (MHRD). The Taiwan Retina Society (TRS) invited nine experienced vitreoretinal surgeons from Taiwan to participate in questionnaire for surgical management of FTMH and MHRD based on Delphi methodology. Among the 49 items, 30 items (61.2%) reached strong consensus after 2 rounds. For FTMH, strong consensus included routine internal limiting membrane (ILM) peeling in all stages of FTMH, ILM flap in large holes ≥ 400 μm, ILM flap covering technique, small peeling area < 5 mm diameter, preservation of adherent epiretinal membrane in the flap if it cannot be separated from ILM, C3F8 as preferred tamponade for ILM peeling alone but not in the presence of ILM flap, post-operative facedown position, simple intravitreal gas injection for early persistent holes, use of pedicle flap or SWIFT for persistent holes in previously small area-peeled macula. For MHRD, strong consensus included the use of ILM flap, ILM flap covering technique, preservation of adherent epiretinal membrane if it cannot be separated from ILM, C3F8 as preferred tamponade, post-operative ace down position, no intentional subretinal fluid drainage during air-fluid exchange in small RD area within arcade, intraoperative use of adjuvants. Strong consensus achieved in a significant portion of key questions frequently encountered in the management of FTMH and MHRD. Recommendations from this Delphi study helps in decision making for clinical practice.
• Classification and Management of Myopic Traction Maculopathy: A Consensus from the Taiwan Retina Society
  李承雍 Cheng-Yung LeeTaiwan Speaker Classification and Management of Myopic Traction Maculopathy: A Consensus from the Taiwan Retina SocietyWith the increasing prevalence of myopia, myopic traction maculopathy (MTM) has become more frequently encountered and often requires surgical management. However, its definitions, classifications, and treatment strategies remain inconsistent. To address the lack of standardized classification and management strategies, a panel of vitreoretinal specialists from the Taiwan Retina Society convened to develop a practical consensus. After reviewing current evidence, six key questions and corresponding statements were formulated through structured discussion and voting among ten panelists. MTM was defined as maculoschisis or maculoschisis with foveal disruption, encompassing lamellar macular hole, full-thickness macular hole, and macular hole with retinal detachment, the latter regarded as the end stage. A classification integrating the extent of maculoschisis and the type of foveal pathology was proposed. The panel emphasized the role of multimodal imaging, including optical coherence tomography, fundus photography, axial length measurement, and visual function assessment, in diagnosis and follow-up. Full-thickness macular hole and macular hole with retinal detachment were considered clear surgical indications, whereas surgery for maculoschisis or lamellar macular hole may be appropriate when visual deterioration occurs. The consensus recommends fovea-sparing internal limiting membrane peeling (foveola-ILM non-peeling) and the inverted internal limiting membrane flap technique as effective surgical approaches.
• Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina Society
  吳宗典 Tsung-Tien WuTaiwan Speaker Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina SocietyRhegmatogenous retinal detachment (RRD) is a significant cause of vision loss and requires appropriate surgical intervention. There are several approaches available, including observation, laser demarcation, pneumatic retinopexy, scleral buckling, and pars plana vitrectomy, which are chosen based on patient condition, surgeon experience, and national health insurance policies. Despite the various options, there is still no consensus on the optimal intervention. To address this, the Taiwan Retina Society assembled an expert committee with 11 experienced retina specialists to review the current evidence and develop a guideline with seven recommendations for managing RRD patients. Additionally, a survey was conducted with six questions to assess treatment patterns in Taiwan, which included input from the expert committee and an open poll at the 2023 Congress of the Taiwan Retina Society. This report provides a comprehensive summary of the current knowledge and expert consensus on the treatment of RRD, discussing the characteristics of current approaches and providing an overview of current treatment patterns in Taiwan. These findings aim to provide ophthalmologists with the best possible treatment for RRD.
• Discussion
• 視網膜專題演講會 Retina Symposium
  吳宗典 Tsung-Tien WuTaiwan Moderator Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina SocietyRhegmatogenous retinal detachment (RRD) is a significant cause of vision loss and requires appropriate surgical intervention. There are several approaches available, including observation, laser demarcation, pneumatic retinopexy, scleral buckling, and pars plana vitrectomy, which are chosen based on patient condition, surgeon experience, and national health insurance policies. Despite the various options, there is still no consensus on the optimal intervention. To address this, the Taiwan Retina Society assembled an expert committee with 11 experienced retina specialists to review the current evidence and develop a guideline with seven recommendations for managing RRD patients. Additionally, a survey was conducted with six questions to assess treatment patterns in Taiwan, which included input from the expert committee and an open poll at the 2023 Congress of the Taiwan Retina Society. This report provides a comprehensive summary of the current knowledge and expert consensus on the treatment of RRD, discussing the characteristics of current approaches and providing an overview of current treatment patterns in Taiwan. These findings aim to provide ophthalmologists with the best possible treatment for RRD.

  陳珊霓 San-Ni ChenTaiwan Moderator Surgical techniques in the management of PDR: Taiwan ConsensusPars plana vitrectomy (PPV) is the main treatment modality for patients with severe diabetic retinopathy. With the development of systems for microincision, wide-angle viewing, digitally assisted visualization, and intraoperative optical coherence tomography, contemporary PPV for diabetic retinopathy has been performed on a wider range of indications than previously considered. In this article, we reviewed, in conjunction with our collective experiences with Asian patients, the applications of new technologies for PPV in eyes with diabetic retinopathy and highlighted several important procedures and entities not generally reiterated in the literature, in order for vitreoretinal surgeons to optimize their approaches when facing the challenges imposed by the complications in diabetic eyes.

  吳為吉 Wei-Chi WuTaiwan Moderator
• ROP: Consensus of Pediatric Retina Group
  賴佐庭 Tso-Ting LaiTaiwan Speaker ROP: Consensus of Pediatric Retina GroupOBJECTIVE: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness, particularly in preterm infants. In Taiwan, the absence of national guidelines and the variability in clinical practice have highlighted the need for locally adapted consensus recommendations. METHODS: An expert panel of eleven ophthalmologists from eight tertiary centers in Taiwan convened to develop a consensus on ROP management. Through a structured process that included key question formulation, systematic literature review, iterative discussion, and voting, the panel established consensus statements. Agreement was defined as >/=75% of panelists voting "agree" or "strongly agree" using a five-point Likert scale. RESULTS: Consensus recommendations were developed across three major domains: screening, treatment, and follow-up. For screening, the panel endorsed criteria commonly used in Taiwan-gestational age <32 weeks or birth weight <1500 g-but emphasized the need for population-based validation. Both anti-vascular endothelial growth factor (VEGF) agents and laser photocoagulation were recognized as acceptable first-line treatments for type 1 ROP, with individualized treatment decisions based on disease characteristics, anesthesia risk, and follow-up capacity. Guidelines were also established for the management of ROP reactivation, procedural protocols, and agent selection. For follow-up, the panel recommended extended surveillance after anti-VEGF therapy and outlined the criteria for identifying and monitoring persistent avascular retina. Follow-up schedules were proposed to detect long-term ocular and neurodevelopmental complications. CONCLUSIONS: This consensus provides updated evidence-based guidance for ROP care in Taiwan, addressing both traditional and emerging clinical challenges. These recommendations aim to standardize care practices while remaining adaptable to future research and evolving clinical needs.What Else Behind Diabetic Retinopathy Beside Anti-VEGF?Diabetic retinopathy (DR) has long been characterized as a microvascular disease, and anti-VEGF therapy remains one of the standard treatments for its sight-threatening complications. However, accumulating evidence demonstrates that DR is a complex neurovascular disorder in which neurodegeneration, oxidative stress, chronic inflammation, dysregulated cell death pathways, and impaired autophagy play central roles. Preclinical studies highlight early retinal neurodegeneration, glial dysfunction, and microglia-mediated inflammation as substantial contributors to DR development and progression, which might precede clinically visible vascular changes. Oxidative stress is another major driver, triggering mitochondrial injury, endothelial dysfunction, and aberrant programmed cell death—including apoptosis, pyroptosis, and necroptosis—which further accelerates neurovascular impairment. A growing body of experimental work has explored therapeutic strategies beyond VEGF suppression. Antioxidants such as astaxanthin have been shown to restore autophagy and enhance Nrf2-mediated defense mechanisms in photoreceptors under high-glucose stress—findings demonstrated in our own studies. Similarly, targeting inflammatory pathways with agents such as fenofibrate or cilostazol has been shown to reduce inflammatory mediators, oxidative damage, and retinal apoptosis in diabetic models. Additional approaches, including fibroblast growth factor 1 treatment and interventions aimed at preventing high-glucose-induced cellular senescence, further underscore the multifaceted nature of DR pathophysiology. Together, these insights suggest that DR extends far beyond vascular endothelial dysfunction, and effective long-term management may require therapies targeting oxidative stress, inflammation, neuroprotection, autophagy regulation, and metabolic resilience. This talk will review these emerging mechanisms and discuss future therapeutic perspectives that complement, rather than replace, anti-VEGF therapy.
• Surgical techniques in the management of PDR: Taiwan Consensus
  陳珊霓 San-Ni ChenTaiwan Speaker Surgical techniques in the management of PDR: Taiwan ConsensusPars plana vitrectomy (PPV) is the main treatment modality for patients with severe diabetic retinopathy. With the development of systems for microincision, wide-angle viewing, digitally assisted visualization, and intraoperative optical coherence tomography, contemporary PPV for diabetic retinopathy has been performed on a wider range of indications than previously considered. In this article, we reviewed, in conjunction with our collective experiences with Asian patients, the applications of new technologies for PPV in eyes with diabetic retinopathy and highlighted several important procedures and entities not generally reiterated in the literature, in order for vitreoretinal surgeons to optimize their approaches when facing the challenges imposed by the complications in diabetic eyes.
• Risk Factors Associated with Sight Threatening Diabetic Retinopathy (STDR) Severity and Progression in Diabetes Mellitus (DM) Patients
  許淑娟 Shwu-Jiuan SheuTaiwan Speaker Risk factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patientsPurpose: This study aims to examine factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patients. Specifically, we focus on the initial HbA1C at diagnosis, its change at ophthalmologic visit and medication adherence (MR). Research Design and Methods: A prospective study involving 300 type II DM patients (≥20 years) was conducted from July 2022 to January 2024. MR was assessed using the Taiwanese version of the Morisky Medication Adherence Scale-8 (MMAS-8). DR progression was evaluated through a defined clinical scoring system. Statistical analyses included chi-square tests and logistic regression to examine the factors associated with STDR severity and progression. Results: After excluding 122 patients for missing data, 178 participants were analyzed. Changes in HbA1c were strongly associated with STDR. Both improvements and deteriorations or sustained high in HbA1c levels were linked to an increased likelihood of advanced DR scores compared to sustained low group. Those with sustained high HbA1c had the most impact. High initial HbA1c had a greater impact on females, age <65, patients lacking exercise or diet control. Patients with low or moderate MR showed significantly higher HbA1c level at ophthalmologic visit, and increased risk developing STDR. Age ≥65 years was a protective factor against higher DR scores. Conclusions: This study highlights the relationship between initial blood glucose levels at diabetes diagnosis, and subsequent HbA1c change during ophthalmology visits concerning DR severity and progression. High initial HbA1c might indicate the need for frequent ophthalmic visit.
• Hidden Variants in Inherited Retinal Degeneration and Their Impact on Gene-Targeted Treatment
  陳達慶 Ta-Ching ChenTaiwan Speaker Hidden Variants in Inherited Retinal Degeneration and Their Impact on Gene-Targeted TreatmentIn this short talk, we would like to share the experience about systematically identifying pathogenic splicing variants and characterizing their transcript-level consequences to enhance the the molecular diagnosis of inherited retinal degeneration (IRD). In 738 IRD families, a splicing variant detection pipeline, integrating two computational algorithms (SpliceAI and dbscSNV_ADA) with functional validation via minigene assays, was implemented to detect splice-disrupting variants beyond canonical sites. Splicing variants accounted for 14% of genetically diagnosed families. Of these, 4% were newly identified through our combined computational and experimental platform. Notably, 28% of all splice-disrupting variants, located in noncanonical, exonic, or deep-intronic regions, would likely have been missed by conventional analysis pipelines, which typically prioritize protein-coding changes and canonical splice sites, and often lack systematic evaluation of splicing effects beyond these regions. Five recurrent splice-disrupting variants were observed across multiple families, including EYS:c.5644+5G>A, which caused exon truncation and was found in 11 unrelated families. Functional assays confirmed aberrant splicing, and the associated phenotypes were consistent with known disease presentations. This study demonstrates the utility of a combined splicing variant detection platform in uncovering hidden pathogenic variants and improving IRD diagnostic yield. These findings have implications for refining genetic testing and guiding the development of splicing-targeted therapies.
• Discussion
• Break
• 視網膜專題演講會 Retina Symposium
  Taiji SakamotoJapan Moderator My journey of retinal detachmentIn the 1990s, I began studying retinal detachment (RD) as a model for neuronal degeneration, particularly apoptosis. I discovered that necrotic retinal cells release highly toxic substances, but the vitreous body neutralizes them. Taking advantage of this, we developed a vitreous surgery method using hyaluronic acid. Subsequently, I worked as a surgeon to treat RD. At that time, vitreous surgery was extremely challenging because we could not visualize the retina or vitreous during surgery. Observing success in simplifying ILM peeling with ICG staining, I developed a method to visualize the vitreous using triamcinolone. Lacking knowledge about patents (At that time, we were already using this method), I initially let another doctor publish the first report, but later we conducted a prospective comparative study demonstrating that triamcinolone-assisted vitrectomy made the surgery safer. Our group then developed a safer vital dye called brilliant blue, which is now used worldwide. While surgical techniques improved, the subjective nature of surgery made objective assessment difficult. To address this issue, I believed a national retinal RD was necessary and established the Japan RD Registry to collect data. Our findings revealed the reality of RD treatment in Japan, including a significant result that in more conservative regions, women were less likely to undergo surgery. This highlighted the need for societal intervention to ensure all patients receive care. Despite my efforts to avoid social activities by focusing on basic medicine and RD treatment, I concluded that improving society was essential to effectively treat RD.

  許淑娟 Shwu-Jiuan SheuTaiwan Moderator Risk factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patientsPurpose: This study aims to examine factors associated with sight threatening diabetic retinopathy (STDR) severity and progression in diabetes mellitus (DM) patients. Specifically, we focus on the initial HbA1C at diagnosis, its change at ophthalmologic visit and medication adherence (MR). Research Design and Methods: A prospective study involving 300 type II DM patients (≥20 years) was conducted from July 2022 to January 2024. MR was assessed using the Taiwanese version of the Morisky Medication Adherence Scale-8 (MMAS-8). DR progression was evaluated through a defined clinical scoring system. Statistical analyses included chi-square tests and logistic regression to examine the factors associated with STDR severity and progression. Results: After excluding 122 patients for missing data, 178 participants were analyzed. Changes in HbA1c were strongly associated with STDR. Both improvements and deteriorations or sustained high in HbA1c levels were linked to an increased likelihood of advanced DR scores compared to sustained low group. Those with sustained high HbA1c had the most impact. High initial HbA1c had a greater impact on females, age <65, patients lacking exercise or diet control. Patients with low or moderate MR showed significantly higher HbA1c level at ophthalmologic visit, and increased risk developing STDR. Age ≥65 years was a protective factor against higher DR scores. Conclusions: This study highlights the relationship between initial blood glucose levels at diabetes diagnosis, and subsequent HbA1c change during ophthalmology visits concerning DR severity and progression. High initial HbA1c might indicate the need for frequent ophthalmic visit.

  陳建同 Jiann-Torng ChenTaiwan Moderator
• Sub-Retinal AAV-RS1 Gene Therapy for X Linkage Retinoschisis: One Year Follow Up (Pre-recorded video)
  Fang LuChina Speaker Sub-retinal AAV-RS1 gene therapy for X linkage retinoschisis: one year follow upDepartment of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China X-linked retinoschisis (XLRS) is a rare congenital disease of the retina caused by mutations in the RS1 gene, which encodes retinoschisin, a protein involved in intercellular adhesion and likely retinal cellular organization. With a prevalence of about 1 in 15,000 to 30,000, XLRS is one of the main causes of juvenile macular degeneration in males. Previous gene therapy showed significant structure and function promotion in animal research, however, failed to achieve significant efficacy in clinical trials in XLRS patients with intra-vitreal delivery. Here we report the efficacy and safety of a small sample trial with sub-retinal delivery of AAV carrying human RS1 gene in 12 pediatric XLRS patients.
• Pediatric Retinal Detachment Following Penetrating Keratoplasty (Pre-recorded video)
  盧海 Hai LuChina Speaker Pediatric Retinal Detachment following Penetrating KeratoplastyPediatric penetrating keratoplasty can usually be multiple procedures. Repeated invasive intraocular operations may cause long-term intraocular changes in both the anterior and posterior segments including retinal detachment. The management of pediatric retinal detachment following penetrating keratoplasty can be more challenging duo to small and hazy cornea conditions. Vitrectomy is usually the choice of surgery and the postop prognosis of both retina and graft remain unfavorable.
• Surgical Treatment of Uveal Tumors
  梁建宏 Jian Hong LiangChina Speaker Surgical Treatment of Uveal TumorsMalignant and benign tumors of the uvea (iris, ciliary body, and choroid) are often challenging in clinical treatment. The surgical removal of tumors is based on vitreoretinal surgery techniques and is one of the very effective methods for treating uveal tumors. However, the surgery is quite complex and different surgical approaches need to be selected mainly depending on the size, location and malignancy of the tumor.
• My Journey of Retinal Detachment
  Taiji SakamotoJapan Speaker My journey of retinal detachmentIn the 1990s, I began studying retinal detachment (RD) as a model for neuronal degeneration, particularly apoptosis. I discovered that necrotic retinal cells release highly toxic substances, but the vitreous body neutralizes them. Taking advantage of this, we developed a vitreous surgery method using hyaluronic acid. Subsequently, I worked as a surgeon to treat RD. At that time, vitreous surgery was extremely challenging because we could not visualize the retina or vitreous during surgery. Observing success in simplifying ILM peeling with ICG staining, I developed a method to visualize the vitreous using triamcinolone. Lacking knowledge about patents (At that time, we were already using this method), I initially let another doctor publish the first report, but later we conducted a prospective comparative study demonstrating that triamcinolone-assisted vitrectomy made the surgery safer. Our group then developed a safer vital dye called brilliant blue, which is now used worldwide. While surgical techniques improved, the subjective nature of surgery made objective assessment difficult. To address this issue, I believed a national retinal RD was necessary and established the Japan RD Registry to collect data. Our findings revealed the reality of RD treatment in Japan, including a significant result that in more conservative regions, women were less likely to undergo surgery. This highlighted the need for societal intervention to ensure all patients receive care. Despite my efforts to avoid social activities by focusing on basic medicine and RD treatment, I concluded that improving society was essential to effectively treat RD.
• Uveal Melanoma Prognostication: Beyond Chromosome 3
  Sarah CouplandUnited Kingdom Speaker Uveal melanoma prognostication: beyond chromosome 3Prognosis for uveal melanoma (UM) is determined by a combination of clinical, histopathological, and molecular factors. Clinical markers include tumour size and location, while histopathological factors include cell type and mitotic activity. The Liverpool Ocular Oncology Centre has a long track record in UM prognostication, and has devised an algorithm (LUMPO3) for more precise risk stratification and identifying patients at high risk for metastasis. It is a multiparametric model, which also included genetic data, particularly chromosome 3 and 8. It has been demonstrated that BAP1 immunohistochemistry is a very close surrogate for the status of the BAP1 gene, which if mutated is associated with a poor prognosis in UM. Our recent work has investigated the inclusion of BAP1 immunohistochemistry in LUMPO3, in labs where chromosomal analysis is not available. Early detection of metastatic UM is critical, as the prognosis is poor once widespread metastases develop. If detected earlier, surgical and newer immunotherapy options have been demonstrated to prolong survival.Decoding intraocular masqueradeIntraocular lymphomas can be divided into 3 main subtypes: primary vitreoretinal lymphoma (VRL), primary choroidal lymphoma, and secondary intraocular lymphoma. VRL is a rare but aggressive form of non-Hodgkin lymphoma that affects the eye. The most common subtype is a Diffuse large cell B-cell lymphoma (DLBCL), and displays a similar morphology, immuno- and genetic profile to the primary CNS lymphomas. Indeed, VRL can relapse in the CNS, and similarly CNSL can involve the eye. VRL often "masquerades" as chronic uveitis, making early and accurate diagnosis challenging but crucial for effective treatment and improved prognosis. In contrast, primary choroidal lymphoma is an indolent non-Hodgkin lymphoma similar to the Marginal Zone B-cell lymphomas of the ocular adnexa, and do not spread to the CNS. This lecture will provide an update about the biology, diagnostics and treatment of VRL and choroidal lymphomas. It will also provide examples of differential diagnoses to consider in vitrectomy specimens.Update of Ocular Adnexal LymphomasOcular adnexal lymphomas are most commonly non-Hodgkin lymphomas (NHL) that develop in the conjunctiva, eyelid, lacrimal gland, and orbit. The most common subtype is an extranodal marginal zone lymphoma (EMZL), which often presents as a painless, salmon-coloured lesion on the conjunctiva or as a mass causing symptoms like proptosis, double vision, or swelling in the orbit. Other common NHL of the ocular adnexa include follicular lymphomas, diffuse large cell B-cell lymphomas and mantle cell lymphomas. Treatment varies as per lymphoma subtype and requires joined-up assessment with the haematologists and radiologists. Typically treatment is local with low-dose radiation therapy being a standard option for localised disease, while systemic treatment may be used for more advanced cases. This lecture will provide an update about the biology, diagnostics and treatment of ocular adnexal lymphomas.
• Discussion
• Closing
  陳建同 Jiann-Torng ChenTaiwan Speaker