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第61次 年度學術研討會

21 Nov 2020 - 22 Nov 2020

(UTC+08:00) Taipei 21 Nov 08:30 - 22 Nov 17:00

台大醫院國際會議中心

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The 61st Annual Meeting of the Ophthalmological Society of Taiwan

Speaker

Agenda

Time

Agenda

08:30
2020-11-21 08:30:00
08:30
11:50
《近視高峰會》 《Myopia Summit Forum》
Room 203
Ying-Wei Wang 王英偉 Ying-Wei Wang 王英偉
09:21-09:34/ 國健署守護學童視力保健措施及展望

兒童近視是近年來各界關注重視的議題,依據本署106年「兒童青少年視力監測調查」結果顯示,幼兒園大班近視盛行率達9%、到小一則上升到19.8%,到小二更攀升到38.7%,達倍數成長。國健署除了持續從監測、篩檢、衛教、宣導與跨部會資源結合推動兒童視力保健作為外﹐也特別將近視防治提早到幼兒階段,在幼兒園健康促進推動計畫介入視力保健議題,期望使家長及照顧者能夠更早重視兒童視力保健。
Pei-Chang Wu 吳佩昌 Pei-Chang Wu 吳佩昌
09:34-09:47/ 疫情時代的兒童近視防治

Myopia is the leading cause of blindness in Taiwan. In the global, the myopia prevalence is also increasing in recent decades. The pandemic of COVID-19 in this year, the children used digital device for online learning is more popular and required. In addition, lack of outdoor activities is also expected. The increased digital device usage and increased screen time of children would have strong impact on myopia, we would discuss the previous evidence and recent data of screen time on myopia and make recommendations on myopia control.
Yi-Chin Lee 李依錦 Yi-Chin Lee 李依錦
09:32 - 09:45/ 大專生近視概況及學校推動策略分享

1. 大專校院新生健康檢查制度及概況:將就新生健檢法令進行介紹。教育部每學年蒐集及分析大專校院健康統計數據,並由各大專校院依據新生健康狀況,列入健康促進學校及校本健康議題推動;並簡介近年大專校院新生視力不良率概況及影響因子分析。
2. 大專校院健康議題策略規劃:教育部組成健康議題種子團隊,第1年將針對視力健康推動重點包含研擬衛教素材、校本推動模式,第2年邀請種子學校進行精準衛教,第3年辦理共識工作坊,發展新生健康圖像。
3. 國立臺灣大學推動經驗:近年來結合社區資源辦理辦理視力保健、光害預防等講座;未來將結合教育部健康議題政策與附設醫院資源推動校內精準衛教活動。
Chun-Chih Peng 彭純芝 Chun-Chih Peng 彭純芝
09:45 - 09:58/ 3-7歲兒童視力的初檢

現行國民健康署提供7歲以下7次免費兒童健康檢查,係透過設有兒科或家庭醫學科之院所提供。健康檢查項目,透過醫師以1對1方式提供家長或主要照顧者免費兒童衛教指導服務,包括1.身體檢查:個人及家族病史查詢、身高、體重、聽力、眼睛等。2.發展診察:針對粗、細動作、語言溝通、語言認知、身邊處理及社會性發展、兒童聽語及自閉症篩檢。3.衛教指導:營養、發展狀況、口腔保健、視力保健、事故傷害預防等。近年來,兒童近視比例居高不下,且學齡前是防治近視關鍵期,兒科醫師如何藉由健康檢查或就診的過程中,發現兒童視力的問題,或傳達重要的視力保健知識,執得執行兒童健康照護的醫護人員一起努力。
Ian Morgan Ian Morgan
09:58 - 10:11/ 近視防控之國家策略

In East Asia, and in Singapore in Southeast Asia, myopia has now reached epidemic proportions. Around 80% of students completing secondary school are myopic, and 10-20% are highly myopic. Intense educational pressures from an early age and limited time outdoors seem to be the major relevant risk factors, while the high prevalence of high myopia results from early onset of myopia, which leads to more rapid and prolonged progression. In these parts of the world, school-based interventions to slow the onset of myopia, through increased time outdoors and reduced educational pressures, need to be implemented. These need to be supplemented with clinical methods for slowing the progression of myopia. Projections developed by the Brien Holden Vision Institute suggest that by 2050, most of the world, with the exception of Africa and Oceania, will have reached the same situation. However, in many other parts of the world, the current prevalence of school myopia is still low, and an epidemic will only emerge if there are rapid changes towards high pressure education systems and lifestyles that markedly restrict time spent outdoors. In these parts of the world, surveillance, rather than intervention is called for. Estimation of the prevalence of myopia in a representative sample of senior high school students, combined with information of what proportion of the age cohort complete 12-13 years of schooling should provide early warning of emerging epidemics in most of the world.
Jung Lo 羅融 Jung Lo 羅融
10:26 - 10:39/ 3C產品對視力的影響及建議

Introduction: In this digital age, children spend more time on using digital devices (computers, tablet computers and smartphones) than traditional media (television and printed publications). Studies conducted in several countries show that more than two-thirds of children exceed 2 hours per day on digital devices. Longer digital screen times for children are associated with several problems including insufficient physical activity, overweight and obesity, lower levels of sleep quality, mental illness (anxiety, depression), and behavior problems (conduct problems, peer problems). Digital screen time has also been cited as a potential environmental risk factor that can increase myopia risk.
Recent findings: Our recent study is to investigate the longitudinal changes in spherical equivalent (SE) refractive error among children who joined the “one Tablet for One Student (TOS)” project launched by Taipei City Government. Tablet computers were provided as educational tools in school. Eligible participants who provided parental consent and had at least 1 year follow-up were assessed with semiannual visual acuity testing, cycloplegic refraction and questionnaires regarding near work habits and outdoor activities. We also have literature reviewed to determine the association between screen time and the risk of developing myopia.
Summary: Use of digital devices were associated with declines in children’s vision. In our study, spending on digital devices more than 1 hour per day is a risk factor to SE progression, and outdoor activities more than 1 hour per day after school seems to have protective effects on SE progression.
Part of our study is presented as Poster (PO-316) in this annual meeting.
Chiu-Tao Shao 邵秋桃 Chiu-Tao Shao 邵秋桃
10:39 - 10:52/ 學校單位如何有效地推動學童近視防治的角色

Dahua Elementary School of Kaohsiung City is located in the area neighboring Cheng-Ching Lake and Kaohsiung Chang-Gung Memorial Hospital. Dahua is a beautiful school with a spacious campus surrounded by lush greenery. Ms. Shao has served as the principal since August 2016, and vigorously promoted the reading and sports programs, continually supported the excellent school values, which emphasize the children’s virtue and health.

Dahua has stepped up efforts in Myopia Prevention as an experimental school in cooperation with Kaohsiung Chang-Gung Memorial Hospital. By encouraging the students to engage in outdoor activities by keeping the classrooms empty during the break time, we have made great strides in improving the children’s eyesight and eye health. Over the last three years, the percentage of poor eyesight of the school has decreased gradually each year. Last month, we obtained the latest results of the eye examinations and the percentage of poor eyesight hasfallen below 30 percent for the first time.
Hui-Ping Lin 林惠萍 Hui-Ping Lin 林惠萍
10:52 - 11:05/ 新北市學童高度近視防治計畫推動成果

新北市101-104學年度學童視力不良率一-六年級平均為29.5%、36.9%、46.7%、54.9%、62.7%、68.4%,顯示年齡增加視力問題越嚴重。為防治學童高度近視,新北市自104年起推動「護眼方案」,並逐年擴大檢查對象為幼兒園中、大班及國小一至六年級。結果顯示,護眼方案有效降低學童近視率,105年與108年國小一、二年級近視率明顯下降,小一下降6.2%、小二下降3.7%,顯示越早介入效果越好。且小一至小六年級學童高度近視率也逐年下降,小一下降0.3%、小三下降0.6%、小六下降1%。學童主要問題包括參與課後輔導比例高時間長、使用3C產品比例高、自覺近視情況與實際檢查結果差距大。未來將持續推動本方案,以達成學童近視防治及近視減度之目標
Fong-Ching Chang 張鳳琴 Fong-Ching Chang 張鳳琴
11:05 - 11:18/ 健康促進學校之近視防治

教育部國民及學前教育署結盟衛生福利部、縣市政府及學者專家積極推動健康促進學校,提升學童健康力。視力保健計畫主持人吳佩昌醫師提倡「兒少近視病、控度來防盲、戶外防近視、3010眼安康」近視防治策略。本計畫在2020年選取全國22縣市國小、國中、高中(職)學生,完成11517名學生網路問卷調查以評價健康促進學校推動成效。結果八成學生表示學校有推動視力保健相關措施與教學活動,有推動視力保健教學活動學校的學生展現出較佳視力保健認知、態度、效能及行為,顯示推動健康促進學校營造健康支持環境可增進學生健康素養與健康行動。
Chung-Yi Sun 孫仲毅 Chung-Yi Sun 孫仲毅
11:18 - 11:31/ 基層醫療在近視病防治的經驗與建議

基層眼科醫師扮演著第一線近視病防治的重要角色。可以在診間對近視患者提供診療處置,同時給予適切的衛教。比如藉由候診室的紙本文宣、海報、電視,讓候診病患與家屬對近視病有所了解;看診時更可利用診間電腦、剪報,校方回條等資訊做進一步的衛教。與家長的充分溝通討論更是治療能否有效與持續的關鍵。

視保回條就診的適度分流可大幅減少患童與家長在診間漫長等待,並給予醫師有充分時間進行點藥驗光與足夠的衛教。

除了被動等待近視病患就診外,主動利用機會推廣近視防治也非常重要。例如參與幼稚園所和學校視檢、到校演講、參與親師座談、社區大學教學等,更能提升民眾對近視病的認識與重視。
08:30
11:50
一般論文及優秀論文獎報告 Free Paper & Awarded Paper Presentation
Room 301
08:30
11:50
一般論文及 優秀論文獎報告 Free Paper & Awarded Paper Presentation
Room 401
08:30
11:50
一般論文及 優秀論文獎報告 Free Paper & Awarded Paper Presentation
Room 402AB
12:00
2020-11-21 12:00:00
12:00
13:00
午餐演講會 Industry Lunch Symposium - 優視德 Crystal-Vision
Room 203
12:00
13:00
午餐演講會 Industry Lunch Symposium - 諾華 Novartis
Room 301
12:00
13:00
午餐演講會 Industry Lunch Symposium - 輝瑞先進 Pfizer
Room 401
12:00
13:00
午餐演講會 Industry Lunch Symposium - 鈦沅 United Medical
Room 402AB
12:00
13:00
午餐演講會 Industry Lunch Symposium - 豪雅 Hoya Vision
Room 402CD
12:00
13:00
午餐演講會 Industry Lunch Symposium - 博士倫 Bausch + Lomb
Room 102
13:05
2020-11-21 13:05:00
13:05
13:25
開幕式 Opening Ceremony (Room 301)
Room 301
13:30
2020-11-21 13:30:00
13:30
14:30
楊燕飛教授紀念演講會(Room 301)
Room 301
Shigeru Kinoshita Shigeru Kinoshita
13:32 - 14:22/ Future Realities in Corneal Endothelial
Regenerative Medicine

Understanding the biological and immunological characteristics of human corneal endothelial cells (CECs) is essential to establishing new strategies for treating corneal endothelial dysfunction such as Fuchs endothelial corneal dystrophy (FECD), intraocular-surgery-related bullous keratopathy, and graft failure. Along this important pathway, our research group has been developing a ‘CEC-injection therapy’ that involves the injection of cultured human CECs into the anterior chamber, which we expect will open the door to entirely new treatment strategies. Towards this end, we have successfully induced non-proliferative CECs obtained from donor corneas to proliferate, without the induction of cell-state transition including epithelial-mesenchymal transition. Our findings in over 60 clinical trial cases have shown this approach to be promising. However, to apply this novel approach to actual clinical practice, several key safety issues must first be addressed and assured, from the aspect of regulatory science.
Our translational-research also focuses on developing a novel medical treatment for an early-phase corneal endothelial disease, including FECD and surgical trauma. To that end, our findings show that the use of Rho-associated protein kinase (ROCK)-inhibitor eye drops is effective for treating partial endothelial dysfunction, as it accelerates the migration and proliferation of CECs and results in the corneal endothelial restoration.
We hope that our present and future findings will help promote the development of novel therapies for the treatment of corneal endothelial dysfunction.
14:30
2020-11-21 14:30:00
14:30
17:15
《角膜》專題演講會 (I) 脈衝光論壇 《Cornea Symposium》(I) IPL Forum
Room 301
Reiko Arita Reiko Arita
14:30-15:00/ Infinite possibilities of intense pulsed light therapy

Despite various treatment options available, some individuals with dry eye disease (DED) are refractory to therapy. Intense pulsed light (IPL) has recently been introduced as a treatment for DED. This treatment modality was originally developed for use in dermatology and was later adopted in ophthalmology for treating meibomian gland dysfunction (MGD). IPL therapy for MGD can improve tear film stability and meibomian gland function, as well as subjective symptoms. We have published 2 reviews and 2 original research articles which showed the safety and efficacy of IPL treatment for MGD. Moreover, we performed IPL for refractory aqueous deficient dry eye (ADDE) with mild MGD. As a result, the induced improvement in the quality and quantity of the lipid layer increased tear film stability and ameliorated symptoms, although IPL-MGX did not affect the aqueous layer of the tear film. IPL-MGX is thus a potential treatment not only for evaporative dry eye but for aqueous-deficient and mixed subtypes of dry eye.
Shu-Wen Chang 張淑雯 Shu-Wen Chang 張淑雯
15:00-15:20/ 脈衝光:全方位的治療?IPL: The omni treatment?
Lung-Kun Yeh 葉龍坤 Lung-Kun Yeh 葉龍坤
15:20-15:40/ 以脈衝光治療蠕形螨引起眼酒糟病例之初步臨床結果
The clinical preliminary outcomes of intense pulsed light (IPL) on ocular rosacea patients caused by demodex infestation

Purpose: Conventional treatment usually could not be satisfied with long-term relief of symptoms and signs for treating ocular rosacea. Intense pulsed light (IPL) has been widely used in the field of dermatology and has been recently introduced for the treatment of dry eye disease caused by meibomian gland dysfunction. We try to provide our clinical experience to manage with safety about IPL on ocular rosacea cases caused by demodex infestation.
Methods: Retrospective, noncomparative, consecutive interventional case series review. All ocular rosacea cases included in this study were proved caused by demodex infestation. Lumenis M22 intense pulsed light therapy (IPL) with three courses was applied in these ocular rosacea cases.
Results: Of the seven cases of ocular rosacea caused by demodex blepharitis who received conventional treatments reviewed were included in this study. The clinical and pathologic findings of patients diagnosed with ocular rosacea caused by demodex blepharitis were described and compared. All cases improved after IPL therapy. The telangiectasia and inflammation reduced after IPL treatment.
Conclusions: Our results indicate that the potential role of IPL therapy in ocular rosacea patients causes by demodex infestation. Further investigations are encouraged to identify factors able to predict the positive outcomes of the IPL therapy.

Keywords: Intense pulsed light (IPL); Ocular rosacea; Demodex infestation
Chun-Chi Chiang 江鈞綺 Chun-Chi Chiang 江鈞綺
15:50-16:10/ 以脈衝光治療乾眼症初步經驗分享
Intense pulsed light (IPL) for dry eye treatment – preliminary results

Intense pulsed light (IPL) treatment, a type of light therapy generally used for dermatologic diseases can now be used to treat dry eye caused by Meibomian gland dysfunction(MGD). In this presensation, I would like to share my experiences in how to choose an ideal IPL machine and setup a practical protocol.
Chang-Min Liang 梁章敏 Chang-Min Liang 梁章敏
16:10-16:30/ 三總優化脈衝光雷射治療瞼板腺異常之經驗
My experience on meibomian gland dysfunction management-intense pulsed light therapy (IPL)

The treatment of MGD is challenging for ophthalmologists. IPL is a new treatment for MGD. Although IPL therapy for MGD is effective and safe, the lack of consensus regarding to the number of IPL treatment sessions or the session intervals and patient selection. A lot of studies use additional treatments, such as MG massage, lid hygiene, warm compress, and lubricating drops. In our presentation, we would like to show our experience on IPL treatment on MGD patients with combination of MG probing. The efficacy and its association with meibography characteristics and lid margin morphology could be evaluated.
Shiuh-Liang Hsu 徐旭亮 Shiuh-Liang Hsu 徐旭亮
16:30-16:50/ 以脈衝光治療瞼板炎的時機與頻率
Timing and frequency of IPL treatment for meibomian gland dysfunction
14:30
17:30
《雷射屈光手術基礎課程》 《Laser Refractive Surgery Didactic Course》
Room 402CD
Hsin-Nung Lee 李欣濃 Hsin-Nung Lee 李欣濃
14:30-14:45/ Patient selection and pre-operative evaluation

In Lasik surgery, we expect better surgical outcomes if there is better preoperative evaluation. Herein we provide an overview of the relevant topics on preoperative evaluation of refractive surgery, including patient selection and topographic evaluation. Topography and tomographic evaluation are important tools for screening of refractive surgery candidates. We also emphasize on risk assessment of ectasia after LASIK surgery. This will provide a basis upon which individuals in training may begin to grow their knowledge base and gain comfort in practicing.
Meng-Chi Wang 王孟祺 Meng-Chi Wang 王孟祺
14:45-15:00/ History and use of lasers in corneal refractive surgery
I-Jong Wang 王一中 I-Jong Wang 王一中
15:00-15:15/ Preoperative assessment of corneal refractive surgery
Wei-Li Chen 陳偉勵 Wei-Li Chen 陳偉勵
15:15-15:30/ Revisit the art and science of surface ablation
David Hui-Kang Ma 馬惠康 David Hui-Kang Ma 馬惠康
15:30-15:45/ LASIK: overview of microkeratomes, femtosecond and excimer laser technique
Chao-Kai Chang 張朝凱 Chao-Kai Chang 張朝凱
16:00-16:15/ Overview of SMILE: Small Incision Lenticule Extraction
Chi-Chin Sun 孫啟欽 Chi-Chin Sun 孫啟欽
16:15-16:30/ Quality of vision evaluation and results of corneal refractive surgery

Despite that the safety and effectiveness of laser in situ keratomileusis (LASIK) has been well documented, however, some patients did report visual symptoms and dry eye disease after surgery. The Patient-Reported Outcomes With LASIK (PROWL) questionnaire has been used to evaluate the visual and ocular symptoms and their effect on activities of daily living. Recent studies indicated that (1) a large proportion reported decreases in visual symptoms, while many participants without visual symptoms at baseline developed symptoms following LASIK; (2) patients were more likely to report visual symptoms on the questionnaire than to their eye doctors; (3) few patients reported functional limitations due to visual symptoms. These findings suggest that the systematic administration of a valid questionnaire to patients who had undergone LASIK surgery is necessary and accurately assesses symptoms and patient satisfaction. Similar study was conducted to assess functional vision and quality-of-life outcomes after bilateral wavefront-guided laser in situ keratomileusis (LASIK) in Taiwan. This talk will present some of our study results.
Ming-Cheng Tai 戴明正 Ming-Cheng Tai 戴明正
16:30-16:45/ Customized ablational procedures

Up to now mostly have had sphere and cylinder based treatments without regard for topography or wavefront specifics of a particular patient. Newer techniques, including wavefront-guided excimer ablation, which take into account patients’ prior HOAs in addition to lower order aberrations, have been developed:
1. Development of computer aided methods to improve outcomes – topography vs. wavefront
2. Human interaction vs. totally computerized
3. CAP & Topolink – topography guided
4. Zyoptics and WaveScan Custom Cornea and others – wavefront guided
Further advances in wavefront imaging technology as well as the possibility of combining wavefront-guided and optimized aspheric treatment algorithms have the potential to improve the clinical outcomes of excimer laser surgery.
Huey-Chuan Cheng 鄭惠川 Huey-Chuan Cheng 鄭惠川
16:45-17:00/ Complications of refractive surgery and management

Laser refractive corneal surgery is a common procedure with a low complication rate. However, as it is an elective surgical procedure for improving the quality of life by restoring uncorrected visual acuity, any adverse events might substantially affect patient satisfaction. Unsatisfactory outcome is often reported by patients who experience an increased glare, halos, residual refractive error, irregular astigmatism, or corneal scarring. Dry eye is one of the most common side-effects and is induced by decreased tear production due to corneal nerve damage and inflammation. Fortunately, dry eye is usually temporary and can be effectively treated with lubricating eye drops or other measures. In surface ablation, haze is the most frequent complication. After LASIK, flap-related complications include flap displacement, diffuse lamellar keratitis, and epithelial ingrowth, all of which can be treated with topical eyedrops or, in some rare cases, a flap re-lift to treat the complication. Rarely, the procedure can weaken the biomechanical strength of the cornea, leading to corneal ectasia. Its pathogenesis is not yet completely understood, and it may occur in "normal" eyes, too. Preoperative evaluation of eyes at risk of ectasia is key to preventing this complication, while early intervention with collagen cross-linking, intracorneal implants, or even corneal transplantation, might be required in some patients with severe postoperative ectasia. Infectious keratitis caused by bacterial, fungal or amoebic pathogens, is one of the most vision-threatening complications after refractive surgery. Rapid recognition of the causative organism and aggressive medical and surgical treatment of the infection may improve the outcome.
Pi-Jung Lin 林丕容 Pi-Jung Lin 林丕容
17:00-17:15/ Refractive reoperations and enhancements

➤Advancements in LASIK
➤Comment to LASIK
•Safety
•Accuracy
•Predictability
•Stability
•Present High Rates of Satisfaction
➤Which is the most suitable?
•Wavefront guide
•Wavefront optimized
•Contoura Vision
•Topo-guided
•Custom-Q
➤Guidelines for patient treatment
➤LASIK Enhancement
➤When the time is right?
•Difficulty driving at night.
•Performing other tasks that require a high degree of visual precision.
•Vision substantially blurry for more than three months after LASIK.
•The results of LASIK do not match the original treatment expectations.
•The need for a LASIK enhancement is a relatively uncommon occurrence.
➤The most common complaints after LASIK surgery
•Glare :27–55%
•Halos 30–55%
•Reduced night vision:12–57%
➤Technology overview
➤Topography-guided
•High order aberration
➤Wavefront-guided
•James Webb Space Telescope
➤Examination before enhancement
➤Standard operating procedures
➤Case report
➤Conclusion
14:30
18:00
《葡萄膜炎》專題演講會 《Uveitis Symposium》
Room 203
Chun-Ju Lin 林純如 Chun-Ju Lin 林純如
14:30-14:45/ Intraocular tuberculosis – A closer look

The clinical manifestations of intraocular TB include acute anterior uveitis, iris nodules, broad-based posterior synechiae, intermediate uveitis, ciliary body tuberculoma, posterior uveitis (serpiginous-like choroiditis, choroidal tubercle, subretinal abscess, and periphlebitis with whitish material accumulated around retinal veins), neuroretinitis, panuveitis, and optic neuropathy. Most diagnoses of intraocular TB were based on ocular signs consistent with intraocular TB and positive IGRA. The collaborative ocular tuberculosis study (COTS)-1 study suggests that positive/negative intraocular fluid TB PCR results may not influence management outcomes in real world scenario. Initiating early ATT is recommended in patients with positive IGRA results and high suspicion of intraocular TB.
Tuberculous retinal vasculitis is typically an obliterative periphlebitis, resulting in retinal nonperfusion, which may lead to proliferative retinopathy. Long-term sequelae of retinal neovascularization and recurrent vitreous hemorrhage with intraocular TB may lead to macular pucker, epiretinal membrane and/ or retinal detachment. Therefore, close monitoring for neovascularization, vitreous hemorrhage, and subsequent tractional retinal detachment is important. Good anatomical and visual improvement may be achieved with timely laser treatment and appropriate vitrectomy.
Recent studies suggest that in patients who have latent TB with vision-threatening uveitis and no identifiable cause, the recurrence rate of uveitis is greatly reduced with ATT and accompanying uveitis management. One-year follow-up of the COTS-1 of tubercular retinal vasculitis (TRV) showed no significant therapeutic effects of ATT. Nevertheless, a long-term multicenter retrospective study in Taiwan found that pyrazinamide for the treatment of intraocular TB resulted in could obtain better BCVA improvement. Ethambutol might be associated with worse visual outcome.
San-Ni Chen 陳珊霓 San-Ni Chen 陳珊霓
14:45-15:00/ Bacterial endophthalmitis – Vitrectomy/steroids?

The current standard of care for infectious endophthalmitis is greatly based on the Endophthalmitis Vitrectomy Study (EVS). The conventional principles in the management of endophthalmitis included intravitreal antibacterial antibiotics with or without surgical intervention (vitrectomy for presenting vision of light perception or less). However, as the advancement in the surgical instrument and in the knowledge of inflammation control, the principles from EVS treatment recommendations needs to be adjusted. This update includes a new way of looking at infectious endophthalmitis, a discussion of the role of early vitrectomy and early steroid use in the management of endopthalmitis. A preliminary result from a single tertiary center was reported. By performing early vitrectomy as well as intravitreal dexamethasone implant (Ozurdex) within 48 to 72 hours of diagnosis, among a total five patients, four patients had complete resolution of inflammation and regained a visual acuity of 10/100 or better within 1 week. Even though one patient had developed rhegmatogenous retinal detachment, only minimal necrotic retina tissue and proliferative vitreoretinopathy was identified during second surgery. A summary statements and recommendations are then provided according to current literature.
Po-Ting Yeh 葉伯廷 Po-Ting Yeh 葉伯廷
15:00-15:15/ Viral uveitis

Viruses are essential etiologies of ocular inflammation, which may cause viral uveitis with myriad presentations. The common clinical manifestations of viral uveitis include viral anterior uveitis, viral intermediate uveitis, acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN) and neuroretinitis. Advances in molecular diagnostics reveal an increasingly broader spectrum of virus-associated intraocular inflammation, including all herpes group of viruses, rubella virus, human immunodeficiency virus (HIV), human T-lymphotropic virus type I (HTLV-I), Epstein–Barr virus and other rarer causes such as influenza virus, mumps virus, measles virus, rift valley fever virus and chikungunya virus. Above all, viruses of the herpes family are critical causes of anterior and posterior uveitis. Owing to their often-fulminant clinical course and persistence in ocular tissues, a rapid and arcuate differential diagnosis is essential to guide acute and long-term treatment. Here, we review the epidemiology, clinical, and laboratory findings of virus-associated uveitis with emphasis on their therapy and management.
Yih-Shiou Hwang 黃奕修 Yih-Shiou Hwang 黃奕修
15:15-15:30/ Infectious or not? The key pictures that hint most

Purpose:
Juvenile idiopathic arthritis (JIA) is an noninfectious disease that affects children under age of 16. Some of the JIA patients have eye inflammatory disease association, which is commonly presented as anterior uveitis. JIA-associated anterior uveitis has high rate of ocular morbidity and visual loss. Treatment is difficult. Target therapy with biologics is the consensus. Aim of this study is to retrospectively review the JIA patients referred to ophthalmology department uveitis service from pediatric OPD or from other hospitals to CGMH from Jan, 2019 to Jul, 2020.
Methods:
Review from uveitis registry database system in CGMH.
Results:
There were 636 uveitis patients with 1242 visits in our uveitis registry from Jan, 2019 to Jul, 2020. In these patients, 52 patients (8.1%) with 104 visits (8.4%) were JIA. There were 13 JIA patients having uncontrolled uveitis (25%) with traditional methotrexate treatment and need long-term anti-TNF treatment with adalimumab. Other long-term morbidity and visual outcome will be presented.
Conclusion:
JIA-associated uveitis is a specific type of uveitis, which commonly presented as anterior uveitis only, but the disease course is not benign as other iritis. Adalimumab has been the drug of choice with good therapeutic effect. Regularly follow-up and morbidity control are the ways to keep good visual outcome.
De-Kuang Hwang 黃德光 De-Kuang Hwang 黃德光
15:30-15:45/ Syphilitic uveitis – Diagnosis & treatment

Syphilitic uveitis is one of the common infectious etiologies of uveitis. It could present as any type of uveitis (anterior, intermediate, posterior, or panuveitis) and any clinicopathological classification (granulomatous, non-granulomatous). Diagnoses of it usually require serum treponemal and nontreponemal test. Recently, the traditional or reverse algorism for diagnosing syphilis has been discussed. In the lecture, I will summarize the updated diagnosis and treatment regimen for syphilitic uveitis.
Yung-Ray Hsu 許詠瑞 Yung-Ray Hsu 許詠瑞
15:45-16:00/ What’s new in parasitic uveitis

Parasitic uveitis is one of the differential diagnoses among posterior/panuveitis. However, it remains a challenge for ophthalmologists in due to various clinical presentation. Meanwhile, subsequent treatment involves not only anti-parasitic medications, but also immunosuppressive drugs due to reactive inflammation, or even surgery. In this talk, real world cases would be shared, with literature update of retinal imagings and molecular tools.
Wei-Chun Chan 詹維鈞 Wei-Chun Chan 詹維鈞
16:30-16:45/ Challenge in Diagnosis and Treatment of Uveitis

We report a neonatal baby with systemic CMV infection. Multifocal chorioretinitis over zone I area was found in his both eyes. Weekly intravtireal injections of ganciclovir were given for 3 weeks. The retinal lesions resolved after injections but recurred after 1 month. The fundus features and treatment options will be discussed in this presentation.
Ning-Yi Hsia 夏寧憶 Ning-Yi Hsia 夏寧憶
16:45-17:00/ Challenge in Diagnosis and Treatment of Uveitis

Discussion about the management and treatment for two young men with underlying of ankylosing spondylitis and infectious disease, those who developed acute anterior uveitis. After blood laboratory test survey, one had positive RPR and TPPA and the other one had positive toxoplasma IgG. How to use antibiotics and steroid in these patients?
Chi-Hsien Peng 彭繼賢 Chi-Hsien Peng 彭繼賢
17:00-17:15/ Challenge in Diagnosis and Treatment of Uveitis

A 43 years old male with newly diagnosed AIDS complained of left blurred vision 1 month after HAART initiation. His BCVA was 6/6 and 6/30 in his right and left eye, respectively. He also underwent anti-tuberculosis therapy combined with Baktar and clindamycin for pneumocystis jiroveci pneumonia, salmonella bacteremia and oral candiditis. On examination, moderate cells were revealed in left anterior chamber. Left fundoscopy showed superior circumferential retinitis with multiple hemorrhage, frosted angitis, kyrielesis plaques, and segmental para-arteritis. With the tentative diagnosis of CMV retinitis, he was treated with twice intravitreal ganciclovir injections. However, aqueous analysis of PCR for HSV, VZV, CMV were all negative, and left necrotizing retinitis revealed no improvement after injections 2 weeks. Challenge of diagnosis was made in HIV-related retinitis and further discussion was necessary for treatment.
Yueh-Chang Lee 李岳章 Yueh-Chang Lee 李岳章
17:15-17:30/ Challenge in Diagnosis and Treatment of Uveitis

A 33-year-old patient with no history of vascular disease was referred to our uveitis OPD, under the impression of unilateral retinal vasculitis with central retinal vein occlusion. After clinical workup, a diagnosis of papillophlebitis was made. It has been postulated that papillophlebitis occurs as a consequence of inflammation of the retinal veins, or the capillaries of the optic disc, leading to venous insufficiency and compression of the central retina vein. It is characterized by painless unilateral disc edema and hyperemia, retinal venous engorgement, and a variable extent of intraretinal hemorrhage and macular edema, in otherwise healthy adults younger than 50 years. The clinical presentation of this patient is described here to illustrate this uncommon form of intraocular inflammation.
Yo-Chen Chang 張祐誠 Yo-Chen Chang 張祐誠
17:30-17:45/ Challenge in Diagnosis and Treatment of Uveitis

We report the case of a boy, aged 10 years, who was diagnosed at the age of 8 years with a bilateral iridocyclitis. Visual acuity was 0.4 in the right eye and 0.8 in the left at presentation. Intraocular pressure was within normal range in both eyes. Both eyes showed some non-granulomatous fine KPs. A 3+ cellular reaction and 2+ flare were found in the anterior chamber of right eye and 2+ cellular reaction and 2+ flare were found in the anterior chamber of left eye. Fundus examinations showed disc edema in his right eye and OCT showed macular edema in her right eye.

Laboratory findings showed a mild increase in C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR). The ANA titer was negative (<1:40), and HLA-B27 was positive. Topical treatment with prednisolone acetate 1%, atropine sulfate 0.5% and systemic therapy with prednisone 0.5 mg/kg was initiated. The ocular inflammation and fundus condition were improved after steroid treatment. However, the uveitis and macular edema recurred while the oral prednisolone been tapered to 10 mg/day. MTX therapy was initiated (10 mg/week) with oral prednisolone 20 mg/day. The ocular inflammation and fundus condition were improved after steroid treatment. However, the uveitis and macular edema recurred while the oral prednisolone been tapered to 7.5 mg/day. This remission and recurrence condition happened several times.

Considering the poor clinical control achieved with the current medications, we decided to add a biologic agent in addition to MTX therapy, and so humira, a
tumour necrosis factor (TNF) inhibitor, was administered subcutaneously at the dose of 40 mg twice weekly. Clinical remission was rapidly obtained, with reduction of intraocular inflammation and resolution of macular edema and without further relapse during 1-year follow-up.
Wei-Yu Chiang 姜威宇 Wei-Yu Chiang 姜威宇
17:45-18:00/ Challenge in Diagnosis and Treatment of Uveitis

Here we present a case of a 56-year-old female with bilateral-eye retinal hemorrhages and infiltrates.
Chest CT revealed several subpleural nodules over bilateral lungs and several prominent lymph nodes at the right paratracheal area.
Other evaluation of lab data and suggested lymph node biopsy is going on...
14:30
18:00
《白內障手術》專題演講會 (I) 《Cataract Surgery Symposium》(I)
Room 401
Damien Gatinel Damien Gatinel
14:35 - 14:50/ Principle of trifocal technology

This paper will present the first extended depth of focus (EDOF) trifocal IOL. This lens (FineVision Triumf -Pod L GF, PhysIOL, Belgium) is designed to broaden the indications of premium trifocal lens technology and further increase the optical quality for distance and intermediate vision. It is made of a glistening-free hydrophobic acrylic lens material. The overall diameter and the optic diameter of the FineVision Triumf are 11.4 and 6 mm, respectively, and the lens is UV- and blue light–filtering. This edge of the back surface of the IOL has been designed with a concave design to reduce unwanted side effects such as negative dysphotopsia.
It is designed with two bifocal elements, one for distance and near and one for distance and intermediate. The width of the steps brings additions of 3.50 and 1.75 D for near and intermediate vision, respectively, but the step heights between the two elements are higher than in a classic trifocal IOL (Figure 1). This difference in design controls chromatic aberration which is introduced into the eye by the optic of the IOL. The expected benefit is an improvement of visual quality and high contrast sensitivity. The variation in the height of the steps also improves vision from distance to intermediate, as for an EDOF optic, but the trifocal property also generates a near power foci thus offering an elongated focus range from distance to near vision (Figure 2). Clinical studies will be conducted to evaluate the results of this new EDOF/trifocal concept.
Ramin Khoramnia Ramin Khoramnia
14:50 - 15:05/ Clinical results from in-vivo and in-vitro
competitor analysis of capsular bag and
supplementary Trifocal optics

PURPOSE: To compare the optical performance of a two-intraocular lens (IOL) system with that of a single capsular bag trifocal IOL.
METHODS: The two-IOL configuration of a monofocal RayOne Aspheric (Rayner Intraocular Lenses, Ltd) and a Sulcoflex Trifocal (Rayner Intraocular Lenses, Ltd) lens was compared in vitro with a single-lens option (RayOne Trifocal; Rayner Intraocular Lenses, Ltd). Two samples of each IOL model were studied with an optical metrology device. The optical quality was assessed using the area under the modulation transfer function (MTF). The impact of the supplementary lens misalignment on the MTF was tested. The light loss was also measured using a power meter.
RESULTS: The two-IOL system produced three well-defined focal peaks comparable to those of the single lens. The MTF area of the single- and two-IOL configuration was, respectively, 22.5 and 20.7 at far, 16.4 and 15.4 at intermediate, and 14.9 for each configuration at near. A moderate decentration (up to 0.6 mm) had a minimal effect at intermediate and near on the supplementary lens MTF and no impact at far. A 5° tilt did not alter the MTF. The supplementary lens caused a 1.3% decrease in the optical power.
CONCLUSIONS: The optical quality of the two-IOL system matched that of the single trifocal lens. A low-power supplementary IOL demonstrated high tolerance to misalignment and minimal light attenuation. The reversibility of the two-IOL approach may prove advantageous clinically.
[J Refract Surg. 2020;36(9):570-577.]
Chang-Ping Lin 林昌平(臺大) Chang-Ping Lin 林昌平(臺大)
15:05-16:00/ Video competition-Team 1
Chang-Min Liang 梁章敏 Chang-Min Liang 梁章敏
15:05-16:00/ Video competition-Team 1
Jia-Kang Wang 王嘉康 Jia-Kang Wang 王嘉康
15:05-16:00/ Video competition-Team 1
Chien-Liang Wu 吳建良 Chien-Liang Wu 吳建良
15:05-16:00/ Video competition-Team 1
Chun-Ju Lin 林純如 Chun-Ju Lin 林純如
Video competition-Team 2
Jian-Sheng Wu 吳建昇 Jian-Sheng Wu 吳建昇
Video competition-Team 2
Chia-Jen Chang 張嘉仁 Chia-Jen Chang 張嘉仁
Video competition-Team 2
Chia-Yen Chou 周佳彥 Chia-Yen Chou 周佳彥
Video competition-Team 2
Tsung-Tien Wu 吳宗典 Tsung-Tien Wu 吳宗典
Video competition-Team 3
Pei-Chang Wu 吳佩昌 Pei-Chang Wu 吳佩昌
Video competition-Team 3
Shiuh-Liang Hsu 徐旭亮 Shiuh-Liang Hsu 徐旭亮
Video competition-Team 3
Daniel H. Chang Daniel H. Chang
16:25 - 16:40/ Perfect Balance Among Visual quality, Range of vision and Dysphotopsias:The Next-generation Presbyopia-correcting IOL

The primary goal of cataract surgery is to improve the vision of our patients. Therefore, when considering an IOL, it
is important to leverage material, design, and manufacturing that allows the maximization of visual quality through
the minimization of ocular aberrations. In particular, the reduction of spherical and chromatic aberration is key to
providing the best visual/optical quality. Visual quality is particularly important when trying to correct presbyopia
because extending the depth of field can compromise visual quality and increase dysphotopsias. The Tecnis Family
of IOLs leverage the minimization and correction of spherical and chromatic aberration to provide surgeons with
great visual quality across the entire line. While all IOLs must make compromises to correct presbyopia, the Tecnis
Symfony IOL and now the Tecnis Synergy IOL are now the latest options that strikes a useful balance, providing
surgeons with an unprecedented ability to provide a continuous range of vision for patients who want desire quality
vision, spectacle independence, and minimal dysphotopsias.
李德孝 李德孝
16:40 - 17:28/ Video competition-Team 4
Shang-Yi Chiang 江尚宜 Shang-Yi Chiang 江尚宜
16:40 - 17:28/ Video competition-Team 4
Meng-Chi Wang 王孟祺 Meng-Chi Wang 王孟祺
16:40 - 17:28/ Video competition-Team 4
莊雅容 莊雅容
16:40 - 17:28/ Video competition-Team 4
Li-Ju Lai 賴麗如 Li-Ju Lai 賴麗如
16:40 - 17:28/ Video competition-Team 5
楊意堅 楊意堅
16:40 - 17:28/ Video competition-Team 5
黃偉成 黃偉成
16:40 - 17:28/ Video competition-Team 5
郭鐘元 郭鐘元
16:40 - 17:28/ Video competition-Team 5
Chih-Chin Pan 潘志勤 Chih-Chin Pan 潘志勤
16:40 - 17:28/ Video competition-Team 6
I-Chin Kuo 郭奕欽 I-Chin Kuo 郭奕欽
16:40 - 17:28/ Video competition-Team 6
Yung-Chen Lee 李永誠 Yung-Chen Lee 李永誠
16:40 - 17:28/ Video competition-Team 6
Chin-yun Chen 陳矜芸 Chin-yun Chen 陳矜芸
16:40 - 17:28/ Video competition-Team 6
14:30
18:00
《眼神經》專題演講會 《Neuro-ophthalmology Symposium》
Room 402AB
Chun-Hsiu Liu 劉峻秀 Chun-Hsiu Liu 劉峻秀
14:30-14:45/ Ischemic optic neuropathy in young adults

Nonarteritic anterior ischemic optic neuropathy (NAION) most frequently occurs in patients aged 50 years or older. Although NAION is less common in younger patients, it is not rare. NAION can occasionally be confused with other optic neuropathy such as optic neuritis. Careful clinical evaluation is essential to rule in the diagnosis. Recognition of some entities can not only alter the visual prognosis but also the neurological prognosis
Chao-Wen Lin 林昭文 Chao-Wen Lin 林昭文
14:45-15:00/ The difference between AQP4 and MOG related optic neuropathy

Neuromyelitis optica (NMO) is a chronic inflammatory and demyelinating autoimmune disorder of the central nervous system (CNS) that predominantly affects the optic nerves and spinal cord. Aquaporin-4-IgG antibody (AQP4) is a sensitive and highly specific serum marker of NMO. About 25% of AQP4-IgG seronegative neuromyelitis optica spectrum disorder (NMOSD) patients have antibodies against myelin oligodendrocyte glycoprotein (MOG). MOG related optic neuropathy is also an antibody mediated demyelinating disease of the CNS. The pathophysiology of MOG related optic neuropathy is incompletely understood and the precise mechanism of MOG-Ab remains ill defined. Symptoms that are highly suggestive of MOG related optic neuropathy include bilateral and recurrent episodes of optic neuritis especially in the setting of steroid responsiveness and steroid dependence. Optic disc edema rather than a retrobulbar optic neuritis is more common in MOG related optic neuropathy. AQP4 antibody-positive patients had a higher prevalence in women than MOG antibody-positive patients. The severity of clinical symptoms in AQP4-positive patients is usually more serious than that in MOG-positive patients. The residual neurological deficit after treatment in AQP4-positive group was usually more serious than that in MOG-positive group. Patients with MOG antibodies have a lower risk for visual and motor disability. We will present some cases of MOG related optic neuropathy and discuss about the difference of clinical manifestations and treatment strategy between AQP4 and MOG related optic neuropathy.
Tzu-Lun Huang 黃子倫 Tzu-Lun Huang 黃子倫
15:00-15:15/ Cancer associated optic neuropathy

The cause of cancer-associated visual disturbance includes paraneoplastic optic neuropathy or retinopathy, infiltrated by tumors, optic neuropathy related to chemotherapy and meningeal carcinomatosis with intracranial hypertension. In other words, cancer involving the visual system are a heterogeneous group of disorders. Few papers have addressed prognostic factors and treatments in cancer patients with meningeal seeding. I will review some important published studies to date outlining the clinical features, pathogenesis, and treatment strategies in cancer-associated optic neuropathy. In addition, I will share with my clinical experiences on handing visual loss in a case of meningeal carcinomatosis in breast cancer. For ophthalmologist, to give such terminal patients an increased chance at better visual quality is a challenging but meaningful work.
Ming-Hui Sun 孫銘輝 Ming-Hui Sun 孫銘輝
15:15-15:30/ Does amaurosis fugax increase risk of stroke and myocardiac infarction?

Amaurosis fugax (AF) is a transient monocular visual loss (TMVL) that lasts from seconds to minutes. AF occurs in patients over the age of 50 who have other vascular risk factors include hypertension, hypercholesterolemia, heart diseases and previous episodes of transient ischemic attacks (TIAs). AF is a result of an occlusion or stenosis of the internal carotid artery circulation. Previous study found incidence of carotid stenosis was 18.9% in patients with AF, incidence of stroke was 1.5~1.8% in patients with AF, and incidence of cardiac embolism was 8.7% in patients presenting with AF. By using Chang Gung Research Database, we aimed to investigate the risk of stroke and myocardiac infarction in patients with AF in Taiwan.
Hui-Chen Cheng 鄭惠禎 Hui-Chen Cheng 鄭惠禎
15:45-16:00/ Clinical approach for vertical diplopia

Vertical diplopia is one of the common scenarios in neuro-ophthalmic clinic and emergency department. The common etiologies of hypertropia included 4th cranial nerve palsy, 3rd cranial nerve palsy, thyroid eye disease, orbital fracture, skew deviation, ocular myasthenia gravis…etc. In this section, a systemic review with schematic approach of vertical diplopia will be provided, which may help for clinical practice.
An-Guor Wang 王安國 An-Guor Wang 王安國
16:00-16:20/ Third nerve palsy revisited

Third nerve palsy is characterized by ptosis, external ophthalmoplegia and mydriasis. Pupil involvement, or mydirasis, is the signature sign of compressive lesion on the third nerve pathway. Neuroimaging study is highly recommended if pupil is involved in a patient with ptosis and external ophthalmoplegia. Nevertheless, isolated mydriasis is seldom considered as a sign of third nerve palsy, especially in a conscious patient. Do we need to consider third nerve palsy in the differential diagnosis of isolated mydriasis? Does the pilocarpine test of diluted and normal concentration still apply in this condition?
Caroline Tilikete Caroline Tilikete
16:20-16:35/ Central Ocular Motor Palsies

Gaze palsies result from dysfunction of the central region controlling conjugate ocular motility. The anatomofunctional organisation of the ocular motility in the central nervous system dissociates the networks for version and vergence eye movements, horizontal and vertical movements, for quick exploration movements (saccades) and for slow stabilisation movements (smooth pursuit, oculocephalic reflex). Therefore, gaze palsies have the particularity of showing dissociations in affected eye movements, allowing distinguishing them from peripheral oculomotor palsies. The most characteristic syndromes are represented by internuclear ophthalmoplegia, abducens nucleus syndrome, oculomotor nucleus syndrome, vertical supranuclear gaze palsy and oculomotor apraxia. The clinical examination is of capital importance and should systematically look for the different types of ocular movements to show dissociated impairments. The recognition of these gaze palsies is essential as it shows the central origin of the disease and helps in establishing a precise topographical diagnosis in most cases.
Caroline Tilikete Caroline Tilikete
16:35-17:00/ Nystagmus and Ocular Instability

Acquired neurological nystagmus and other abnormal eye movements may be valuable diagnostic tools. The identification of abnormal eye movement is based on close observation of the slow or quick phase, direction, monocular or binocular characteristic, frequency, regularity and of the general pathological context. In case of precise and correct identification, it can be a challenging tool to establish a topology, etiology or prognosis of some neurological diseases. Here, we provide a "practical'' approach, with the objective of highlighting for neuro-ophthalmologists the importance of abnormal eye movement observation in order to improve the subtlety of clinical diagnosis.
Nan-Shih Chen 陳南詩 Nan-Shih Chen 陳南詩
17:00-17:15/ Case 1

The 70-year-old male patient had blurred vision of his left eye for 30 years. He was diagnosed of POAG 3 years ago and was treated in the local hospital since. Hemi-CRVO (OS) occurred to his left eye four mouth ago. This time upon his admission to the Internal ward, we found that his presentation was somewhat more than POAG.
Wei-Yu Lai 賴薇羽 Wei-Yu Lai 賴薇羽
17:15-17:30/ Case 2

A 39-year-old Filipino man presented with painful right eye and blurred vision for 2 weeks associated with intermittent right-side headache at the occipital area. His medical history was significant for hypertension, dyslipidemia and sleep apnea. Visual acuity was HM/10cm in the right eye (OD) and 1.0 in the left eye (OS) with a relative afferent pupillary defect (RAPD) and diminished colour vision OD. His dilated fundus examination showed marked disc edema with peripapillary hemorrhage and tortuosity and dilation of retinal veins OD. Visual field showed central scotoma OD and normal OS. A magnetic resonance imaging (MRI) of brain and orbits showed enhancement along the right optic nerve. He was diagnosed with optic neuritis OD and treatment with methylprednisolone 250 mg intravenously (IV) four times daily (qid) for 3 days was given, which improved his vision to 1.0. However, disc edema OD persisted and progressed 8 weeks after his initial presentation while his vision remained unaffected. This led us wonder, was it optic neuritis or was it something else?
Chia-Wei Lee 李加崴 Chia-Wei Lee 李加崴
17:30-17:45/ Case 3
陳姵穎 陳姵穎
17:45-18:00/ Case 4
16:00
2020-11-21 16:00:00
16:00
16:20
Invited Abstract: Neuro-ophthalmology Symposium
Room 102
An-Guor Wang 王安國 An-Guor Wang 王安國
16:00-16:20 Third Nerve Palsy Revisited
An-Guor Wang 王安國 An-Guor Wang 王安國
16:00-16:20 Third nerve palsy revisited.
18:30
2020-11-21 18:30:00
18:30
21:00
會員聯誼餐會Gala Dinner (Room 101)
Room 101

Time

Agenda

08:30
2020-11-22 08:30:00
08:30
00:00
《角膜》專題演講會 (II) 《Cornea Symposium》(II)
Room 301
Yi-Hsun Huang 黃奕勛 Yi-Hsun Huang 黃奕勛
11:40-12:00/ 凝血酶調節素在眼表疾病中的角色:老物質的新用途
The role of thrombomodulin in ocular surface diseases: An old dog in a new house.

Thrombomodulin (TM) is a transmembrane glycoprotein that is originally identified on vascular endothelium. It consists of 5 domains including a highly charged N-terminal lectin-like domain, a domain with six epidermal growth factor-like structures, a serine and threonine-rich domain, a transmembrane domain, and a cytoplasmic domain. TM is a multifunctional protein that performs distinct function in different cell types. In endothelium, TM inhibits thrombin's pro-coagulant effects, whereas it significantly enhances thrombin-dependent activation of anticoagulant protein C. In keratinocyte, the expression of TM is regulated during differentiation. It was further demonstrated that recombinant TM epidermal growth factor-like domain plus serine/threonine-rich domain promotes cutaneous wound healing in a mouse model of full-thickness wound healing.
Although TM is well studied in various cells, tissues and organs, the exact role of TM in the eye remains unclear. Previously report showed that TM was detected in corneal epithelial and endothelial cells, limbus, lens epithelial cells, trabecular meshwork, nonpigmented ciliary epithelial cells, and Schlemm’s canal. In addition, the role of TM has been investigated in endophthalmitis, herpetic and bacterial keratitis. We have also found that TM expression increased in the early phase of corneal wound healing process and decreased after wound recovery. Despite the previous reports of TM in ocular diseases, the potential of TM in ophthalmology has not been fully investigated. Therefore, we will rediscover the role of this old dog (TM) in a new house (Ophthalmology)
Shigeru Kinoshita Shigeru Kinoshita
08:55-09:30/ 角膜移植中種子的重要性
Seeds are important in corneal transplantation

The Cornea Donor Study demonstrated that endothelial cell density was gradually decreasing year by year after corneal transplantation, and female donor and a younger donor was seemed to be associated with more prolonged graft survival. We examined, in a different way, the association between the viability of cultured corneal endothelial cells (CECs) from the donor rim and the donor corneal endothelial cell density (ECD) after corneal transplantation. The findings in this study demonstrated that the high mature differentiated CEC content indicated an index to predict the long term survival of ECD. This prospective study revealed that there was a different trend of postoperative endothelial cell density between groups with high or low mature differentiated cultured corneal endothelial cells. This type of reverse translational research will give us eventually the essential biological marker in the survival of corneal transplantation.
Hsin-Yuan Tan 譚欣媛 Hsin-Yuan Tan 譚欣媛
09:30-09:50/ 多光子顯微鏡平台於小鼠角膜活體影像應用
Multiphoton microscopy platform for live imaging of mouse cornea

Multiphoton microscopy allows long-term intravital imagin with subcellular resolution in live animals. When coupled with either autofluorescent signals or fluorescence protein targeting, and second harmonic generation signals from natural collagenous extracellular matrixes as contrast, multiphoton microscopy enables intravital tracing of cells and cell-matrix interaction. Compared with conventional histological analysis, it can bring new insight into the cell dynamics in vivo. Here, we demonstrate intravital cell imaging and tracing at a single cell resolution in the cornea using a customized multiphoton microscopic platform in transgenic mice of which specific cell populations are tagged with fluorescent proteins.
Hsiao-Sang Chu 朱筱桑 Hsiao-Sang Chu 朱筱桑
09:50-10:10/ 要怎麼收穫先那麼栽:探討角膜上皮培養的水源與種子
Water and Seed for Growing Healthy Corneal Epithelium

Healthy corneal epithelia are known to ensure wellness of ocular surface and clear vision, and the limbus is known to be responsible for replenishment of healthy corneal epithelium. Hence, if we think of healthy corneal epithelia as flowers and ophthalmologists as gardeners, a good strategy in revitalizing a barren garden (severe ocular surface disease coupled with limbal stem cell deficiency, LSCD) would be planting healthy seeds (limbal stem cells) and securing their water supply (tear). My talk will address several critical obstacles under the current strategies for ocular surface reconstruction and possible solutions to them. I will then highlight my ongoing project of successfully treating severe dry eye of cicatricial conjunctivitis patients by autologous minor salivary gland transplantation, namely, using saliva as substitute for tears. Finally, I will dissect the expression of progenitor cell markers of our recently developed, ex-vivo cultivated, human limbal epithelial cell sheet and explore its potential application as cell therapy for LSCD.
Shizuya Saika Shizuya Saika
10:30-11:00/ 三叉神經與角膜組織的內在穩定性
Trigeminal nerve and tissue homeostasis in cornea
Yu-Chi Liu 劉郁琦 Yu-Chi Liu 劉郁琦
11:00-11:20/ 屈光手術後的眼表面變化
Ocular surface changes after refractive surgery

Refractive surgery is one of the most commonly performed procedures in the world. Small incision lenticule extraction (SMILE) has become a viable alternative to laser-assisted in situ keratomileusis (LASIK) for the refractive correction of myopia and myopic astigmatism. Due to the small incision in SMILE, as opposed to a circumferential flap in LASIK, the impact on the ocular surface is expected to be less. Our aim is to decipher the ocular surface changes following refractive surgery by linking three domains: imaging on corneal nerves, clinical assessment and proteomic analysis. In this talk, I will discuss the changes in tear protein expression and its associated biological process, using an approach of advanced quantitative proteomics (sequential window acquisition of all theoretical fragment mass spectra (SWATH-MS)), following SMILE versus LASIK in a randomized controlled trial. The neuromediator profiles as well as postoperative clinical dry eye profiles following these two procedures will be discussed and compared. I will also present the long-term results of corneal denervation after SMILE and LASIK.
Nai-Wen Fan 范乃文 Nai-Wen Fan 范乃文
11:20-11:40/ 火上加油:Th17免疫功能在慢性眼表面疾病的腳色
Pouring fuel on the fire: Th17 immunity in chronic ocular surface disorders

Chronic ocular surface disorders represent a broad spectrum of conditions with significant socioeconomic burdens due to huge healthcare cost on millions of patients and substantial productivity loss from the visual disability and mood disorders; such burden is projected to continue to grow with the increasing aging seniors. Characterized by sustained ocular inflammation, chronic ocular surface disorders still lack effective treatment to date, primarily due to incomplete understanding of the underlying pathogenesis. In the past decade, both clinical and experimental data have demonstrated critical roles of T lymphocytes in mediating the chronicity of the disorders, and recently accumulating new evidence has further delineated the subtype of T cells, namely T-helper 17 (Th17) as the dominant pathogenic T effectors in dry eye disease (DED), the most prototypical ocular surface disorders. Th17 immunity that drives ocular surface inflammation is unlashed and infiltrated to the ocular surface via draining lymph node – eye axis. As acute inflammation subsides, the generation of Th17 memory sustains the chronicity of the disease, as well as predisposing aged population vulnerable to desiccating stress. This unrestrained Th17 activation is further exacerbated by dysfunction of a variety of immune and neuroimmune regulatory mechanisms at the ocular surface microenvironment and eye draining lymphoid tissues, that normally contain overactivated immune reaction. Accordingly, therapeutic strategies suppressing Th17 immunity by directly inhibiting Th17 effectors or indirectly enhancing Th17-regulating components have been widely studied, and the rapidly increasing data resulting from those studies suggest Th17 a promising target for effectively treating chronic ocular surface disorders.
Shigeru Kinoshita Shigeru Kinoshita
08:30-08:55/ 達成史蒂夫強森症侯群零角膜性失明的遠程目標
The long-term scope for achieving zero incidence of corneal blindness in Stevens-Johnson syndrome

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are challenging to treat appropriately. Thanks to state-of-the-art regenerative medicine and the latest advancements in ocular surface biology and immunology, several types of transplantable cultivated mucosal epithelial sheets are now available to reconstruct a chronically damaged ocular surface. Autologous cultivated oral mucosal epithelial transplantation (COMET) is the surgery choice at present for SJS and TEN because these diseases are biologically, immunologically, and microbiologically abnormal. Furthermore, the use of a limbal-supported rigid contact lens after the COMET procedure facilitates the visual improvement, and the ocular-surface stabilization can be well restored.
Our great hope that ophthalmology-related translational research, such as that described above, will receive official governmental approval based on the accumulated data of the safety and efficacy aspects of the procedures, thus ultimately resulting in the worldwide prevention of blindness.
08:30
11:40
《小兒眼科》專題演講會 (I) 《Pediatric ophthalmology Symposium》(I)
Room 203
Ho-Min Chen 陳禾旼 Ho-Min Chen 陳禾旼
08:30-08:45/ The fat muscles

Strabismus can occur due to muscle dysfunction or enlargement. Enlarged extraocular muscles are not specific for thyroid eye disease and may occur with other processes such as inflammatory disorders (including the recently described immunoglobulin G4-related disease; IgG4-RD), neoplasms (including metastatic disease), vascular lesions, infections, and metabolic abnormalities. Computed tomography (CT) scan is often the first examination chosen, for it is widespread, easy to perform, rapid and efficient and has no complication and no contraindication.
Magnetic Resonance Imaging (MRI) provides complementary information's about the morphology and the structure of the involved muscles and is more and more used. Early identification through clinical presentation, image study or muscle biopsy can help earlier proper treatment.
Tzu-Hsun Tsai 蔡紫薰 Tzu-Hsun Tsai 蔡紫薰
08:45-09:00/ Strabismus following scleral bucking surgery

The etiology of strabismus following RD surgery is complex. Multiple mechanism might attribute to its formation including restrictive, paralytic, myogenic and sensory. Restrictive factors include bleeding/ inflammation during surgery, adhesion between muscle and buckle explants, the explant itself and scarring. Paralytic causes such as detached muscle or nerve damage from traction suture or anesthetic agent injection. The decreased visual function as a sensory factor following retinal detachment should also be taken into consideration.

Proper diagnosis depends on detailed orthoptic measurements, forced duction test and imaging study if necessary. Conservative management can be used initially with small angle strabismus, or in patient with poor prognosis. Which eye to be operated on depends on patient’s preference, fusional ability and strabismus comitance. Whether or not to remove buckling explants depends its interference with motility, and its removal is better combined with strabismus surgery. Finally, re-detachment of retina should be also taken into consideration.
Chong-Bin Tsai 蔡忠斌 Chong-Bin Tsai 蔡忠斌
09:00-09:15/ Treatment of recalcitrant strabismus with lateral orbital wall anchoring

Severe sixth nerve palsy with recurrent esodeviation is challenging to strabismus surgeons. If there is residual lateral rectus function, horizontal muscle surgery may work. When there is inadequate or absence of lateral muscle function, the deviation usually recurs due to unopposed medial muscle action. Vertical muscle transposition is often indicated to create an abducting force to counter balance the medial rectus.
We report a case of sixth nerve palsy with repeated recurrence after several surgeries. The case was treated using a globe fixation procedure with a lateral orbital wall tether. No recurrence was observed after 10 months follow-up.
Jason Yam Jason Yam
09:15-09:30/ Management of Myopic Strabismus Fixus
An-Guor Wang 王安國 An-Guor Wang 王安國
09:30-09:45/ Endoscopic plication of inferior rectus for traumatic IR injury

Traumatic rupture of the inferior rectus is an uncommon cause of diplopia following orbital trauma. Treatment for the ruptured ocular muscles remains a challenging clinical issue. A variety of surgical options had been developed, including emergent repair and reapproximating the lost proximal portion of the IR muscle, anterior transposition of the inferior oblique, and inverse Knapp’s procedure, with or without recession of the ipsilateral antagonist muscles. In this report, a 40-year-old male suffered syncope and falling down with face contusion. Inferior rectus rupture was noted during the emergent surgery without repair in another hospital. He visited our hospital with right hypertropia and limited infraduction. He received plication of the proximal stump of inferior rectus by endoscopic surgery. He could fuse and his eye position was orthophoric at primary position postoperatively, though still with mild limitation of infraduction.
Rosario  Gomez De Liano Rosario Gomez De Liano
09:45-10:00/ Treatment of VI nerve palsy

Treatment depends on etiology of the abducens nerve palsy. Around 50-75% of them usually recover within 3-6 months depending the underlying cause. Paresis and microvascular causes have better prognosis than complete paralysis, bilateral, trauma and tumoral cases. Firsts stages are managed with occlusion, botulinum toxin, prisms or surgery. In this talk we are going to focus on the management of the complete VI nerve palsy and to discuss about different transposition techniques.
Ko-Jo Lin 林珂如 Ko-Jo Lin 林珂如
10:15-10:30/ Myopic control in ortho-K patient with or without low dose atropine (0.01%) use

We demonstrate the myopic control progress in children under orthokeratology combine with low concentration atropine.
Some patient still had excess axial length increase under ortho-k single strategy. Atropine can play an important role to support 
the myopic control effect in these kind of patient.
Jason Yam Jason Yam
10:30-10:45/ Low-concentration atropine eye drops for childhood myopia control
Li-Chung Chi 紀立中 Li-Chung Chi 紀立中
10:45-11:00/ Photoscreening device for amblyopia

Amblyopia is a disorder in which the visual cortex fails to develop during infancy or early childhood that leads to decreased central vision. Amblyopia is an important topic in pediatric ophthalmology because if delayed detection passes treatable age, the visual impairment can persist for life. If detected early, most amblyopic eyes are treatable.

In Taiwan, direct screening of amblyopia by checking visual acuity usually starts in kindergartens or elementary school. By that time, children are already 3 to 6 years old. For detection of amblyopia risk factors as early as 6 months old, instrument-based testing is preferred. While photoscreening device was already in use in US as early as 1995, only recently were these instruments introduced into Taiwan.

PlusoptiX photoscreener has been implemented by many pediatricians in Taiwan. The device uses an infrared video recorder to obtain images. It trigger a referral if one eye deviates by more than 10 degrees (suggesting strabismus) or if 2 round pupils cannot be seen (detecting colobama or ptosis). It can also produce a non-cycloplegic autorefractive reading.

Another popular choice on the market is Spot, a hand-held infrared photoscreener. It also creates a diagram with eye location, detects strabismus, and provides autorefractive reading.

It must be stressed that photoscreening device is not portable auto-refractor. It does not produce refractive data accurately enough for glasses prescription. We as pediatric ophthalmologist probably don’t need screening device to diagnose amblyopic child, but we need to know how it works to understand its merit and limitations.
Hui-Ju Lin 林慧茹 Hui-Ju Lin 林慧茹
11:00-11:20/ Mobile Femtosecond Laser Anterior Capsulotomy and Forceps Capsulorhexis for Posterior Capsulotomy in Pediatric Cataract

Purpose: Due to higher incidence of postoperative posterior capsule opacification and anterior capsule fibrous capture in pediatric cataract surgery. The surgical approaches of anterior continuous curvilinear capsulorhexis (ACCC), primary posterior capsulotomy (PPC) and anterior vitrectomy are all important in maintaining long- standing clear visual axis in pediatric cataract surgery eyes.
Methods: We use mobile femtosecond laser in ACCC and forceps capsulorhexis for posterior capsulotomy combing anterior vitrectomy in 4 eyes of 2 patients. The mobile femtosecond laser was brought into the operating room before surgery. After general anesthesia was induced, the femtosecond laser was docked onto the eyes with a liquid-filled interface and anterior capsulotomy was created with the femtosecond laser, ACCC could be well and completely created in well docking patients (Fig 1). After traditional lens extraction lens material was aspirated bimanually with irrigation–aspiration cannulas. Then the posterior capsule was stained with 1% trypan blue under and PPC was performed with the microforceps (Fig 2), its important that the circle of PPC must smaller than the circle ACCC (Fig 3). After PPC anterior vitrectomy was performed and intraocular lens (IOL) can be insert into bag (Fig 4).
Results: Docking and capsulorhexis can be successful in cases when perpendicular docking of the PI and horizontal holding of the laser head were performed correctly. No perioperative or intraoperative complications were noted. All patients had improved best-corrected visual acuity, normal IOP and no iris and IOL synechiae.
Conclusion: Mobile femtosecond laser can create a relatively perfect sized of ACCC with high precision and accuracy in pediatric cataract cases. Besides high-frequency and low-energy laser with minimizing laser energy, spot size, and spot separation can reduce femtosecond lasers induce microridges that potentiate capsular tags and tears formation, which are benefit in pediatric cataract patients. Moreover, using microforceps to perform PCC can minimize the vitreous lost into anterior chamber then vitrectorhexis does PCC, such can reduce the post operation increasing IOP and iris synechiae. Complete ACCC and PCC is promising of IOL in bag. With follow up 2-6 months (mean 4 months). Femtosecond laser in ACCC and forceps capsulorhexis for posterior capsulotomy are safe and effective in pediatric cataract and can provide long-standing clear visual axis in these patients.
Rosario  Gomez De Liano Rosario Gomez De Liano
11:20-11:40/ Topical Anesthesia in Strabismus surgery

Late incorporation in strabismus surgery due to the age of our patients and the discomfort of our surgical procedures. New techniques allow presently to operate under surgical topical and subtenon anaesthesia. In the talk we will discuss the techniques to be used, the benefit of avoiding a general anaesthesia and of the intraoperative adjustment and the results of this technique versus Adjustable surgery under general Anaesthesia.
08:30
11:50
《視網膜》專題演講會 《Retina Symposium》
Room 101
Pei-Zen Chang 張培仁 Pei-Zen Chang 張培仁
08:30-08:45/ COVID-19國家防疫隊-工研院如何回應挑戰

During the COVID-19 outbreak, ITRI put together its multidisciplinary R&D resources and top-notch talents to defend the country against the virus. The Institute responded swiftly and integrated eight epidemic-prevention technologies with its strong innovation capability and the commitment to society. These involve the early participation of ITRI technicians in the National Mask Team to ramp up the production capacity of medical masks. Other R&D achievements include the development of the iPMx Molecular Rapid Test System, Smart Thermal Image Body Temperature Detection Technology, HoMe Care Quarantine Service, Positive Pressure COVID-19 Testing Booths, Contact-Free Patient Monitoring System, a medical grade ventilator prototype, and a smart elder care verification and testing field. Taiwan Vice President Lai Ching-te also praised ITRI as a behind-the-scenes hero fighting the pandemic. Looking ahead, the pandemic is accelerating the digital transition and urging industries to form resilient supply chains. Amid this rapidly changing environment, ITRI is deploying digital innovations early and working with industries to secure new opportunities in the post-pandemic era.
Wei-Chi Wu 吳為吉 Wei-Chi Wu 吳為吉
08:45-09:00/ COVID-19 eye related disease and PPE

PURPOSE: Although Taiwan was one of the first countries to develop coronavirus disease 2019 (COVID-19), with effective antiepidemic measures. Taiwan has effectively controlled the spread of the disease. The purpose of this article is to provide useful safety strategies for ophthalmologists in daily practice during the COVID-19 pandemic.

MATERIALS AND METHODS: Infection control strategies in the hospital and Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou are discussed.

RESULTS: Ophthalmologists are at high risk of contracting COvID-1:9 infection, as they have close contact with patients during ocular examinations, and are also facing high patient volume in outpatient clinics as well as emergency consultations. Furthermore, ocular symptoms, such as conjunctivitis, may be the presenting signs of CO VID-19 infection. We provide our strategies, which include hospital's gate control with triage station, patient volume control, proper personal protective equipment, and consultation with telemedicine technology, to decrease the risk of cross-infection
between medical staffs and patients.

CONCLUSION: To achieve the goal of preventing viral spread and maximizing patient and medical staffs' safety, besides providing proper protective equipment, it is also crucial for staffs and patients to strictly follow antiepidemic measures. We hope that our experience can held ophthalmologists and health-care workers to have a safer working environment when facing COVID-19 pandemic.
Wen-Chuan Kuo 郭文娟 Wen-Chuan Kuo 郭文娟
09:00-09:15/ New applications of OCT in biomedicine

Optical coherence tomography (OCT) is an optical tomographic imaging modality invented in 1991. The resolution of OCT images is up to 10 times better than that of the conventional ultrasound and has a deeper imaging depth than confocal or multi-photon microscopy. The OCT technique was originally meant for imaging human retinas. Now, this method has become a critical diagnostic technology in the areas of ocular diseases. The advances of fast and high resolution OCT instruments during the past 10 years have opened new fields of applications and perspectives for further development of OCT imaging. Moreover, functional extension of OCT combines the advantages of OCT with additional image contrast obtained by using the Doppler flow, spectroscopy, or polarization as a contrast source. In this presentation, I will focus on our recent works: development of OCT for the new biomedical applications.
San-Ni Chen 陳珊霓 San-Ni Chen 陳珊霓
09:15-09:30/ Intra-operative OCT-clinical application

Intraoperative optical coherence tomography- Clinical application
First performed with hand held optical coherence tomography for intraoperative evaluation of retinal structure, intraoperative optical coherence tomography (iOCT) had been proven useful to evaluate the retinal structure real time intraoperatively and monitor the surgical procedures. With the advancement of Integration of a spectral domain dptical coherence tomography system into a surgical microscope for Intraoperative Imaging, iOCT was further shown to be feasible and useful for intraocular surgery, both for anterior segment and posterior segment surgery.
Application of iOCT in anterior and posterior segment surgery includes DALK, DSAEK, glaucoma surgery, phakic intraocular lens, etc. had been widely reported. In addition, iOCT is also useful in the posterior segment surgery, including epiretinal membrane removal, macular hole and retinal detachment surgery. The real time imaging not only reveals the sturcutral changes during the operation , but also may change the surgical decision making. Intraoperative real time imaging with iOCT including DSAEK, macular hole, epiretinal membrane surgery, etc. will be presented in this talk.
Yi-Ting Hsieh 謝易庭 Yi-Ting Hsieh 謝易庭
09:30-09:45/ OCTA for retinal vascular disease

Optical coherence tomography angiography (OCTA) is a noninvasive technique which shows the retinal vascular structure. Not only can it provide the en-face image of retinal vascular network with a better resolution than that from the fluorescein angiography, but also it can provide the B scan image to show the exact position of the vasculature within the retinal layers. Quantified microvascular parameters can also be obtained from OCTA images, either from the preinstalled software or by image processing. In this talk, we will discuss about the utility of OCTA for various retinal vascular diseases.
Shwu-Jiuan Sheu 許淑娟 Shwu-Jiuan Sheu 許淑娟
09:45-10:00/ ILM-my precious

The internal limiting membrane (ILM) is formed by the Muller cell footplates and represents the boundary between the vitreous and the retina. Back to eighties, surgical specimens of ERM removed during vitreous surgery revealed varying degrees of ILM fragments interspersed among the ERM. ILM was first intentionally removed during macular surgery for hemorrhagic macular cyst in 1994, which claimed to relieve traction. Some forms of subsequent Muller cell damage were reported, but there was no consensus about the reversibility or functional effect on case of macular pucker. On the contrary, the important role of ILM is well accepted in the management of macular hole. Different techniques of ILM as adjunctive will be reviewed in this presentation and focused on “tailed ILM flap” in the management of primary macular hole.
Ernesto Bali Ernesto Bali
10:20-10:35/ How to avoid PFCL in the subretinal spaces
Chung-May Yang 楊中美 Chung-May Yang 楊中美
10:35-10:50/ Lamellar macular hole in non-idiopathic conditions

Lamellar macular hole (LMH) is a partial defect of the central fovea commonly seen in otherwise healthy old-aged individuals. Its formation is frequently associated with the contraction of epiretinal membrane (ERM). In addition to this idiopathic condition, LMH may be associated with other eye diseases, notably high myopia (HM) or diabetic retinopathy (DR). In highly myopic eyes, the complex anteroposterior and tangential traction, along with the posterior staphyloma greatly complicate the clinical course of LMH. In DR, excessive cytokines and growth factors secondary to abnormal vascular permeability and/or retinal ischemia stimulate the formation of cystoid macular edema, ERM, or fibrovascular membrane, causing various macular abnormalities, including the frequently seen LMH. In this presentation, the clinical manifestations and surgical prognosis of LMH in HM and DR will be discussed.
Kuan-Jen Chen 陳冠任 Kuan-Jen Chen 陳冠任
10:50-11:05/ Pars plana vitrectomy for severe open globe injury

Open-globe trauma involving the posterior segment is a significant cause of visual loss, despite advances in our knowledge of the pathophysiology, our ability to identify prognostic factors, and the improvements in surgical techniques and instrumentation introduced over the past few decades. The standard of practice includes repairing the open ocular wound at the earliest presentation, followed by vitreoretinal surgery in eyes with concurrent intraocular damage. A near complete pars plana vitrectomy (PPV) with removal of the posterior hyaloid within 14 days of an open globe injury, to relieve vitreoretinal traction and to remove the scaffold for future traction and prevent stimulus of the wound healing response, has become the standard of care to reduce the risk of tractional retinal detachment. Early PPV reduces the risks of posttraumatic endophthalmitis, development of severe inflammatory changes and fibroblastic tissue within the vitreous, and secondary complications such as retinal detachment and cyclitic membrane.
Suh-Hang Juo 卓夙航 Suh-Hang Juo 卓夙航
11:05-11:20/ 學術單位如何從事眼科新藥物之開發

Myopia is a common eye disorder worldwide, especially being prevalent (~85%) in Asian countries. Myopia is primarily caused by abnormal elongation of the eyeball axial length. Using genetic association studies and gene regulation analysis, we identified overexpressed microRNA-328 as a key and novel factor for myopia. We have shown that microRNA-328 regulates several myopia-related genes. Using monocular form deprivation myopia, we also demonstrated that microRNA-328 is over-expressed in the myopic eyes than the fellow eyes in both mice and rabbits.

Our team has developed a series of “small anti-sense oligonucleotides” in eye drop form to neutralize over-expressed microRNA-328 in cells and animal models of myopia. By utilizing our eye drops, we successfully treated myopic mice and rabbits. Additionally, our eye drops were shown to be no inferior to 1% Atropine. Our product by using the brand new mechanism makes a breakthrough in curing myopia.

In terms of safety, we have conducted 5 GLP graded toxicity studies and 3 core safety pharmacology studies. All the data consistently show no adverse or unwanted side effects. We are preparing the documents and will file a request for phase I study, which is expected to be conducted in Taiwan in 2021.
Shun-Ping Huang 黃舜平 Shun-Ping Huang 黃舜平
11:20-11:35/ Genomic analysis of hereditary retinal dystrophy

Hereditary retinal dystrophies (HRD), including retinitis pigmentosa, Leber's congenital amaurosis, Usher syndrome, retinoschisis and etc., are a group of genetic retinal disorders exhibiting both genetic and phenotypic heterogeneity. Retinitis Pigmentosa is the most common hereditary retinal dystrophy affecting 1 in 3000 to 4000 people worldwide. Symptoms include progressive retinal degeneration and constricted visual field that severely affect patients' normal lives. Some patients will be complete blindness. Currently, at least 40% of cases affected with retinitis pigmentosa bear not-yet-identified genes/mutations that have become a major barrier to accurate diagnosis and effective treatment. We recruited a total 135 unrelated families with HRD; most of them were retinitis pigmentosa (64%). There were 63 pathogenic variations identified in 29 known genes among 51 families, including 18 mutations reported for the first time in this study. We applied next-generation sequencing of targeted gene panel. Identification of disease-causing genes enhances our understanding of genotype-phenotype correlations in order to provide effective genetic counseling and promote the development of novel treatments.
Shih-Hwa Chiou 邱士華 Shih-Hwa Chiou 邱士華
11:35-11:50/ 奈米醫學基因編譯在視網膜疾病之診斷治療應用
08:30
12:00
《青光眼》專題演講會 《Glaucoma Symposium》
Room 401
Yu-Wen Lan 藍郁文 Yu-Wen Lan 藍郁文
08:30-08:42/ OCT artifacts and pitfalls

Optical coherence tomography (OCT) has been widely incorporated into clinicians’ daily practice in recent years for both the diagnosis and follow-up of glaucoma. It provides information about the optic disc parameters, peripapillary retinal nerve fiber layer (RNFL) thickness and ganglion cells-related thickness in macular area. A high-quality scan is essential for a reliable result. Devices with dirty lens or reduced laser power, patients unable to fixate properly, with dry eye or cataract, blink or poor centration during scan acquisition and inexperienced operator may affect the image quality which leads to inaccurate measurements.
Artifacts, such as image truncation and segmentation errors of the optic disc margins or RNFL can misguide physicians to wrong conclusion. Vitreous opacity, posterior vitreous detachment, vitreoretinal traction and epiretinal membrane are common ocular diseases associated with segmentation errors.
Based on the manufacturer’s normative database, the printout of OCT provides colored images, tables, and graphs for easy interpretation. These results may be erroneous, because the database does not account for high refractive error and anatomic variations, such as split and sifted RNFL peaks. In addition, subtle localized RNFL thinning can be overlooked on RNFL thickness graphs which present the average values. Retinal edema by diabetes or uveitis can obscure the preexisting glaucomatous thinning. All of these have to bear in mind to prevent false-positive (red disease) and false-negative (green disease) diagnoses.
With the knowledge of these artifacts and pitfalls, careful interpretation and thorough ophthalmological examination, we can avoid misleading by the OCT and make the correct judgement.
Yi-Chun Chen 陳怡君 Yi-Chun Chen 陳怡君
08:43-08:55/ Detecting glaucoma progression by OCT- pros and cons

The determination of glaucoma progression usually relies on clinical assessment of the optic nerve, disc photos over time, and visual field (VF) analysis. In many patients, progressive structural damage frequently precedes functional deterioration. Prevention of disability from glaucoma may benefit from early detection of structural loss before significant functional damage. The evaluations of structural changes of glaucoma are subjective and qualitative in nature which limiting their ability to detect progression reliably. The major advantage of optical coherence tomography (OCT) is its ability to show detailed and quantitative information of glaucomatous structural changes which can assist us to monitor glaucoma progression.
OCT can obtain objective measurements of the retinal nerve fiber layer (RNFL), optic nerve head, and macula for assessing glaucoma progression. Combining information from different structural measurements may be useful. OCT should be used in conjunction with clinical evaluation and VF testing. Different stages of glaucoma may require different monitoring tools. In early glaucoma, OCT of the RNFL and macula may be important for patients with normal or unreliable VF tests. In moderate glaucoma, the correlation between OCT measurements and VF tests helps to confirm progression. In advanced glaucoma, we need to be aware of the floor effect in RNFL OCT measurements and consider the use of macular OCT and 10-2 VF tests to detect progression. When monitoring glaucoma progression by using OCT, we should combine our clinical evaluation with a VF assessment and understand how to avoid artifacts and other errors in OCT that can lead to misinterpretation.
Mei-Ju Chen 陳美如 Mei-Ju Chen 陳美如
08:56-09:08/ The role of OCT angiography in glaucoma management

Vascular dysfunction plays a role in the pathogenesis of glaucoma. Optical coherence tomography angiography (OCTA) is a novel imaging method that can quickly provide evidence of vascular changes in the optic nerve head, optic nerve head, and macula. A large number of studies on the use of OCTA have shown that the superficial optic nerve, peripapillary retina and the macular microcirculation in glaucoma patients are reduced. This lecture aims to outline the basic principles of OCTA technology, the latest literature on the application of OCTA in glaucoma patients, and the role of OCTA in glaucoma management.
Pei-Wen Lin 林蓓雯 Pei-Wen Lin 林蓓雯
09:09-09:21/ What to do when the OCT and VF don’t match

Glaucoma is a progressive optic neuropathy characterized by retinal ganglion cell layer and retinal nerve fiber layer (RNFL) loss, structural changes of optic nerve head and corresponding visual field (VF) defects. Recently, clinicians are increasingly reliant upon optical coherence tomography (OCT) to provide information about structural damage and to help in the diagnosis and monitoring of glaucoma. Despite significant improvements in OCT technology, many clinicians focus OCT scans of the optic disc but miss the glaucomatous damage in macular region. Further, clinicians depend heavily upon summary metrics of RNFL thickness around the disc, or within quadrants or clock hours of the disc. This will miss glaucomatous damages on the probability maps. Besides, the commercial OCT reports are not optimally organized to help clinicians to understand the relationship between structural damage on OCT and functional abnormalities on VFs. In this talk, I will discuss how to improve glaucoma detection with structural and functional correlations.
Han-Yi Tseng 曾漢儀 Han-Yi Tseng 曾漢儀
09:22-09:34/ Angle closure disease –scenarios when laser PI/pilocarpine is not helpful

Laser peripheral iridotomy combine with pilocarpine relieves pupillary block and is commonly used to treat a wide range of angle closure diseases, including primary angle closure, primary angle closure suspect, and a variety of secondary angle closure conditions. However, in some angle closure patients the procedure may fail and require additional treatment such as laser iridoplasty, lens extraction, or filtering procedure. These scenarios and management strategies are listed and discussed.
Pei-Yao Chang 張珮瑤 Pei-Yao Chang 張珮瑤
09:35-09:47/ Angle closure disease – scenarios when lens extraction is the first choice

Lens extraction for primary angle-closure glaucoma (PACG) is a subject with advocates promoting its benefits of anatomical opening of the angle, intraocular pressure (IOP) reduction and improved vision. The present talk seeks to evaluate recent available evidence to provide clarity on this intervention within the armamentarium of approaches for PACG.
The emergence of recent case–control studies, cohort studies and randomized controlled trials has provided a stronger evidence base to equip ophthalmic surgeons with the necessary information to utilize lens extraction in the management of PACG, and to consider whether this should be combined with
trabeculectomy or goniosynechialysis. Imaging modalities such as anterior segment optical coherence tomography have yielded new insights into the mechanical features of the lens in angle closure, with the lens thickness and lens vault now quantifiable. A trend is emerging regarding the improvement in IOP control, reduced complication rates and reduced need for IOP-lowering medications in patients who undergo lens extraction for PACG. These issues are discussed, along with aspects of preoperative assessment and surgical outcomes.
Ying-Ying Chen 陳瑛瑛 Ying-Ying Chen 陳瑛瑛
09:48-10:00/ Cataract surgery in angle closure glaucoma – challenges and solutions

Purpose: To improve the safety and efficacy of phacoemulsification in PACGs through a small pupil using minimal iris manipulation.
Methods: This study included 30 consecutive eyes with a maximally dilated pupil size of 2.5 mm or smaller. Except synechiolysis and occasional pupil stretching with a chopper and a sinsky, there was no iris manipulation with special surgical instruments or devices for dilating the pupil. Pupil stretching is accomplished with two blunt instruments. The instruments are introduced and placed in the same meridian 180 degrees away from one another. The iris is then stretched with each instrument simultaneously toward the angle, momentarily held, and then released. The phacoemulsification technique included creation of deep central space, and step-by-step chop in situ and lateral separation of the nucleus.
Results: The mean pupil size measured under an operating microscope was 2.3 mm preoperatively, 5.3 mm after viscoelastic and mechanical pupil dilation, and 4.1 mm at the end of a surgical procedure, and 3.1mm at final visit. Small iris-sphincter rupture and small hemorrhages occurred during pupillary manipulation, but they were not evident at the end of the surgery. Signs of significant corneal edema and iritis were observed on the first postoperative day. One month postoperatively, the pupil was round and reactive to light, the anterior chamber was quiet, and the cornea was clear in all eyes.
Conclusion: Successful phacoemulsification was done with minimal or no pupil-widening maneuvers, restoring the preoperative pupil configuration.
Yi-Hao Chen 陳怡豪 Yi-Hao Chen 陳怡豪
10:20-10:32/ Ways to improve surgical outcome in trabeculectomy

Trabeculectomy is still the most popular incisional procedure for glaucoma filtration surgery worldwide. The advent of anti-fibrotic agents reduced the surgical failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimize the risk of complications and surgical failure. The pre-operative, intra-operative and post-operative strategies may improve the outcome of trabeculectomy. Postoperative hypotony would be prevented by minimizing over-drainage, postoperative wound leaks, and poor bleb morphology. Surgical modification to reduce the postoperative fibrosis of bleb is using anti-fibrotic agents. However, a simple, ideal, and fixed procedure of trabeculectomy which is fit to every patient is lacking. The need to address pre-, intra-, and post-operative issues in each patient is individualized. It is hoped that trabeculectomy can become a more efficient and safer procedure for glaucoma treatment in the further.
Yu-Chieh Ko 柯玉潔 Yu-Chieh Ko 柯玉潔
10:33-10:45/ MIGS: Xen gel stent 1-year results- safety and efficacy

XEN45 gel stent, a minimally invasive glaucoma surgery (MIGS) device, was designed to lower intraocular pressure (IOP) through subconjunctival flow with an attempt to minimize tissue manipulation and eliminate intractable postoperative hypotony. We did a retrospective review to understand the effectiveness and safety of the XEN45 gel stent in our patients with primary open angle glaucoma (POAG).
We retrospectively reviewed thirty-seven medically uncontrolled POAG patients underwent XEN45 gel implantation. The primary outcomes were reduction in IOP and in the number of glaucoma medications 12 months after surgery. The secondary outcomes were requirement for intervention and further glaucoma surgery. The adverse intraoperative and postoperative events were investigated.
We found that at the 12-month postoperative follow-up, the mean IOP was significantly reduced from the preoperative value of 21.7 ± 7.7 mmHg to 15.0 ± 2.0 mmHg (P = 0.001). The mean number of glaucoma medications decreased from 3.4 ± 0.9 to 1.3 ± 1.5 (P < 0.001). Seventeen patients (45.9%) required postoperative interventions. Four patients (10.8%) received additional glaucoma surgery. Postoperative IOP at month 1 was significantly associated with outcomes at the 12-month follow-up and the need for subsequent intervention and additional glaucoma surgery.
The XEN45 gel stent effectively reduced the IOP values and number of glaucoma medications in our patients with POAG. No major complications were observed, but almost half of the eyes in the study required intervention for wound healing modification. Postoperative IOP at month 1 was a predictor of surgical success at 12 months after surgery.
Wei-Wen Su 蘇蔚文 Wei-Wen Su 蘇蔚文
10:46-10:58/ MIGS: istent-candidate selection and efficacy

To date, the main treatment for preventing glaucomatous damage is IOP lowering. For decades, trabeculectomy + MMC has been considered the gold standard for glaucoma surgery. While very effective, trabeculectomy + MMC is associated with significant risks, such as hypotony, hyphema, and bleb-related infection or other complication. Since the early 2000s, a series of new treatment modalities, which the US FDA refers to as “minimally invasive glaucoma surgical” (MIGS) devices, has emerged. MIGS are ab interno or ab externo procedures that require minimal to no conjunctival manipulation or scleral dissection, which are readily combined with another intraocular procedure such as phacocmulsification cataract extraction.
According to the anatomical outflow pathway as well as surgical approach, MIGS can be classified into trabecular, suprachoroidal, and subconjunctival based devices. Currently in Taiwan, only the Xen gel and iStent are available. In this talk, I will share my experience in patient selection and the efficiency of iStent implantation.
Yi-Ching Shao 邵儀菁 Yi-Ching Shao 邵儀菁
10:59-11:11/ Normal tension glaucoma masqueraders

Making a diagnosis of normal tension glaucoma (NTG) can be challenging—not only because glaucoma itself is complex and involves many variables, but also because many other pathologies can masquerade as NTG. Early recognition of NTG masqueraders is important, and timely alternative management could avoid potential adverse outcomes.
Various forms of glaucoma presenting with intermittently elevated IOP, such as POAG with diurnal IOP fluctuations, intermittent angle-closure glaucoma, uveitic glaucoma and pigmentary glaucoma, can simulate NTG. Also, patients with POAG who have thin central corneas may have falsely low IOP readings. Confirmation of NTG requires repetitive and diurnal IOP measurements to rule out ocular hypertension and/or POAG.
Disorders of the optic nerve not caused by IOP elevations have been reported to produce optic disc cupping and VF defects. Ischemic optic neuropathy, Leber’s hereditary optic neuropathy, optic nerve drusen, optic pits, compressive lesions of the optic nerve and toxic/nutritional optic neuropathy should be considered be mistaken for NTG.
Branch retinal artery occlusion can result in glaucoma-like arcuate visual field defects that correspond to the damaged retinal tissue. Retinal vascular occlusions can also complicate the clinician’s ability to diagnose a glaucomatous optic disc.
Utilization of imaging modalities such as optic nerve photos, modern OCT imaging study and reviewing visual field data in detail will help to distinguish those cases of non-glaucomatous cupping. This presentation will discuss the various NTG masqueraders to help clinicians properly identify the underlying disease and plan a management strategy.
Shin-Lin Chiu 邱欣玲 Shin-Lin Chiu 邱欣玲
11:12-11:24/ Does the use of 3rd and 4th medication effective and sensible?

Clinically, glaucoma treatment mainly reduces the damage to the optic nerve by reducing intraocular pressure. There are three ways to lower intraocular pressure: drugs, lasers and surgery. At the beginning of the treatment of glaucoma, doctors usually choose medication, which is more acceptable to patients. There are five types of drugs for glaucoma. When the first drug does not work well, the principle of treatment is to replace a different drug instead of adding another drug. However, when the effect of lowering intraocular pressure after the replacement of the drug did not meet the expectations, the treatment was changed to add another type of drug. This lecture will discuss whether it is a wise choice to add the third or even the fourth drug to the treatment of glaucoma.
Jehn-Yu Huang 黃振宇 Jehn-Yu Huang 黃振宇
11:25-11:37/ Why glaucoma patients go blind? Disease nature? Patient factor? Physician factor?

Glaucoma is a progressive optic neuropathy and is the leading cause of irreversible blindness worldwide. Although we may stop the progression of glaucoma by lowering intraocular pressure (IOP) effectively, possible IOP-insensitive factors, such as blood flow or neurodegeneration, still cause the disease progression. Underdiagnoses of glaucoma, un-detection of progression, and improper treatment can also lead to blindness from glaucoma. Even though most glaucoma patients can be managed with medications, lack of access to health care and non-adherence to medical therapy can also lead to blindness from glaucoma.
Low-cost artificial-intelligence assisted screening modality and safer IOP-lowering surgical procedures may help more people preventing from blindness from glaucoma.
09:30
2020-11-22 09:30:00
09:30
09:45
Endoscopic Plication of Inferior Rectus for Traumatic IR Rupture
Room 203
12:10
2020-11-22 12:10:00
12:10
13:10
午餐演講會 Industry Lunch Symposium - 參天 Santen
Room 402CD
12:10
13:10
午餐演講會 Industry Lunch Symposium - 諾華 Novartis
Room 101
12:10
13:10
午餐演講會 Industry Lunch Symposium - 科林 Clinico
Room 102
12:10
13:10
午餐演講會 Industry Lunch Symposium - 酷柏 CooperVision
Room 203
12:10
13:10
午餐演講會 Industry Lunch Symposium - 愛爾康 Alcon
Room 301
12:10
13:10
午餐演講會 Industry Lunch Symposium - 眼力健 J&J Vision
Room 401
12:10
13:10
午餐演講會 Industry Lunch Symposium - 卡爾蔡司 Carl Zeiss
Room 402AB
13:20
2020-11-22 13:20:00
13:20
13:50
第 19 屆第一次會員大會及團體照 General Assembly & Group Photo(Room 301)
Room 301
14:00
2020-11-22 14:00:00
14:00
16:45
《眼瞼及淚道》專題演講會 《Eyelid and Lacrimal Duct Symposium》
Room 401
Yip Chee Chew Yip Chee Chew
14:00-14:25/ Minimally invasive lateral canthoplasty
Yun-hai Tu 涂云海 Yun-hai Tu 涂云海
14:25-14:50/ 甲狀腺相關性眼病的內鏡微創診療
Zhi-Feng Lin 林志峰 Zhi-Feng Lin 林志峰
14:50-15:05/ Endoscopic sinonasal and peri-orbital surgery: from setup to real cases

In the past 30 years there has been a significant shift from external sinus surgery to endoscopic sinus surgery (ESS). ESS is now accepted as the surgical management of choice for chronic rhinosinusitis. Ancillary techniques such as endoscopic lacrimal surgery, orbital decompression and optic nerve decompression have also been explored. The developments of specialized surgical instruments and navigation system have facilitated the endoscopic management of benign endonasal tumors and some of malignant tumors of the nose and sinuses invading peri-orbital structures.

Powered microdebriders, high-speed drills and endoscope cleaners now form the essential part of the instrumentation required to perform ESS. Recently developed 3D image, 4K monitor, and integrated neurosurgical navigation system provide better image quality for the surgeons and decrease the risk of complications.

In this talk, we will focus on the setup and principles of endoscopic sinus surgery, and share our experiences in this filed. A multidisciplinary team approach is an essential component for surgical planning and management. As the cumulative surgical experience increases, the indications for this approach will likely continue to expand.
Cheng-Hsien Chang 張丞賢 Cheng-Hsien Chang 張丞賢
15:05-15:20/ Navigation assisted endoscopic approach for orbital and lacrimal diseases

Endoscopic approach for orbital surgery is a novel trend for ophthalmologists. To assist the beginners, navigation with image guided system provides clear orientation and location while the endoscopic surgery is processing. To help identifying the structure changes in case of trauma and recurrence, navigation clarify the unusual anatomy. The situation is of great importance in lesion of orbital apex, either for decompression or tumor excision/ biopsy. In orbital decompression of thyroid orbitopathy, navigation helps maximal opening of orbital bone to minimize fat removal and manipulation. Lacrimal sac surgery does not routinely use navigation, however, it helps in case of lacrimal tumor and traumatic nasolacrimal duct obstruction. Navigation assisted endoscopic approach for orbital and lacrimal surgery is new to ophthalmologists. Yet it provides a new frontier of orbital surgery.
Yun-hai Tu 涂云海 Yun-hai Tu 涂云海
15:20-15:45/ 淚道的生理解剖基礎與臨床應用
Fang-Yu Liu 劉芳瑜 Fang-Yu Liu 劉芳瑜
15:45-16:00/ The technical challenges of endoscopic DCR for the beginner

Dacryocystorhinostomy (DCR) is the most widely performed surgical procedure for the treatment of nasolacrimal duct obstruction. DCR is performed either by endonasal way or external way. Endoscopic Dacryocystorhinostomy is more and more favored by patients due to the advantage of leaving no external scars and the theoretical advantage of not affecting the orbicularis oculi, thus preserving the lacrimal pump mechanism.
It requires a higher level of skill to achieve a high success rate for endoscopic DCR. Because unlike other ocular surgeries, endoscopic DCR requires a thorough understanding of the anatomical structures inside the nose as well as the skilled use of surgical devices such as endoscopes. However, most ophthalmologists are not familiar with such devices. It was reported that a surgeon should be required to perform at least 30 endoscopic DCR procedures to obtain stable surgical skill for this procedure. I, as a beginner, will share some of challenges I faced during the surgery.
Yi-Lin Liao 廖依琳 Yi-Lin Liao 廖依琳
16:00-16:15/ How to optimize the surgical outcomes of endoscopic DCR?

Endoscopic dacryocystorhinostomy (Endo DCR) becomes a more popular approach for managing primary acquired nasolacrimal duct obstruction (PANDO) and secondary acquired nasolacrimal duct obstruction (SANDO) in Taiwan. We can feel very positive feedback from the patients who underwent Endo DCR due to fast recovery, no scar gain, and resolving their epiphora.
How to locate and expose the fundus of lacrimal sac precisely under endoscopy is the key to help sac marsupialization. Performing adequate size osteotomy and nasal mucosa approximation is also crucial for primary wound healing and long-term outcomes.
However, there is still some room for improvement, such as achieving functional success and dealing with high-risk cases with adjuvant therapy by endoscopic approach. Relevant clinical experiences will be shared in this section.
Pei-Yuan Su 蘇姵元 Pei-Yuan Su 蘇姵元
16:15-16:30/ Endoscopic assessment of ostium after endoscopic DCR

Dacryocystorhinostomy (DCR) is a common surgical procedure performed for the management of nasolacrimal duct obstruction and chronic dacryocystitis. The success rate of previous reports ranging from 80%~95% regardless of different surgical techniques. The most frequent postoperative conditions associated with failure are obstruction of the intranasal ostium by healing or granulation tissue, nasal cavity synechia, inadequate size and position of the osteotomy, mucosa flap fall, and incomplete lacrimal sac opening. Therefore, ostium evaluation is important in providing information about etiology of surgical failure and helpful in improving surgical techniques.
The aim of our study is to compare the postoperative intranasal ostium
morphology following external and endoscopic dacryocystorhinostomy (DCR) through endoscopic examination, and to investigate its correlation to surgical outcomes. We included a consecutive series of patients underwent DCR from September 2011 to September 2019 in Far-Eastern Memorial Hospital. Patients were follower up at post-opreative 1st week, 1st month, 3rd month, and 6th month. Intranasal endoscopic examination was performed at postoperative 6th months and the size and morphology of the ostium were recorded. The morphology of the ostium will be presented and was evaluated in a systemic fashion. The ostium difference between external and endoscopic DCR groups are compared and its relation to surgical outcomes will be discussed.
Yi-Hsuan Wei 魏以宣 Yi-Hsuan Wei 魏以宣
16:30-16:45/ Endoscopic conjunctivodacryocystorhinostomy

Conjunctivodacryocystorhinostomy (CDCR) creates a bypass tract between the conjunctiva and the nasal cavity, and inserts a tube to maintain its patency. In this talk, we will focus on the transnasal endoscopic for CDCR (endoscopic CDCR). I will briefly introduce the surgical indications, techniques, complications, and outcomes.
14:00
17:00
《白內障手術》專題演講會 (II) 《Cataract Surgery Symposium》(II)
Room 101
Fam Han Bor Fam Han Bor
14:00-14:15/ Cataract surgery in 3D: Seeing more with the first digital microscope

Objective:
To introduce the concept of surgeon-assist digital microscope system.
Method:
Today’s technology has enabled us to detect and better visualize tissues beyond normal microscopes. Making use of these technologies and together with digital display technology, important real-time and pre-existing information can be made readily available to the surgeon intraoperatively and non-disruptively to enhance his or her surgery and improving safety outcomes. When integrated into a digital microscope, a new era of micro-surgery has become a reality. It opens a whole new realm of ophthalmic surgery.
With network connectivity, surgeon-assist digital microscope enhances efficiency of workflow while simultaneously reduces transcriptional error that compromises patient safety
Conclusion.
Surgeon-assist digital microscope will make challenging surgeries easier.
Ke Yao Ke Yao
14:15-14:30/ Clinical Studies on FLACS in Zhejiang University

Since 2014, FLACS has been applied in Zhejiang University. In 2019, we performed about 3,000 FLACS cases in our eye center, which accounted for 17.6% of the total of 17,000 cataract surgeries.
We did a series of clinical studies to gain a more comprehensive understanding of FLACS, including technique steps, complications, complex case applications, large sample investigation and meta analysis. We believe FLACS may become the normal state of cataract surgery in the future to benefit more patients.
Robert Ang Robert Ang
14:30-14:45/ Strategies for managing difficult cases – Small pupil and intraoperative miosis

Pupil dilation is an integral preparatory step prior to cataract surgery. We need a large pupil to visualize every step of the procedure. Causes of poorly dilating pupil are diabetes, pseudopexfoliation, synechiae and previous episodes of high intraocular pressure. Prior to surgery, you need eyedrops such as tropicamide, phenylephrine and ketorolac to dilate the pupil. During the surgery, if the pupil still does not dilate enough, or we encounter intraoperative miosis, we have options such as intracameral epinephrine, viscoelastics, devices or expanders that can help dilate the pupil and maintain the dilation throughout the entire procedure. It is important to recognize the problem of small pupil preoperative to prepare for it and to have devices or techniques which can be used during cataract surgery to ensure a smooth completion of the procedure.
Li Wang Li Wang
14:45-15:00/ Avoiding or solving complicated cataract cases using laser ray tracing aberrometer

The iTrace ray tracing aberrometer is uniquely designed to combine a Placido corneal topography with a ray tracing aberrometer to measure quality of vision. It allows surgeons to analyze optical quality of the whole eye, cornea, and the internal optics. Preoperatively, the device provides us with data for patient education, consultation, expectation management, and intraocular lens selection. Postoperatively, it helps us solve mysteries of unhappy patients and surprise results. Case samples illustrating the critical role of this device in managing cataract cases will be presented and discussed.
14:00
17:00
《醫療倫理》 《Medical Ethics Symposium》
Room 203
Cheng-Hsiung Teng 鄧政雄 Cheng-Hsiung Teng 鄧政雄
14:00-14:30/ 橫看成嶺側成峰,誰對誰錯大不同
從醫療與法律互看醫病之間的溝通

醫療法律,醫師習慣從醫療看法律,除了常常感覺法院不懂醫療外,更因為自己在檢視自己熟悉的醫療時,真的很少能看到自己在法律上可能有錯的地方,也因為如此,每當出現醫療爭議或糾紛時,醫師第一時間想到的是病人哪裡錯,自己哪裡對,想到最後就會覺得都是病人錯,自己沒有錯。但法官或檢察官卻是從法律看醫療,也許他們不是很懂醫療,但他們熟悉法律,他們常看到我們不知或不懂的法律面,所以為了能解如何從法律看醫療,當我們在面對醫療糾紛時,該做的不是先想自己哪裡對,病人哪裡錯,而是該先想病人哪裡對,自己哪裡沒有錯,如此方能讓醫師面對醫療糾紛時,能更自己面對醫療糾紛的真正真實的面項羽面貌。
Hsien-Jang Chou 周賢章 Hsien-Jang Chou 周賢章
14:30-15:00/ 醫療爭議事件的調處與調解機制與流程

醫療爭議調解乃指事件發生後,紛爭無法由雙方當事人達成共識而和解時,兩造可以共同委託公正中立第三人居中斡旋調和排解,在彈性的程序下居中調和,促使發生糾紛的雙方當事人依法自願達成協議而去解決糾紛,以使爭議落幕,避免訴訟程序的一種形式制度。我國醫療糾紛之調解類型可分為訴訟上調解(司法調解)與訴訟外調解,而後者可細分為衛生局醫審會之調處與鄉鎮市公所調解。不同調解類型的法律依據及法律效果有間,機制與流程亦有別。
Pyng-Jing Lin 林萍章 Pyng-Jing Lin 林萍章
15:00-15:30/ 醫療爭議事件的鑑定機制與實務

鑑定實務:
我國「醫療糾紛鑑定作業要點」第一六條之鑑定標準為「基於醫學知識與醫療常規,並衡酌當地醫療資源與醫療水準,提供公正、客觀之意見」,應是地方標準說與國家標準說之折衷說。但我國醫療糾紛鑑定人多參考最新的教科書、醫學文獻而作鑑定。質言之,鑑定醫師係以世界一流醫學中心的“世界標準說”來審查台灣醫療院所的醫療過失案件。因此,我國醫療糾紛鑑定機構或法院首先要確立鑑定醫師採用之鑑定標準,即地方標準說與國家標準說之折衷說。

病歷記載
病歷是直接代表醫師在醫療上之第一手診察紀錄,通常係完成於診察當下或不久之後(至少絕非臨訟之時),且依其工作性質、及累積看診病患之數量龐大,應無預見日後將成為呈堂事證而虛偽填載之可能,可信度自然極高。

舉證責任
蓋病患通常雖應就因果關係負舉證責任,但因醫療處置者之重大醫療瑕疵行為,使得如採取合法處置時之因果歷程發展為何成為不明。由於醫療處置者是「更接近」於醫療行為之作成,故應由其負擔證明上風險,而不應由病患負擔因果歷程不明之不利益。

親自診察義務
醫師法第11條第1項:醫師非親自診察,不得施行治療、開給方劑或交付診斷書。 嚴格強制醫師每次都必須親自到場診察,以免對病人病情誤判而造成錯誤治療或延宕正確治療時機。

正確記載義務
沒記載或記載不完整:並不等同於醫療行為處置上有疏失」、醫師未就檢查結果詳予記載,要屬科以行政罰鍰的問題,與醫療處置有無疏失,係屬兩事。但是法院可能舉證責任轉換。
病歷銷毀:
a.民事訴訟法第 282-1 條:當事人因妨礙他造使用,故意將證據滅失、隱匿或致礙難使用者,法院得審酌情形認他造關於該證據之主張或依該證據應證之事實為真實。
b.民事訴訟法第 345 條:當事人無正當理由不從提出文書之命者,法院得審酌情形認他造關於該文書之主張或依該文書應證之事實為真實
Chih-Chia Wang 王志嘉 Chih-Chia Wang 王志嘉
15:50-16:20/ 人工智慧的相關倫理與法律議題

人工智慧包括大數據處理與深度學習二部分。有關大數據的處理,依據最高行政法院對於全民健康保險資料用於醫學研究的判決(106年度判字第54號判決),必須符合公益性、去識別化以及資訊安全維護機制等要件,而大數據的應用不僅於醫學研究,於醫療實務或臨床工作亦有其重要性,加上人工智慧以及智慧醫療興起後,如何兼顧個人資料保護法第1條的規定,在人格權的保護與個人資料的合理利用取的衡平,成為臨床與研究的重要課題值得探討。本次演講的大綱如下
• 智慧醫療與人工智慧
• 大數據的處理
• 醫用軟體的問題
• 實務運用端的問題
• 其他非醫療端的議題(含智財權相關議題)
Fu-Chang Tsai 蔡甫昌 Fu-Chang Tsai 蔡甫昌
16:30-17:00/ 細胞與基因治療之倫理法律議題

當代基因治療在Crispr/Cas9技術發明後邁入新的里程,也因為2018年中國基因編輯嬰兒案件引發國際性的倫理爭議。細胞治療因為iPS cell技術發展也為再生醫學精準醫療帶來無限生機。本演講將回顧基因治療暨細胞治療發展所涉及之醫學倫理問題,介紹相關的倫理與法規概況,包括過去各國對「人類胚胎幹細胞研究」之政策、國際倫理指引以及台灣相關規範,並分析當前「誘導多功能幹細胞研究」、我國開放「特管辦法」規範所衍生爭議現象,並以研究倫理原則來分析細胞及基因治療之臨床試驗所涉及的倫理考量。

延伸閱讀:蔡甫昌、莊宇真、賴品妤,生殖系基因編輯之倫理法律分析:以中國基因編輯嬰兒為例,台灣醫學2019;23:2:133 – 153
http://www.airitilibrary.com/Publication/alDetailedMesh?DocID=10281916-201903-201904100004-201904100004-133-153
14:00
17:00
《隱形眼鏡》專題演講會 《Orthokeratology Symposium》
Room 301
Peter Chen Zi Peter Chen Zi
14:00-14:20/ The Missing Link between Myopia and Control: What does ortho K studies tell us

As the prevalence of myopia increases in juveniles, the rate of high myopia has increased accordingly, in which the patients bear a long-term risk of blindness. Treatment modalities such as ortho-k and low-dose atropine have been applied to halt myopia progression, with the mechanisms largely unknown. Studies have shown that scleral hypoxia is one of the remarkable pathologies underlying myopia progression and axial elongation; thinning in choroidal thickness and decrease in vessel density could be part of the reason. Our previous study has showed that both ortho-k and atropine have impact on choroidal thickness. However, the effect of these treatments on choroidal vessel density remains unknown; the additive effect of these treatments combined warrants further investigation. In this talk, I will look into the effects of ortho-k, low-dose atropine, and their combination on myopia control and choroidal thickness and blood flow, and discuss the mechanisms underlying these phenomena, which will provide insights for establishing myopia control strategies.
Huey-Chuan Cheng 鄭惠川 Huey-Chuan Cheng 鄭惠川
14:20-14:40/ Increasing the effectiveness of Orthokeratology in Myopia Control

Myopia has become a worldwide public health issue. Recent studies have consistently reported that orthokeratology (Ortho-K) significantly inhibits the progression of myopia by slowing the elongation of axial length. It has been hypothesized that this effect results from the induction of peripheral myopic defocus, which is a result of the effects of the Ortho-K lenses on the midperipheral corneal topography. Previous studies have investigated the relationship between predicting factors and the inhibitory effect of Ortho-K for slowing childhood myopic progression and found some meaningful results; however, some of the findings are controversial.
To enhance the effectiveness of Ortho-K in slowing childhood myopic progression, the factors affecting this process were reviewed.
Randy Kojima Randy Kojima
14:40-15:00/ Custom Parameter Requirements of the Modern Ortho K Lens

Orthokeratology lens construction is evolving in step with the volumes of myopia control findings in children. What should the modern orthok lens incorporate into its design to create the best possible orthokeratology outcomes and optimal myopia control? This talk will review numerous recent studies and how they guide orthok lens customization as it pertains to lens size, treatment zone size, tear layer force, corneal power profiles and optimal landing. It is intended that this broad review of scientific findings and known techniques will provide practitioners with new insight in modern orthokeratology lens construction.
Pauline Cho Pauline Cho
15:00-15:40/ 2020 COVID 19 and Contact Lens Wear
Topic A: Safe Ortho K Practice
Topic B: Antiseptic-resistance genes in staphylococci isolated from orthokeratology lens and spectacle wearers

Topic A: Safe Ortho K Practice Topic
Orthokeratology (ortho-k) has and is increasing in popularity for myopia control in children, but it is not without risks or challenges. The risk of microbial keratitis (MK), which although rare, is increased with contact lens wear, especially overnight wear. MK can cause serious vision impairment. The good news, however, is that the risk can be reduced with stringent vigilance and diligence. In ortho-k, all parties involved, patients, parents, and practitioners, have to work closely together and compliance is essential. Like any other types of contact lens wear, non-compliance is a serious threat to safe ortho-k lens wear and it is important for practitioners to understand, recognise, and manage non-compliant behaviours. Strict standards of practice cannot be undermined or overemphasised. This presentation will review problems with and possible solutions to non-compliance in ortho-k lens wear and what practitioners can do to increase safe ortho-k practice.

B: Antiseptic-resistance genes in staphylococci isolated from orthokeratology lens and spectacle wearers
Staphylococcus aureus can cause a wide range of diseases including soft tissue infection, keratitis and endocarditis. Wide-spread use of disinfectants based on quaternary ammonium compounds (eg. benzalkonium chloride) and biguanides (eg. chlorhexidine) may contribute to the emergence of disinfectant-resistant microorganisms. Resistant strains of bacteria can lead to increased infection risk. This talk will present results of a study comparing the prevalence of disinfectant-resistance genes harbouring staphylococci colonizing the conjunctival sac, eyelid, and on the lens and lens accessories of ortho-k lens wearers with those of spectacle wearers. A brief discussion on the need for alternative disinfecting solutions (eg. new povidone-iodine-based formulation) will also be presented.
Yi-Chen Sun 孫逸珍 Yi-Chen Sun 孫逸珍
15:40-16:00/ Current status of therapeutic contact lens application

Therapeutic contact lens has been used in managing many ocular surface diseases for decades. Nowadays, a lot of therapeutic contact lenses made of various materials with different water contents have been available. In 2015, we published the results of a phase II clinical trial. Instead of PROSE lens, we found that disposable soft contact lens can be another option for chronic ocular graft-versus-host disease (oGVHD) patients. In addition to chronic oGVHD, many other microtrauma-related ocular surface disorders can benefit from applying therapeutic contact lens. We will review and revisit the current status of therapeutic contact lens application.
Shiuh-Liang Hsu 徐旭亮 Shiuh-Liang Hsu 徐旭亮
16:00-16:20/ Application of using RGP as therapeutic contact lens
Matthew Lampa Matthew Lampa
16:20-16:40/ Soft Lenses – What Comes after Daily Disposables

This course will highlight the “Who, What, When, Where and Why” of custom soft lens prescribing for both the regular and irregular cornea. The majority of soft lenses manufactured today are designed for the “average” cornea. This lecture will explore the dynamic relationship between corneal diameter and curvature as well as corneal irregularity.
Fabian Conrad Fabian Conrad
16:40-17:00/ Soft Lenses – Optics of Myopia Management

Increasing prevalence and severity of progressive childhood myopia is a growing concern for patients, parents and practitioners worldwide. Whilst pharmaceutical options, as well as lifestyle choices, play an important role in achieving the optimal outcome for patients, optical means to manage the progression of myopia are part of most treatment regimes. Through altering the optics of central and peripheral image formation, and possibly binocular function and accommodation, it appears that eye-growth can be slowed. Different spectacle and contact lens designs have shown efficacy in achieving this ‘myopia-control’ effect. This lecture will provide an overview of the possible mechanisms involved in regulating eye-growth and the various optical interventions used in myopia-control.
14:00
17:00
第19屆 理監事選舉 <投/開票>
Room 402AB

會埸平面圖










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