陳達慶 醫師

• Opening Remarks
  王一中 醫師Taiwan Speaker

  林慧茹 醫師Taiwan Speaker Advances in Artificial Intelligence Models and Algorithms in Amblyopia and Strabismus Review of Artificial Intelligence (AI) models that detect strabismus and amblyopia risk factors from smartphone photos, videos, and images, facilitating large-scale, accessible community screening. Discussion on how AI is personalizing amblyopia therapy, thereby maximizing efficacy and engagement. Critical appraisal of the requirements for clinical validation, regulatory approval, and the ethical integration of these AI tools into standard ophthalmic practice. AI is poised to fundamentally reshape the management of strabismus and amblyopia by introducing unprecedented levels of objectivity, accessibility, and personalization. the knowledge to understand, evaluate, and eventually integrate these powerful technologies into their practice to improve patient outcomes. AI screening and diagnosis to treatment optimization and monitoring.
• Cornea / Anatomy
  林慧茹 醫師Taiwan Moderator Advances in Artificial Intelligence Models and Algorithms in Amblyopia and Strabismus Review of Artificial Intelligence (AI) models that detect strabismus and amblyopia risk factors from smartphone photos, videos, and images, facilitating large-scale, accessible community screening. Discussion on how AI is personalizing amblyopia therapy, thereby maximizing efficacy and engagement. Critical appraisal of the requirements for clinical validation, regulatory approval, and the ethical integration of these AI tools into standard ophthalmic practice. AI is poised to fundamentally reshape the management of strabismus and amblyopia by introducing unprecedented levels of objectivity, accessibility, and personalization. the knowledge to understand, evaluate, and eventually integrate these powerful technologies into their practice to improve patient outcomes. AI screening and diagnosis to treatment optimization and monitoring.

  孫逸珍 醫師Taiwan Moderator
• Outcomes of 320-degree Intrastromal Corneal Ring Segment Implantation for Advanced Keratoconus
  陳南妮 醫師Taiwan Speaker Prepared and Ready for Your First Refractive SurgeryEvidence-based recommendations for KLEx in clinical practice -preoperative screening for keratoconus -surgical planning -management and prevention of complications and infection.
• Emergence Point of the Infratrochlear Nerve With Reference to the Nasion and Its Clinical Implications in Craniofacial Surgery
  Hyun Jin ShinKorea (Republic of) Speaker Emergence Point of the Infratrochlear Nerve With Reference to the Nasion and Its Clinical Implications in Craniofacial SurgeryAbstract Infratrochlear nerve (ITN) block is widely utilized for achieving surgical anesthesia, reducing postoperative pain, and treating neuralgia. The aim of this study was to identify the emerging point of the ITN (EP-ITN) in the medial orbital margin with reference to the nasion in order to enhance the effectiveness of regional ITN block in craniofacial surgery. Thirty-eight hemifaces from 19 embalmed Korean cadavers were dissected. Measurements were made of the vertical distances from the EP-ITN to key landmarks such as the nasion, the inferior border of the trochlea, and the medial canthus. The study also analyzed facial morphology by measuring the horizontal and vertical dimensions of the midface and orbit. The spatial relationships between these landmarks and the EP-ITN relative to the dimensions of the midface and orbit were also evaluated. The distances from the EP-ITN to the nasion, trochlea, and medial canthus were 1.6±1.3 mm (mean±standard deviation), 19.7±1.7 mm, and 11.7±2.0 mm, respectively. The distance between the trochlea and the EP-ITN also tended to increase as the horizontal dimensions of the midface and orbit increased. However, the dimensions of the midface and orbit did not significantly affect the distance from the nasion to the EP-ITN. In conclusion, the nasion is located nearer to the EP-ITN than to other landmarks and maintains a consistent spatial relationship that is unaffected by variations in the size of the midface or orbit. This means that it can serve as a reliable external landmark for guiding the ITN block technique.
• Mouse Meibomian Gland Progenitor Cell Organoids as an In Vitro Model of Acinar and Ductal Differentiation
  Sun Woong KimKorea (Republic of) Speaker Mouse Meibomian Gland Progenitor Cell Organoids as an In Vitro Model of Acinar and Ductal DifferentiationPurpose: Recent studies have shown that two-dimensional (2D) culture of primary rabbit and immortalized human meibomian gland epithelial cells (iHMGEC) do not recapitulate normal meibocyte differentiation, but 3D-spheroid culture of iHMGEC can facilitate meibocyte differentiation. The purpose of this study was to develop mouse meibomian gland (MG) organoid which can be capable of differentiating to MG acini and duct. Methods: Mouse meibomian gland epithelial cells were isolated and were suspended in matrigel/basement membrane matrix and grown in proliferation media supplemented with Rock inhibitor (Y-27632), Noggin, A8301, FGF10, and Rspondin1 to form adult progenitor cell clusters or spheroids. Cells were then differentiated with serum-free, differentiation media with or without synthetic agonists for the nuclear lipid receptor, peroxisome proliferator activator receptor gamma (PPARγ). Cells were then evaluated for differentiation markers using western blotting, immunocytochemistry (ICC) and real-time PCR. Results: The 3D culture induced the formation of KRT5+ spheroids that were enriched with Lrig1+, Sox9+, and Lgr6+ cells at the outer layer. These MG progenitor cell organoids can be passaged more than 30 times and were still capable of developing MG-like phenotypes as indicated by lipid synthesis as well as expression of essential proteins related to meibum synthesis. When MG progenitor cell organoids were switched to differentiation media containing PPARγ agonists, accumulation of lipid droplets and cell death were observed in the center of organoids, which demonstrates that these progenitor cell organoids can differentiate and response to differentiation signals. Meibocyte differentiation marker, AWAT2+/PPARγ+ were expressed in acini-like organoid and KRT6a+ duct like organoids were also formed. Some organoids showed both duct and acini phenotypes. Conclusions: The 3D culturing of mouse MG progenitor cells can induce the formation of both acini and ductal organoids and may thus serve as a better in vitro model system for studying the regulatory mechanisms controlling meibomian gland function. Mimicking MG homeostasis, the outer layer of MG organoids is composed of proliferating cells that migrate inward, undergo terminal differentiation and generating lipid-filled meibocytes.
• Break
• Neuro-ophthalmology / Glaucoma
  王安國 醫師Taiwan Moderator Upshooting Eye After TED IR Myectomy: How Do We Manage? Two TED patients received IR myectomy for hypotropoia. They developed upshooting eyes with severe limitation of infraduction postoperatively. We collaborated with ENT surgeon using endoscopic surgery with navigation system to identify the proximal stump of IR, and repair with non-absorbable suture. Both patients recovered their binocular vision after the operation.

  呂大文 醫師Taiwan Moderator
• Association between Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy (Pre-recorded video)
  周建志 醫師Taiwan Speaker
• Monitoring Changes in Optic Nerve Thickness Using OCT in Patients with Pseudopapilledema Associated with Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS)
  Min Chae KangKorea (Republic of) Speaker Monitoring Changes in Optic Nerve Thickness Using OCT in Patients with Pseudopapilledema Associated with Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS)This study investigated longitudinal changes in optic nerve thickness using spectral-domain optical coherence tomography (SD-OCT) in patients with pseudopapilledema associated with peripapillary hyperreflective ovoid mass-like structures (PHOMS). Ninety-two eyes from 48 patients were evaluated, and peripapillary retinal nerve fiber layer (pRNFL) thickness was measured in five sectors (average, superior, inferior, temporal, and nasal) for up to 24 months. Eyes were classified as either “with increase in pRNFL thickness” or “without increase,” based on an average pRNFL increase of ≥5 μm compared with the previous measurement and a monthly rate of ≥10 μm. Sixty-four eyes showed no increase, while 28 demonstrated thickening. Age, sex, refractive error, and time to maximal thickening did not differ significantly between groups. The group with thickness increase had greater average (116.95 ± 29.41 vs. 106.87 ± 19.02, p = 0.034) and inferior (161.18 ± 60.12 vs. 136.63 ± 28.01, p = 0.034) sectoral values. Changes from the previous measurement were larger in this group for the average (0.81 ± 16.02 vs. −3.43 ± 12.50, p = 0.029) and inferior (4.73 ± 35.08 vs. −5.10 ± 16.11, p = 0.013) sectors, with the inferior sector showing the greatest change (p = 0.037). The monthly rate of change was also higher across several sectors in eyes with increased thickness. These results suggest that PHOMS-related pseudopapilledema demonstrates dynamic optic nerve morphology, and that inferior sector pRNFL fluctuations on OCT may serve as a useful indicator of optic nerve changes in these patients.
• Deep Learning for Differentiating Glaucomatous and Non-glaucomatous Optic Neuropathy with Retinal Nerve Fiber Layer and Optic Disc Photographs
  Yun Jeong LeeSouth Korea Speaker Deep Learning for Differentiating Glaucomatous and Non-glaucomatous Optic Neuropathy with Retinal Nerve Fiber Layer and Optic Disc PhotographsPurpose: To develop a deep learning (DL)-based algorithm to differentiate glaucomatous optic neuropathy (GON) and non-glaucomatous optic neuropathy (NGON) with retinal nerve fiber layer (RNFL) and optic disc photographs. Methods: A total of 765 image pairs (618 GON, 147 NGON) were retrospectively collected and preprocessed using histogram matching and region-of-interest cropping based on Hough circle detection. An external validation dataset consisting of 177 pairs (103 GON, 74 NGON) was also used. DL models were developed using ResNet34 for optic disc images and DenseNet121 for RNFL images, with feature-level fusion implemented via cross-attention mechanisms. Model training involved data augmentation, class imbalance correction, and five-fold cross-validation. Model interpretability was assessed using Grad-CAM visualization. Results: The proposed model demonstrated robust performance in both internal and external datasets. In the internal validation set, the DL model achieved an AUC of 0.98 with the RNFL images, which was comparable to that with the optic disc (AUC of 0.99, P = 0.23) or combined RNFL and optic disc images (AUC of 0.98, P = 0.70), and was significantly superior to that with the masked RNFL (AUC of 0.94, P < 0.05) or combined masked RNFL and optic disc images (AUC of 0.96, P < 0.05). In the external validation set, the fusion model integrating both RNFL and optic disc images achieved superior diagnostic performance compared to single-modality models, with the highest AUC (0.88). Conclusions: The proposed multi-input DL model effectively differentiates between GON and NGON using RNFL and optic disc photographs. By integrating structural features via cross-attention, the model achieves consistent diagnostic performance, even in external datasets. This suggests the potential value of our DL model in clinical practice by helping clinicians make accurate diagnoses and treatment decisions.
• Break
• Retina
  楊嶺 醫師Taiwan Moderator

  陳達慶 醫師Taiwan Moderator 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.
• Cross-Sectional Analysis of Outer Retinal Tubulation in Inherited Retinal Diseases: A Multicenter Study (Pre-recorded video)
  劉沛綱 醫師Taiwan Speaker
• Use of Sodium-Glucose Co-Transporter 2 Inhibitors in Patients With Type 2 Diabetes and the Incidence of Retinal Vein Occlusion in Taiwan
  蔡厚任 醫師Taiwan Speaker
• Updated Retinoblastoma Incidence and Outcome in Children in Taiwan from 1980 to 2019: A 40-year Nationwide Study
  廖恩泰 醫師Taiwan Speaker
• High Prevalence of Exon-13 Variants in USH2A-related Retinal Dystrophies in Taiwanese Population
  林育薇 醫師Taiwan Speaker
• Rearrange Anatomy Inputs Like LEGO Bricks: Applying InSSS-P and a Mobile-Dense Hybrid Network to Distill Vascular Significance From Retina OCT-Angiography
  張高榮 醫師Taiwan Speaker
• Pseudophakic Cystoid Macular Edema (PCME): The Central Role of Lens Removal and Anterior Uveal Remodeling
  Sung who ParkKorea (Republic of) Speaker Pseudophakic Cystoid Macular Edema (PCME): The Central Role of Lens Removal and Anterior Uveal RemodelingBackground: PCME, commonly manifesting 4 to 12 weeks following cataract surgery, is characterized by increased vascular permeability. While its high responsiveness to topical NSAIDs suggests prostaglandin involvement, key paradoxes remain: Why is PCME frequently induced by the relatively simple cataract procedure, yet rarely follows more invasive surgeries like vitrectomy or trabeculectomy? And how do topical NSAIDs achieve therapeutic efficacy at the macula despite anatomical barriers such as the cornea and continuous aqueous flow? Hypothesis and Methods: We hypothesize that the pathological trigger is not generalized surgical trauma, but the structural changes caused by crystalline lens removal. The replacement of the large, heavy crystal lens with a small, lightweight intraocular lens necessitates adaptive remodeling of the anterior uvea. We propose that this remodeling results in prostaglandin release from this key pathological structure. To verify this, we conducted two studies analyzing PCME incidence after vitrectomy alone versus phacovitrectomy. Results: Our findings demonstrated that PCME incidence is significantly higher following phacovitrectomy compared to vitrectomy alone, strongly implicating lens removal as the main trigger for the syndrome. Furthermore, PCME was effectively reduced by topical NSAID administration after phacovitrectomy but was not significantly affected by the same treatment following vitrectomy alone. Conclusion: PCME pathogenesis is redefined by circumstances changes induced by crystalline lens removal, leading to prostaglandin release mediated by the anterior uvea. This novel model challenges the traditional view that PCME is solely a consequence of non-specific surgical inflammation, offering a precise anatomical target for both research and prophylaxis.

• 視網膜專題演講會 Retina Symposium
  鄭成國 醫師Taiwan 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 醫師Taiwan Moderator

  吳佩昌 醫師Taiwan Moderator
• Opening
  陳建同 醫師Taiwan Speaker
• ERM: TRS Consensus of Surgical Indication and Surgical Management
  黃德光 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan Moderator
• ROP: Consensus of Pediatric Retina Group
  賴佐庭 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan 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 醫師Taiwan Moderator
• Sub-Retinal AAV-RS1 Gene Therapy for X Linkage Retinoschisis: One Year Follow Up (Pre-recorded video)
  陸方 醫師China 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 醫師China 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 醫師China 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 醫師Taiwan Speaker