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EN
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林慧茹 Hui-Ju LinTaiwan
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.
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林慧茹 Hui-Ju LinTaiwan
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.
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陳南妮 Nan-Ni ChenTaiwan
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.
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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.
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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.
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王安國 An-Guor WangTaiwan
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.
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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.
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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.
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陳達慶 Ta-Ching ChenTaiwan
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.
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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.
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ZH
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馬惠康 David Hui-Kang MaTaiwan
Moderator
Cultivated Oral/Nasal Mucosal Epithelial Sheets for Ocular Surface Reconstruction in TaiwanBackground
To investigate the in vivo epithelial phenotypes of cultivated nasal mucosal epithelial cell (CUNMEC) sheets generated by a microspheroidal suspension culture technique.
Methods
Human nasal mucosal tissues were obtained during DCR. The tissues were digested with 2 mg/mL collagenase A, then the cell aggregates were seeded onto a de-epithelialized AM and cultivated for 2 weeks. The CUNMEC sheets were then transplanted into New Zealand albino rabbits. The animals were subjected to immunosuppression for two weeks and then sacrificed. The samples were subjected to light and electron microscopy (EM) and immunoconfocal microscopy examinations.
Results
The presence of CUNMECs in rabbit eyes was confirmed by anti-human cytoplasmic
antibody staining. Keratins 3, 4, and 13 were positively expressed in the suprabasal
region, whereas p63 expression was observed only in the basal layer. Transmission
EM revealed stratified epithelium with the formation of desmosomes and
hemidesmosomes. Scanning EM revealed a cobble stone-like epithelial surface
without cilia formation. α-Tubulin, a major component of cilia, was expressed only in
the apical region of the nasal mucosa and showed diffuse cytoplasmic staining in the
CUNMEC sheets. ZO-1, a component of tight junctions, was expressed in the apical
region of the nasal mucosa and was expressed at intercellular borders in CUNMECs.
Conclusion
Following transplantation, the CUNMEC sheet presented a stratified epithelial layer
containing GCs but without cilia and expressed progenitor cell markers, which are
morphologically similar to those of ocular surface epithelia and may have the potential to function as a surrogate epithelium for ocular surface reconstruction, especially in dry eye conditions.
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呂宥萱 Yu-Hsuan LuTaiwan
Speaker
Innovation in KLEx SurgeryKeratorefractive Lenticule Extraction (KLEx) continues to evolve as a leading minimally invasive approach for corneal refractive correction. Among emerging technologies, Johnson & Johnson Vision’s Smooth Incision Lenticule Keratomileusis (SILK) represents a significant advancement within the KLEx family by addressing key limitations of earlier lenticule-based procedures. SILK is engineered around three core innovations: exceptionally low pulse energy, smooth continuous dissection, and a biconvex lenticule design.
SILK operates at an ultralow pulse energy of approximately 50 nJ, one of the lowest among current refractive laser platforms. This reduced energy delivery minimizes collateral stromal disruption, promotes cleaner interface quality, and may decrease postoperative inflammation. Complementing this, SILK utilizes a smooth, continuous dissection pattern that creates highly uniform cleavage planes. This design facilitates gentle lenticule separation and extraction through a micro-incision, reducing mechanical stress on the cornea and supporting rapid early visual recovery.
A further distinguishing feature is the biconvex lenticule configuration, which improves its natural conformability to the stromal bed and reduces interface mismatch. This enhanced anatomical fit may help preserve subbasal corneal nerves during tissue creation and extraction, thereby lowering the risk of postoperative dry eye symptoms and supporting overall ocular surface health.
Together, these innovations position SILK as a refined next-generation KLEx technique with strong potential in clinical practice. Ongoing investigations comparing the strengths and limitations of different KLEx approaches will continue to guide technique optimization, with the ultimate goal of providing patients with the safest and most effective refractive surgical outcomes.
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歐又齊 You-Ci OuTaiwan
Speaker
KLEx Surgery Procedure & TipsKLEx surgery mainly includes procedures such as SMILE, SMILE Pro, and SILK. In essence, these surgical techniques are quite similar. However, to further reduce surgical time and enhance patient comfort and satisfaction, we can incorporate certain refinements and add small but effective techniques to our own surgical workflow. In this discussion, I will share some of my personal experiences before, during, and after surgery—specifically, how I optimize each step to achieve a smoother procedure and better postoperative outcomes.
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陳南妮 Nan-Ni ChenTaiwan
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.
-
-
馬惠康 David Hui-Kang MaTaiwan
Moderator
Cultivated Oral/Nasal Mucosal Epithelial Sheets for Ocular Surface Reconstruction in TaiwanBackground
To investigate the in vivo epithelial phenotypes of cultivated nasal mucosal epithelial cell (CUNMEC) sheets generated by a microspheroidal suspension culture technique.
Methods
Human nasal mucosal tissues were obtained during DCR. The tissues were digested with 2 mg/mL collagenase A, then the cell aggregates were seeded onto a de-epithelialized AM and cultivated for 2 weeks. The CUNMEC sheets were then transplanted into New Zealand albino rabbits. The animals were subjected to immunosuppression for two weeks and then sacrificed. The samples were subjected to light and electron microscopy (EM) and immunoconfocal microscopy examinations.
Results
The presence of CUNMECs in rabbit eyes was confirmed by anti-human cytoplasmic
antibody staining. Keratins 3, 4, and 13 were positively expressed in the suprabasal
region, whereas p63 expression was observed only in the basal layer. Transmission
EM revealed stratified epithelium with the formation of desmosomes and
hemidesmosomes. Scanning EM revealed a cobble stone-like epithelial surface
without cilia formation. α-Tubulin, a major component of cilia, was expressed only in
the apical region of the nasal mucosa and showed diffuse cytoplasmic staining in the
CUNMEC sheets. ZO-1, a component of tight junctions, was expressed in the apical
region of the nasal mucosa and was expressed at intercellular borders in CUNMECs.
Conclusion
Following transplantation, the CUNMEC sheet presented a stratified epithelial layer
containing GCs but without cilia and expressed progenitor cell markers, which are
morphologically similar to those of ocular surface epithelia and may have the potential to function as a surrogate epithelium for ocular surface reconstruction, especially in dry eye conditions.
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萬懿 Yi WanTaiwan
Speaker
From Preoperative Findings to Procedure Choice: A Practical Overivew of Corneal and Intraocular Refractive SurgeryThe outcome of refractive surgery is closely tied to how well patients are evaluated before surgery. This talk will give a practical overview of how preoperative findings help guide the choice between corneal and intraocular refractive procedures, drawing on the insights from recent literature.
Topics include ocular surface condition, corneal biomechanics, and optical quality. Special attention will be given to findings that may limit certain procedures, such as severe dry eye, corneal dystrophy or degeneration, significant high-order aberrations, unstable biomechanics, nystagmus, previous enhancement, systemic disease, and large angle kappa.
Age, refractive range, and lifestyle factors also play a role in deciding between corneal laser surgery and intraocular options like phakic or pseudophakic IOLs. The aim is to share a clear, clinically useful approach for safer and more individualized refractive surgery planning.
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陳弘誌 Hung-Chih ChenTaiwan
Speaker
Intra OP & Post OP Complication Management in Corneal Refractive SurgeryCorneal refractive surgery has evolved significantly with modern laser platforms, diagnostic technologies, and surgical techniques, offering high safety, predictability, and patient satisfaction. Despite advancements, intraoperative and postoperative complications remain critical determinants of visual outcomes, warranting prompt recognition and evidence-based management. This review highlights key complication profiles and practical strategies for optimized peri-operative care in refractive procedures, including PRK, LASIK and KLEx.
Intra-OP complications in corneal laser surgery primarily involve flap-related issues in LASIK (incomplete, irregular, free, or displaced flaps), docking or suction loss in femtosecond platforms, and interface problems. In KLEx, challenges include suction loss, black spots, cap perforation, retained lenticule fragments, incision tearing, and extraction difficulty. Immediate management strategies emphasize maintaining tissue integrity, minimizing further manipulation, and appropriate surgical abort or conversion when indicated.
Post-OP adverse events may include dry eye disease, epithelial ingrowth, diffuse lamellar keratitis (DLK), infection, corneal haze, ectasia, residual refractive error, night vision disturbances, and elevated intraocular pressure. Management requires a tailored approach, such as aggressive lubrication and anti-inflammation support for ocular surface disease, early steroid escalation for haze and DLK, interface washout for progressive ingrowth, corneal cross-linking for biomechanical instability, and enhancement surgery when refractive targets are unmet. Regular monitoring via corneal tomography, epithelial mapping, and wavefront analysis aids early detection and intervention.
A structured management algorithm, proactive risk assessment, surgeon experience, and patient-specific optimization remain essential to achieving safe, sustainable refractive outcomes and minimizing long-term morbidity.
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胡鴻琳 Hung-Ling HuTaiwan
Speaker
Preoperative Tomographic and Biomechanical Corneal Assessment for Refractive SurgerySummary
Appropriate patient selection remains fundamental to safe refractive laser surgery. Corneal tomography and corneal biomechanics are central to identifying early ectatic changes and biomechanical vulnerability.
Tomography offers a 3-dimensional assessment of anterior and posterior corneal surfaces, enabling detection of subtle keratoconus and other contraindications. Key parameters such as posterior elevation patterns and pachymetric distribution help quantify ectasia risk.
Corneal biomechanics, assessed with technologies like the Corvis ST or ORA, provide direct measurements of tissue stability. Metrics including deformation amplitude and corneal stiffness can uncover susceptibility to postoperative ectasia, even when tomography findings are within normal limits.
Integrating both modalities improves preoperative risk stratification, enhances surgical safety, and supports more individualized refractive planning.
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