EPOS 2021 Vision 2020 - EPOS 2021

Final programme & Abstract book

EPOS 2021 Virtual Conference 18 - 19 June 2021 www.epos2021.dk EPOS 2021 Vision 2020 - EPOS 2021 2

Contents Final programme ...... 3 Invited speaker abstracts ...... 5 Free paper presentations . . . . 33 Rapid fire presentations 60 Poster presentations 70

Local organizing Committee:

Conference chair: Lotte Welinder Dept. of Ophthalmology, Aalborg University Hospital

Members: Dorte Ancher Larsen Dept. of Ophthalmology, Aarhus University Hospital Else Gade Dept. of Ophthalmology, University Hospital Odense Lisbeth Sandfeld Dept. of Ophthalmology, Zealand University Hospital, Roskilde Kamilla Rothe Nissen Dept. of Ophthalmology, Rigshospitalet, University Hospital of Copenhagen Line Kessel Dept. of Ophthalmology, Rigshospitalet (Glostrup), University Hospital of Copenhagen Helena Buch Heesgaard Copenhagen Eye and Strabismus Clinic, CFR Hospitals

EPOS Board Members: Darius Hildebrand President Eva Larsson Secretary Christina Gehrt-Kahlert Treasurer Catherine Cassiman Anne Cees Houtman Matthieu Robert Sandra Valeina EPOS 2021 Programme 3

Friday 18 June

8.50-9.00 Opening, welcome remarks 9.00-10.15 Around ROP and prematurity - Part 1 Moderators: Eva Larsson (SE) and Lotte Welinder (DK) 9.00-9.10 L1 Visual impairment. National Danish Registry of visual Kamilla Rothe Nissen (DK) impairment and blindness? 9.10-9.20 L2 Epidemiology of ROP Gerd Holmström (SE) 9.20-9.40 L3 The premature child. Ethical issues in neonatal care Gorm Greisen (DK) 9.40-9.50 L4 Ocular development and visual functioning in prematures Birgit Lorenz (DE) 9.50-10.05 Free paper & rapid fire presentations (3 min each) 10.05-10.15 Live Q&A/Panel discussion 10.15-10.35 Coffee break, Posters and Exhibition 10.35-11.20 Around ROP and prematurity - Part 2 Moderators: Eva Larsson (SE) and Kamilla Rothe Nissen (DK) 10.35-10.50 L6 Visual perception in children in the Express study Kerstin Hellgren (SE) 10.50-11.00 L7 The new European Registry for Childhood Cataract (EuReCCa) Marie-José Tassignon (BE) 11.00-11.10 LEGO Dansk Blindesamfund (DBS) 11.10-11.20 Live Q&A/Panel discussion 11.20-11.50 Sponsored Symposium (Platinum sponsor) 11.50-12.10 Lunch, Posters and Exhibition 12.10-13.25 Surgery in the first year - Part 1 Moderators: Dorte Larsen (DK) and Darius Hildebrand (UK) 12.10-12.30 L8 Anterior segment surgery in babies Ken Nischal (US) 12.30-12.45 L9 ROP: follow up after intravitreal bevacizumab Grace Prakalapakorn (US) 12.45-12.55 L10 40 years of primary congenital glaucoma in Denmark Daniella Bach Holm (DK) 12.55-13.05 L11 Vitrectomy in children with ROP – to be or not to be in the Marek Prost (PL) treatment of ROP? Results of 1000 vitrectomies. 13.05-13.15 Free paper presentations (3 min each) 13.15-13.25 Live Q&A/Panel discussion 13.25-13.40 Coffee break, Posters and Exhibition 13.40-14.45 Surgery in the first year - Part 2 Moderators: Daniella Bach Holm (DK) and Sandra Valeina (LV) 13.40-13.50 L12 Craniosynostosis, who needs surgery and when Hanne Hove (DK) 13.50-14.00 L13 Simple repair of eyelid coloboma Peter Toft (DK) 14.00-14.20 L14 Video session Ken Nischal (US) and others 14.20-14.35 Free paper presentations (3 min each) 14.35-14.45 Live Q&A/Panel discussion 14.45-15.05 Sponsored Symposium (Gold sponsor) 15.10-16.00 General assembly All EPOS board members EPOS 2021 Programme 4

Saturday 19 June

9.00-10.15 Neuroophthalmology in babies Catherine Cassiman (BE) and Matthieu Robert (FR) 9.00-9.10 L15 Delayed visual maturation - what’s in a name? Ingele Casteels (NO) 9.10-9.20 L16 Signs of brain tumours in babies Sarah von Holstein (DK) 9.20-9.30 L17 Midline from eyes to brain: an evolutionary perspective Marcel ten Tusscher (BE) 9.30-9.40 L18 The Brain stem and corpus callosum Anne Cees Houtmann (BE) 9.40-9.50 L19 The optic nerve as a cause of visual impairment Robert Matthieu (FR) 9.50-10.05 Free paper presentations (3 min each) 10.05-10.15 Live Q&A/Panel discussion 10.15-10.25 Coffee break, Posters and Exhibition 10.25-10.55 Sponsored Symposium (Platinum sponsor) 10.55-12.10 Pharmacological treatments & infectious diseases in Moderators: the first year Olivert Ehrt (D) and Lisbeth Sandfeld (DK) 10.55-11.05 L20 Tips and tricks to examining the baby Darius Hildebrand (UK) 11.05-11.15 L21 What to consider when using eye drops in babies Jens Chr. Nørregaard (DK) 11.15-11.25 L22 Steroids. Differences in pharmacokinetics between Regitze Bangsgaard (DK) different steroids, systemic side effects and influence of genetics 11.25-11.35 L23 Congenital Zika and the Eyes Grace Prakalapakorn (US) 11.35-11.50 Free paper presentations (3 min each) 11.50-12.10 Live Q&A/Panel discussion 12.10-12.50 Lunch, Posters and Exhibition 12.50-14.10 The baby who doesn't see - Part 1 Moderators: Line Kessel (DK) and Christina Gerth-Kahlert (CH) 12.50-13.10 L24 The critical role of high-fidelity visual input in the Agnes Wong (CA) development of audiovisual integration as revealed in amblyopia." 13.10-13.20 L25 Lebers congenital amaurosis and retinal dystrophies in Mette Bertelsen (DK) young children 13.20-13.35 L26 Gene therapy Bart Leroy (BE/US) 13.35-13.45 L27 The role of early visual electrodiagnostics Manca Tekavcic Pompe (SLO) 13.45-14.00 Free paper presentations (3 min each) 14.00-14.10 Live Q&A/Panel discussion 14.10-14.25 Coffee break, Posters and Exhibition 14.25-15.20 The baby who doesn't see - Part 2 Moderators: Else Gade (DK) and Anne Cees Houtman (NL) 14.25-14.40 L28 Early intervention for infants and very young children Naomi Dale (UK) with severe-profound visual impairment and share the scientific findings of our group.” 14.40-14.55 L29 Mother–infant interactions with infants with congenital Elena Sakkalou (UK) visual impairment and associations with longitudinal developmental outcomes 14.55-15.05 L30 Epidemiology and causes of nystagmus and lack of eye Line Kessel (DK) contact in babies 15.05-15.15 L31 Albinism Karen Grønskov (DK) 15.15-15.25 Live Q&A/Panel discussion 15.25-16.00 Closing remarks & Presentation of EPOS 2022 EPOS 2021 Invited Speaker Abstracts 5

[L1] VISUAL IMPAIRMENT. NATIONAL DANISH REGISTRY OF BLIND AND PARTIALLY SIGHTED CHILDREN

Kamilla Rothe Nissen, Annette Rasmussen

The study population was drawn from The Danish Registry for the Blind and Partially Sighted Children which is a national registry of all children (<18 years) with visual impairment or blindness. Defined as visual acuity ≤6/18, hemianopia or visual field <20 degrees on the better seeing eye. In addition, all children with progressive retinal disease must be registered at the time of diagnosis irrespective of visual function. The registry covers the years since 1970.

Danish Registry for the Blind and Partially Sighted Children 31.12.2020. Total number of children: 1836

For the present study we included 1) Children < 1 year of age: N= 57.

We focus on 2) The premature and the children with ROP seqvl at registration 2002-2020

Premature Children (Gestational age < 32 weeks or birth weight < 1500 g). Onehundred-and-sixtysix premature children of which ROP were described in 51 children were included.

In conclusion • During the first year of life the primary cause of visual impairment in the Danish Registry is delayed visual maturation CVI 49%, congenital cataract 11%/ albinism 11% are the second common cause. Congenital nystagmus 9% is the third frequent cause. • ROP is noted in 2% of the diagnoses. • Among newly registered premature children the vision improved to withdrawal of the Registry (v.a.> 0.3) in 20% of the prematures and in 16% of the children with ROP. • In the group of prematures the majority is partially sighted 56%. Partially sight and blindness almost have the same frequency 43%/41% in children with ROP. • Visual impairment as a single disability was found in 23 % of the prematures and in 51 % of the children with ROP. Visual impairment and an additional disability was described in 77 % of the premature children and in 49% of the children with ROP. EPOS 2021 Invited Speaker Abstracts 6

[L2] EPIDEMIOLOGY OF ROP

Gerd Holmström

Dep Neuroscience, ophthalmology, University Hospital, Uppsala, Sweden

Retinopathy of prematurity (ROP) remains an important cause of childhood blindness worldwide. Also, in countries like Sweden, where national screening programs have been available for decades, prematurely born infants go blind from ROP. The panorama of ROP is continuously changing and varies in different parts of the world. In developing countries, a third epidemic of ROP is evolving and very big babies may develop ROP. In highly developed countries, continuously improved neonatal care has resulted in increased survival of extremely immature babies with a high risk of very severe ROP, and, at the same time, a reduced incidence of ROP in the less immature babies, as illustrated in a recent Swedish study based on a national ROP register. Further, the most immature babies sometimes develop a central and rapidly progressing ROP requiring very prompt and efficient treatment. National screening programs for ROP are strongly recommended worldwide, to identify infants with severe ROP, to provide treatment at a correct time and to prevent prematurely born infants from going blind. Regarding inclusion criteria, however, such programs need to be adjusted to each country. EPOS 2021 Invited Speaker Abstracts 7

[L3] THE PREMATURE CHILD. ETHICAL ISSUES IN NEONATAL CARE

Gorm Greisen

Dept Neonatology, Rigshospitalet and Copenhagen University

Being premature means being born before term, 3 weeks or more. Infants born a few weeks preterm are usually healthy at birth and even if ill or malformed may be treated by advanced intensive care and surgery like infants born at term or older infants. But at greater degrees of prematurity the immaturity of organ systems often creates problems of their own, such as respiratory distress syndrome, cerebral hemorrhage – or retinopathy of prematurity. Some infants born at 20 weeks of gestation – 50% of normal have been saved, but survival of infants below 22 weeks is extraordinary, hospitalization lasts many months, severe complications are unavoidable, and significant neurodevelopmental deficit is the rule. Furthermore, this is the gestational age at which termination of pregnancy is available in many countries for clinical problems that are minor compared to this. Children born at 23, 24, 25, and 26 weeks have progressively better chances, but chances are also affected by intrauterine growth restriction, pregnancy, delivery complications, as well as gender. Neonatologists face a particular ethical dilemma in this area when deciding on lifesaving or palliative care at birth, and possibly later when facing significant deterioration. Does birth represent the definitive difference between the fetus and the child, or is there an ethically relevant difference between a freshly born, preterm child and an older child? EPOS 2021 Invited Speaker Abstracts 8

[L4] OCULAR DEVELOPMENT AND VISUAL FUNCTIONING IN PREMATURES

Birgit Lorenz1,2

1Justus Liebig University Giessen, Germany, 2Dept. of Ophthalmology, Universitaetsklinikum Bonn, Germany

Premature birth may lead to disruption of normal ocular development such as persistent immaturity of the geometry of the anterior segment or deviation from the physiological macular maturation. This talk will focus on the consequences of macular development arrest (MDA) that may have a longlife impact on visual performance. SD-OCT and SD-OCT-A together with advanced psychophysical and electrophysiological methods allow previously impossible quantitative and qualitative structure- function correlations (1- 4). The data presented here were mainly collected in prospective studies based on a large cohort of premature infants originally imaged as part of a multisite telemedical program with a digital wide-field fundus camera in North- Eastern Bavaria (5). MDA has not only significant long-term effects on central cone photoreceptor performance, affecting central photopic function seen as reduced light increment sensitivity (LIS), but also indicates a more widespread disturbance of rod photoreceptor function up to the morphological rod ring where rod density is highest. The significant impairment could affect the daily life of children. Considering the findings of previous studies of preterm-born and ROP subjects the results indicate that persistent functional deficits of the photoreceptor outer segments may be present in preterm-born children independent of ROP. The mechanisms that lead to the association of rod- or cone-mediated altered functions and MDA remain to be defined. Support: DFG LO 457/10-1

References: 1 Bowl W, ……. Lorenz B. OCT-Based Macular Structure-Function Correlation in Dependence on Birth Weight and Gestational Age-the Giessen Long-Term ROP Study. (2016) IOVS 2016, 57(9) 2 Bowl W, Lorenz B et al. Correlation of central visual function and ROP risk factors in prematures with and without acute ROP at the age of 6-13 years: the Giessen long-term ROP study. (2016) BJO Sep;100(9) 3 Bowl W, …… Lorenz B. OCT Angiography in Young Children with a History of Retinopathy of Prematurity. Ophthalmol Retina. 201, 2(9) 4 Bowl W, Raoof S, Lorenz B et al. Cone-Mediated Function Correlates to Altered Foveal Morphology in Preterm-Born Children at School Age. IOVS 2019 60(5). 5. Lorenz B et al. Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six- year results of a multicentre field study. Graefes Arch Clin Exp Ophthalmol. 2009, 247(9 EPOS 2021 Invited Speaker Abstracts 9

[L6] VISUAL PERCEPTION IN CHILDREN IN THE EXPRESS STUDY

Kerstin Hellgren

Background: Extreme prematurity is a well-known risk factor for long-term visual, perceptual and cognitive deficits. These deficits, although sometimes difficult to evaluate clinically, might have a negative impact on daily life and academic achievements.

Methods: The prospective, population-based Extremely Preterm Infants in Sweden Study (EXPRESS) explores the long-term outcome of a national Swedish cohort of infants born at <27 weeks’ GA. At age 6.5 years ophthalmological outcome, general cognition, visual motor integration, visual approximate number sense as well as form and motion coherence detection were assessed and compared with a group of full-term controls. In addition, a questionnaire surveying daily life visual problems was answered by care-givers.

Results: The extremely preterm born children performed worse on all assessments than the term born children. Ophthalmological and cognitive deficits were associated with low gestational age in the extremely preterm group. Most visual perceptual outcomes were related to but not fully explained by general cognition. The parents of extremely preterm born children reported more daily life visual problems and their answers were congruent with other evidence of visual, perceptual, and cognitive deficits.

Conclusion: This study demonstrated that extremely preterm school-aged children have a disadvantage regarding a variety of perceptual skills compared to term born peers and that their parents identify visual problems on structured questionnaires EPOS 2021 Invited Speaker Abstracts 10

[L8] ANTERIOR SEGMENT SURGERY IN BABIES

Ken Nischal

As our understanding of the anatomy and physiology of the infant eye improves, so does our ability to treat anterior segment disorders in children. This has been helped enormously in the past decade by an improvement in the instruments that we have, the machines that we use, and now imaging techniques. It is important for the pediatric ophthalmologists to understand that certain imaging modalities are now integrated into operative microscopes, namely OCT. This has resulted in the ability to undertake certain surgeries that perhaps would not have been undertaken previously. In this session, we will cover the importance of understanding the role of anesthesia in anterior segment surgery in infants, our understanding of the anatomy of the infant’s eye, and understanding how we can utilize integrated intraoperative OCT to do surgeries that perhaps we would not have been able to do previously. There will be detailed discussion about infant cataract surgery, infant and pediatric corneal surgery, and a mention of the use of integrated intraoperative OCT in the management of infant and pediatric glaucoma. EPOS 2021 Invited Speaker Abstracts 11

[L9] ROP: FOLLOW UP AFTER INTRAVITREAL BEVACIZUMAB

S. Grace Prakalapakorn

Associate Professor of Ophthalmology and Pediatrics, Duke University, Durham, NC, USA

Following anti-vascular endothelial growth factor (VEGF) treatment for retinopathy of prematurity (ROP), current United States ROP screening guidelines recommend continued ROP screening examinations until complete retinal vascularization or ³65 weeks postmenstrual age. Since proliferative ROP has been reported to recur years following anti-VEGF treatment, some clinicians prophylactically laser any remaining avascular retina to attempt to prevent ROP recurrence and potentially poor structural and visual outcomes. In a retrospective chart review (2015-2019) among infants initially treated with bevacizumab for ROP and followed until the conclusion of ROP screening examinations at our institution, we compared the number and duration of ROP follow-up examinations among eyes initially treated with bevacizumab and either prophylactically lasered pre-hospital discharge or followed per current guidelines. We found that following initial bevacizumab treatment for ROP, there was no statistically significant difference in the total number of follow-up ROP screening examinations (i.e. the total number of combined inpatient and outpatient ROP screening examinations), but prophylactically lasering eyes pre-hospital discharge reduced the number and duration of outpatient follow- up ROP screening examinations versus continued surveillance. Performing prophylactic laser pre-hospital discharge may be beneficial because it reduces the risk of late ROP recurrence, examining older/larger infants is challenging, and adherence to frequent outpatient visits can be burdensome for families. These potential benefits must be weighed against the risk of laser- associated complications. EPOS 2021 Invited Speaker Abstracts 12

[L10] 40 YEARS OF PRIMARY CONGENITAL GLAUCOMA IN DENMARK

Daniella Bach Holm

Purpose: To describe diagnostic delay, surgical management and visual acuity in a cohort of 118 patients with primary congenital glaucoma (PCG), diagnosed in the period 1977-2016 and a follow-up period of 3 to 34 years in Denmark.

Methods: Chart reviews of 118 patients (162 eyes) with primary congenital glaucoma were performed. 54 patients (92 eyes) participated in a follow-up examination performed at the Department of Ophthalmology, University Hospital of Copenhagen, Glostrup in 2009-2011. In patients with bilateral PCG, the eyes were divided into first and second eye.

Results: 94.8 % of patients with bilateral primary congenital glaucoma and 83.2% of patients with unilateral PCG was diagnosed before the first year of life. A trabeculotomy was performed as the primary procedure in a majority of the children. More than one surgical procedure was required in 25 % of patients with unilateral PCG and in 40 %/29.6 % of patients with bilateral PCG (first/ second eye) to obtain success. Some of the eyes failed after a time period of more than 5 years. 67.9% of the eyes had a visual acuity > 0.33 at the last follow-up visit while 12.3 had a visual acuity < 0.05. 49 out of 67 patients with bilateral PCG had a binocular visual acuity > 0.5.

Conclusion: We found that a majority of the children with primary congenital glaucoma is diagnosed before the first year of life. Some of children may require additional pressure controlling surgeries even after 5 years why dedicated long-term follow-up is necessary in these patients. Patients with primary congenital glaucoma are visually challenged but 75% of the patients have a visual acuity allowing them to drive a car in Denmark. EPOS 2021 Invited Speaker Abstracts 13

[L11] VITRECTOMY IN CHILDREN WITH ROP - TO BE OR NOT TO BE IN THE ROP TREATMENT. RESULTS OF 1000 VITRECTOMIES.

Marek Prost1

1 Center for Pediatric Ophthalmology, Department of Ophthalmology, Military Institute of Aviation Medicine, Warsaw, Poland

Introduction: Despite improvements in neonatal care ROP is still leading cause of blindness in the world. The most treatment problems pose stage 4 and 5 of this disease. Performing vitrectomy is a subject of controversy among ophthalmologists due to unsatisfactory functional results of stage 5 of this disease after the surgery.

Methods: The aim of this presentation is to presents the results of 1000 vitrectomies performed by the author in years 1995-2020 in children with stage 4 and 5 of ROP. In these children scleral buckling, limbal approach and pars plana vitrectomies and scleral resections were performed.

Results: The results obtained depend primarily on the stage of the disease and progression of fibrovascular proliferation before surgery and ranged from 0,4 to no light perception in stage 4 and 0,04 to no light perception in stage 5. It is difficult to predict the end results of treatment because of possibility of development of reproliferations and individual differences in the development of vision function in operated children.

Conclusion: Although the results of vitrectomies in children with stage 4 and 5 are still unsatisfactory, improvement of visual acuity can be obtained in some of the operated children.

EPOS 2021 Invited Speaker Abstracts 14

[L12] CRANIOSYNOSTOSIS, WHO NEEDS SURGERY AND WHEN

Hanne B Hove1,2

1Center for Rare Diseases, Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark 2The RAREDIS Database, Center for Rare Diseases, Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

Craniosynostosis affects 1:2.500 births. The most common craniosynostosis is non-syndromic scaphocephaly and trigonocephaly due to premature fusion of the sagittal and metopic synostosis, respectively, followed by non-syndromic unicoronal synostosis and Muenke syndrome associated unicoronal synostosis. Simple craniosynostosis – i.e., sagittal and unicoronal synostosis is handled with corrective cranioplasty in the age of 6-9 months-of-age and re-surgery is rarely necessary. The complex craniosynostosis includes premature synostosis of two or more cranial sutures and often also involves the synchondroses of the cranial base and the sutures of the maxillary complex and can, hereby, have an impact of the development of the midface (direction and speed of growth). All complex craniofacial patients are followed by a multidisciplinary team of craniofacial experts and computer assisted planning is utilized for all patients undergoing craniofacial correction. Plans for treatment is individualized and based on 3D-CT. Timing of surgery depends on symptoms and virtual surgical planning is performed based on surgical guides for cutting and repositioning or with the use of patient specific implants. Guided surgery leads to much more precise reconstructions and shorter operation time. Severe midface or mandibular retrusion are treated by distraction osteogenesis typically at age 10-12 years-of-age, but respiratory or other severe health problems can accelerate surgery intervention. Final correction of associated dentofacial anomalies is delayed until skeletal maturity, typically at 16-19 years-of-age. EPOS 2021 Invited Speaker Abstracts 15

[L13] SIMPLE REPAIR OF EYELID COLOBOMA

Peter Bjerre Toft

Eye Clinic, Rigshospitalet, Denmark

Introduction: Repair or eyelid coloboma can be accomplished by direct closure and by various complex procedures including eyelid sharing procedures. The purpose is to review examples of direct closure.

Methods: Review of records and photographs of patients operated for eyelid coloboma with direct closure with and without cantholysis.

Results: The result was dependent on the pre-operative condition, but reasonable results could be achieved without eyelid sharing procedures.

Discussion: Simple repair is feasible and sufficient in most cases of eyelid coloboma. EPOS 2021 Invited Speaker Abstracts 16

[L15] DELAYED VISUAL MATURATION - WHAT’S IN A NAME?

Ingele Casteels

Normally, full term babies show evidence of visual fixation at birth or shortly afterwards. The absence of visual responsiveness in a baby of more than 8 weeks old warrants careful investigation. In an apparently normal baby with poor visual contact and no visible ocular structural abnormality, with or without nystagmus, a careful and systematic examination is necessary. The flash electroretinogram will differentiate an underlying sensory defect nystagmus from a congenital idiopathic nystagmus. The term ‘delayed visual maturation’ (DVM) has been used in different ways in the literature. DVM is a retrospective diagnosis preferably used in a normal developing baby with a transient visual deficit and normal ophthalmological findings. However, with longer follow-up more neurological problems emerge in this group of patients. Babies and children with the initial diagnosis of ‘isolated DVM’ should be carefully monitored by the paediatrician for neurodevelopmental problems. ‘Temporary visual inattention’, as described by Beauvieux in 1947, is a more accurate terminology as it does not preclude ‘a perfect normal outcome’. EPOS 2021 Invited Speaker Abstracts 17

[L16] SIGNS OF BRAIN TUMORS IN BABIES

Sarah von Holstein

We will present unpublished data from all infants diagnosed with a brain tumor before the age of one year in Denmark in the period of 2007-2017 (total of 41 patients). The focus of the talk is onset signs and symptoms with special emphasis on the ophthalmological manifestations. EPOS 2021 Invited Speaker Abstracts 18

[L17] MIDLINE FROM EYES TO BRAIN: AN EVOLUTIONARY PERSPECTIVE

Marcel ten Tusscher1

1 Universitair Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium

Introduction: The superior colliculus, lateral geniculate nucleus and visual cortex receive input from both eyes. For bilateral functional integration, animals with bilateral symmetry need axonal connections between the right and left side of the nervous system. To this end commissural systems are present throughout vertebrate and invertebrate species.

Methods: Most vertebrate species have eyes that are set laterally in the head, without uncrossed retinal ganglion cell fibres in the optic chiasm. In species with frontal eyes monocular visual fields overlap. Within this binocular visual field ipsilateral ganglion cells appear. The more binocular the visual field, the more uncrossed retinal ganglion cell fibres are found in the optic chiasm. In human primates nearly 50% of fibres in the optic chiasm do not cross. A small area along the vertical midline of the monocular visual field is represented by retinal ganglion cells that both cross and do not cross. The uncrossed ganglion cell fibres in this so called ´callosal´ visual field are the footing for right-left connections in the corpus callosum.

Results: The initial routing of the visual pathways depends on genetic programs. Connections are at first exuberant. Guided by visual experience this is succeeded by selection and elimination.

Conclusion: Partial decussation in the optic chiasm and corpus callosum seem pivotal for normal binocular vision. EPOS 2021 Invited Speaker Abstracts 19

[L18] INTERHEMISPHERIC CALLOSAL AND COMMISSURAL VISUAL PATHWAYS

Anne Cees Houtman1, Marcel Ten Tusscher2

1 Oogziekenhuis Zonnestraal, Ziekenhuisweg 100 Aa Lelystad, Netherlands 2 Universitair Ziekenhuis Brussel, Belgium

Introduction: During normal binocular visual development, the corpus callosum (CC) establishes very specific reciprocal interhemispheric connections between the primary visual cortices and contributes to binocular vision along the midline and stereopsis in front of the fixation plane. This specific organization emerges progressively from the elimination of juvenile exuberant connections, mainly during the critical period of visual development. In cats with experimentally induced unilateral strabismus in the critical period such connections have been found to be abnormal with persistence of exuberant callosal fibers. Callosal fibers are not the only interhemispheric connections involved in the development of binocular vision; in non-placental mammals the anterior commissure (AC) may fulfill a similar role. Possible alternative interhemispheric pathways via the AC were investigated in normal and strabismic human subjects and in one subject with complete agenesis of the CC.

Methods: DTI/Tractography in 9 normal controls, 4 subjects with IE and 1 with complete agenesis of the CC. Regions of interest were defined in the V1 and V2 areas, the splenium of the CC and in the midline at the level of the AC.

Results: All subjects showed interhemispheric visual connections through the CC except the subject with complete agenesis of the CC. In one subject with infantile esotropia and manifest latent nystagmus, and in the subject with complete agenesis of the CC connections were found via the AC.

Conclusion: In humans callosal fibers form the main visual interhemispheric connections but commissural fibers may serve as an alternative under pathological conditions. EPOS 2021 Invited Speaker Abstracts 20

[L19] THE OPTIC NERVE AS A CAUSE OF VISUAL IMPAIRMENT

M. Robert

In babies, visual impairment resulting from an optic nerve dysfunction will result in an infantile nystagmus syndrome (INS). Bilateral optic nerve hypoplasias are a common cause of INS; they are often overlooked on the first examination in non- specialised clinics but should prompt specific endocrine investigations.

Bilateral optic nerve colobomas are also frequent. They are easier to diagnose and should also prompt specific investigations in order to look for associated malformations.

In the context of an INS, a pale optic disk with no associated sign of albinism is almost always the sign of a Leber congenital amaurosis, even when the retina looks clinically normal and the key investigation is then full-field electroretinogram. True optic nerve atrophies in babies are rare in isolation. They can result from very severe congenital hydrocephalus, which clinical diagnosis should be obvious. They can also result from malignant osteopetrosis, which clinical signs should be known by paediatric ophthalmologists, as they sometime can present as early visual dysfunction. EPOS 2021 Invited Speaker Abstracts 21

[L20] TIPS AND TRICKS TO EXAMINING THE EYES OF YOUNG CHILDREN!

Göran Darius Hildebrand FRCS FRCOphth FEBO1,

1 Oxford University Eye and Children Hospitals, Oxford OX3 9DU, United Kingdom

In ophthalmology, the eye examination is most difficult in young children, especially in babies. At the same time, the need for an examination is greatest in very young children as they cannot give a reliable description of their symptoms in detail and important information may be missed. A number of useful clinical techniques have been developed to achieve a complete eye examination even in babies young toddlers to avoid the need for sedation or a general anesthetic which will be demonstrated by video, including the use of swaddling, milk and sleep.

EPOS 2021 Invited Speaker Abstracts 22

[L21] WHAT TO CONSIDER WHEN USING EYE DROPS IN BABIES.

Jens Christian Nørregaard

Drug Information Handbook (ProMedicin.dk)

Most eye drops are not for approved for use in babies as the pharmaceutical industry has not conducted the studies that are needed for approval. However, we still need the drugs. This talk highlights where you should be cautious when using drugs for dilatation, glaucoma, and infections off label in newborn. Steroid and VeGF inhibitors will be presented by other speakers. EPOS 2021 Invited Speaker Abstracts 23

[L22] STEROIDS. DIFFERENCES IN PHARMACOKINETICS BETWEEN DIFFERENT STEROIDS, SYSTEMIC SIDE EFFECTS AND INFLUENCE OF GENETICS. – THE IMPORTANT FIRST YEAR.

Regitze Bangsgaard

Steroids are mainly used in their topical form and as per- and postoperative treatment in infants below one year of age. They have a permissive effect on numerous anti-inflammatory and immunosuppressive enzymes and hormonal systems. Steroids exert physiological and adverse effects through gene transcription interreference, and growing evidence suggests that they also have a faster action mediated through interaction with lipids and proteins on the cell membrane and in the cytosol. The exact local or systemic dose is dependent on numerous factors apart from the inflammatory strength and half-life of the chosen synthetic steroid. Children below one year of age are especially vulnerable to adrenal suppression which can lead to adrenal crisis and Cushing. There is large individual variation with respect to effects and side effects and this may in part be ascribed to genetic variation. At present polymorphisms in the gene loci encoding the glucocorticoid receptor as well as 11β-HSD are leading candidate genes. EPOS 2021 Invited Speaker Abstracts 24

[L23] CONGENITAL ZIKA AND THE EYES

S. Grace Prakalapakorn

Associate Professor of Ophthalmology and Pediatrics, Duke University, Durham, NC, USA

Following the Zika virus (ZIKV) outbreak in the Americas in 2015, a lot has been learned about the effects of antenatal ZIKV infection. Although most people with ZIKV infection are asymptomatic, antenatal ZIKV infection can lead to a distinctive constellation of structural anomalies and functional disabilities, defined as congenital Zika syndrome (CZS), characterized by the following: (1) severe microcephaly with partially collapsed skull; (2) brain abnormalities, including thin cerebral cortices with subcortical calcifications; (3) ophthalmologic findings, including macular scarring and focal pigmentary retinal mottling; (4) congenital contractures; and (5) marked early hypertonia and signs of extrapyramidal involvement. Our knowledge of the effects of ZIKV infection on the eye and vision is still growing. Both anterior and posterior ocular findings have been reported. The most commonly reported findings involve the macula (i.e. focal pigmentary mottling/clumping and well-demarcated chorioretinal scars) and the optic nerve (i.e. hypoplasia, cupping, and pallor). Both infants with and without microcephaly have been reported to have ocular findings and/or visual impairment. Because children without structural ocular abnormalities have been found to have visual impairment, cortical visual impairment may be the most common cause of visual impairment among these children. Currently, the United States Centers for Disease Control and Prevention recommends that all infants with clinical findings consistent with CZS born to mothers with possible ZIKV exposure in pregnancy or without clinical findings consistent with CZS born to mothers with laboratory evidence of possible ZIKV exposure in pregnancy should have a comprehensive ophthalmologic exam by 1 month of age. EPOS 2021 Invited Speaker Abstracts 25

[L24] THE CRITICAL ROLE OF HIGH-FIDELITY VISUAL INPUT IN THE DEVELOPMENT OF AUDIOVISUAL INTEGRATION AS REVEALED IN AMBLYOPIA

Agnes Wong

High-fidelity visual input is critical for the development of optimal audiovisual integration. Children and adults with amblyopia have reduced ability to integrate visual and auditory signals, and they also exhibit altered spatial hearing, independent of visual acuity. Evidence from animals and blind humans suggests that early visual experience influences the calibration of sound localization during development. It is unclear whether deficits in sound localization contribute to impaired audiovisual integration in amblyopia. To investigate this, we recruited adults with amblyopia and found that early visual impairment interferes with the precise calibration of auditory localization. The pattern of deficits suggests that visual input during early development calibrates the auditory spatial map in phylogenetically ancient retinocollicular pathway. EPOS 2021 Invited Speaker Abstracts 26

[L25] LEBER CONGENITAL AMAUROSIS AND RETINAL DYSTROPHIES IN YOUNG CHILDREN

Mette Bertelsen

Department of Clinical Genetics, Rigshospitalet, Copenhagen

Generalized retinal dystrophies encompass a heterogeneous group of hereditary retinal disorders with a progressive degeneration of both rod and cone photoreceptors that is considered one of the most frequent causes of visual impairment and blindness in children. Leber congenital amaurosis (LCA) represents the most severe form with an onset during the first year of life. The aim of this presentation is to present the prevalence and diagnostic spectrum of generalized retinal dystrophy in Danish children, with special focus on the genetic spectrum and phenotypical characteristics in Danish patients with LCA. In an epidemiological survey using Danish national registries, we found a prevalence of generalized retinal dystrophy of 13 per 100,000 children aged 0-17 years. The age-specific prevalence increased prominently with increasing age. In 43% of the children the eye condition was part of a syndrome, while the remaining 57% had eye disease only. The most common hereditary pattern was autosomal recessive (99 children, 66%). In a genetic study of Danish patients with LCA, RPE65 was found to be the most prevalent mutated gene. Updated numbers of the genetic spectrum of Danish LCA patients will be presented. Many of the dystrophies are the subject of gene therapy treatment and trials, and nation-wide epidemiological data and genetic studies can help assess the future need for treatment and ensure availability of gene therapy for the patients with a relevant genetic diagnosis. EPOS 2021 Invited Speaker Abstracts 27

[L26] GENE THERAPY

Bart P Leroy

Dept of Ophthalmology & Ctr for Medical Genetics, Ghent University Hospital, Ghent, Belgium & Dept of Head & Skin, Ghent University, Ghent, Belgium & Div of Ophthalmology & Ctr for Cellular & Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA The talk will give an overview on the current achievements, successes and challenges for gene therapy in the broader sense. From gene augmentation therapy over CRISPR/Cas9 to antisense oligonucleotides, technologies differ, with a common end result: correcting a gene product so that function can be partially restored. EPOS 2021 Invited Speaker Abstracts 28

[L27] THE ROLE OF EARLY VISUAL ELECTRODIAGNOSTICS

Manca Tekavcic Pompe

Visual electrodiagnostics (VE) is often routinely used in establishing the diagnosis and in the monitoring of conditions affecting visual pathway function in a baby. Combined recording of electroretinogram (ERG) and visual evoked potentials (VEP) can functionally dissect the visual pathway and identify the site of potential dysfunction, whether the retina, optic nerve or visual cortex are the primary reason for visual impairment. Recording of the VEP and ERG is possible from the first day of life and requires no subjective input from the baby, which gives VE additional clinical value. Standardized adult based VE protocols established by the International Society for Clinical Electrophysiology of Vision (ISCEV) need adaptation for successful implementation in paediatric practice. An adaption which will be shown as a successful additional clinical tool and is used in our tertiary paediatric centre includes: the use of skin electrodes in recording flash ERG, non-dilated pupils, and no formal dark adaptation. The rod and cone contributions are separated by scotopic blue vs. red and 30 Hz flashes. Stimulation protocols for VEP to pattern-reversal, pattern-onset and flash stimuli are adapted according to individual needs. During a recording, attention grabbers such as cartoon, music, audio books and noisy toys are used. The use of VE will be demonstrated in a few real-life clinical scenarios and major clinical questions such as “Does this baby see?”, “What is the cause of the nystagmus in this baby?”, “Which part of the retina is primarily affected in retinal dystrophy of this baby?” shall be answered with the help of VE. EPOS 2021 Invited Speaker Abstracts 29

[L28] EARLY INTERVENTION FOR INFANTS AND VERY YOUNG CHILDREN WITH SEVERE- PROFOUND VISUAL IMPAIRMENT: SCIENTIFIC FINDINGS OF EFFICACY

Naomi Dale

This presentation discusses recent research on efficacy of early intervention for infants and very young children with severe visual impairment (the OPTIMUM study, England, Dale et al 2019 Dev Med Ch Neurol) and some future implications for clinical practice and research. Early developmental or therapeutic intervention remains the main treatment option for the majority of congenital childhood ocular and cerebral disorders leading to permanent visual impairment and blindness. Until recently the efficacy of early childhood intervention has not been known nor which is the most effective method of intervention. The OPTIMUM study scientifically evaluated and compared the Developmental Journal for babies and young children (DJVI), a developmental structured programme including developmental monitoring and guidance integrated with vision promotion, with ‘other support’ provided by peripatetic teachers for the visually impaired in a national cohort of 90 children with heterogeneous congenital disorders of the anterior visual system (ratio of profound (light perception at best) to severe (basic ‘form’ vision, near detection) of 1:4). The research findings were promising showing clinically relevant greater developmental gains in sensorimotor understanding and expressive language (linear mixed effects modelling controlling for age and vision level: profound versus severe VI), significant reduction in behaviour difficulties and parenting stress and greater satisfaction of the parent with the practitioner. Holistic benefits for the child and family are discussed, including the importance of the parent-partnership support relationship. Potential implications for early intervention practice following the OPTIMUM study are discussed including training and service delivery models. EPOS 2021 Invited Speaker Abstracts 30

[L29] MOTHER–INFANT INTERACTIONS WITH INFANTS WITH CONGENITAL VISUAL IMPAIRMENT AND ASSOCIATIONS WITH LONGITUDINAL DEVELOPMENTAL OUTCOMES.

Elena Sakkalou

Congenital visual impairment (VI) has a profound effect on development and the relationship between the caregiver and child, particularly in the early years. Infants with VI tend to be more passive, lack eye contact and parents are reported to find it harder to read and interpret their infants’ cues. Our previous research (Sakkalou et al., 2018) has also found that by the second year of life parents report more stress in parenting a child with VI. These factors suggest that both parent and child may experience obstacles in achieving coordinated interactions, which may have a cascading effect on developmental outcome. The talk will discuss recent research (Sakkalou et al., 2021) which investigated mother-infant interactions in a group of 55 children with severe and profound VI, and longitudinal developmental outcomes from 12 months to 3 years of age. This study is part of the Optimum longitudinal project (Dale et al., 2017). Mothers and their infants were video recorded playing with a standard set of toys at 12 months of age (T1) and children were assessed longitudinally for nonverbal cognition, expressive language, and receptive language at T1 (12 months), T2 (12 months later) and T3 (24 months later). Two measures of mother behaviour were coded, maternal maintaining of infant attentional focus and maternal sensitivity. Results revealed that maternal sensitivity (but not maintaining) positively influenced progression in verbal comprehension from T1 to T3. The discussion will focus on the need to incorporate maternal sensitivity as a component of early intervention for young infants with VI. EPOS 2021 Invited Speaker Abstracts 31

[L30] EPIDEMIOLOGY AND CAUSES OF NYSTAGMUS AND LACK OF EYE CONTACT IN BABIES.

Line Kessel

Department of Ophthalmology. Rigshospitalet and University of Copenhagen. Denmark

Background: Establishing eye contact between babies and parents is important for early child-parent bonding. Babies can present with poor eye contact with or without nystagmus. The aim of the presentation is to give an overview of the epidemiology and causes of nystagmus and/or poor vision in babies based on the Danish population.

Methods: We evaluated babies referred with poor eye contact (n=99) or nystagmus (n=103) during the first year of life. Hospital records including imaging of brain and eyes, laboratory results, electrophysiology and genetic analyses were reviewed.

Results: The prevalence of poor eye contact in the first year of life was 12.7 infants per 10,000 liveborn. The most common cause of poor eye contact was neurologic disease 36.4%, delayed visual maturation 24.2%, ocular disease 21.2% and idiopathic nystagmus 4.0%. The prevalence of nystagmus was 6.1 per 10,000 live births but 97.3/10,000 in those born extremely premature. The most common causes of nystagmus were ocular disease (44%) followed by idiopathic nystagmus (32%), neurological disorders and genetic syndromes (20%) and prematurity without retinopathy of prematurity (4%).

Conclusion: Fortunately, poor eye contact and nystagmus are rare, but they can both by signs of severe underlying disease and requires careful examination and close collaboration between pediatric ophthalmologist and pediatricians to detect the cause and manage the disease and family. Although visual function may seem extremely poor initially, nearly all infants demonstrate a positive development with improvement in visual attention and function as vision matures. EPOS 2021 Invited Speaker Abstracts 32

[L31] GENETICS IN ALBINISM

Karen Grønskov

Albinism is a condition affecting the eye and, in some cases, also the skin and hair. Albinism can occur isolated or as part of a syndrome such as Hermansky-Pudlak syndrome (HPS) and Chediak-Higashi syndrome (CHS). The isolated forms of albinism are referred to as oculocutaneous albinism (OCA) for which six genes are known or ocular albinism (OA) for which one gene are known. In the later years is has become evident that the skin and hair phenotype in OCA varies depending on the affected gene and the mutations. The six genes associated with OCA, are either involved in the enzymatic conversion of tyrosine to melanin (TYR, TYRP1) or involved in maintaining the correct environment in the melanosomes (OCA2, SLC24A5, SLC45A2). The function of the sixth gene, LRMDA, is thought to be important for differentiation of melanocytes. Mutations in these genes show autosomal recessive inheritance. The gene associated with ocular albinism, GPR143, is a G-protein coupled receptor located in the membranes of melanocytes and RPE cells (retinal pigment epithelium). Mutations in GPR143 show X-linked inheritance. The symptoms of the syndromic forms, HPS and CHS, are besides OCA, hematological symptoms such as prolonged bleeding, symptoms from the lungs such as interstitial pulmonary fibrosis and inflammatory bowel disease. These symptoms need treatment, and therefore molecular genetic analysis it is very important in individuals with OCA. EPOS 2021 Free Paper Presentations 33

[FP1] LATE IMPROVEMENT IN VISION IN CHILDREN WITH ALBINISM

Claudia Yahalom1, Karen Hendler2, Anat Blumenfeld2, Atara Juster2, Ayan Galbinus2, Ana Navarrete2

1 Hadassah-Hebrew University Medical Center, Israel, United Kingdom 2 Hadassah-Hebrew University Medical Center, Jerusalem, Israel

Introduction: To determine if visual maturation continues through school years in children with albinism and whether this is related to the albinism type, refractive error or nystagmus presence.

Methods: Retrospective study of children with clinical and genetic diagnosis of albinism seen during early school years (Visit 1) with at least 4 years of follow up (Visit 2+3). Type of albinism, B-BCVA (bilateral best corrected visual acuity), refractive error and presence of nystagmus were recorded in different visits during the long term follow up period.

Results: Seventy-nine children with clinical and genetic diagnosis of albinism were included in the study (OCA1:48; OCA2:27; HPS:3; OA:1) Follow up ranged from 4- 12 years Mean B-BCVA was: at visit 1 (age 5-6 years), 6/42 in OCA1 group and 6/32 in OCA2 group; at visit 2 (age 10-12), 6/28 in OCA1 group and 6/30 in OCA2 group, at visit 3 (age 13-16), 6/28 in OCA1 group and 6/23 in group OCA2. B-BCVA improved in 70% of patients in OCA1 group and in 51% of patients in OCA2 group. Mean visual acuity in children without nystagmus was significantly better in both OCA1 group (6/19) and OCA2 group (6/10), but improvement with time was similar than children with nystagmus. There was no correlation between visual improvement and refractive error. HPS and OCA4 groups were too small to reach conclusions.

Conclusion: B-BCVA often improves in albinism in the early school years beyond the age of six, and worth taking into consideration when counseling albino children’s parents. In the OCA1 group a mean visual improvement of 2 lines was registered by age 10-12 (visit 2) whereas in the OCA2 group a mean visual improvement of 1 line was seen progressively up to age 16. The reason for this late improvement in vision is not clear but may be related to improvement in nystagmus with time or late maturation of macular area.

EPOS 2021 Free Paper Presentations 34

[FP2] CLINICAL PERFORMANCE OF THE SPOT VISION PHOTO SCREENER BEFORE AND AFTER INDUCTION OF THE CYCLOPLEGIA IN CHILDEREN

Konuralp Yakar1

1 Çeşme Alper Çizgenakat State Hospital, Izmir, Turkey

Introduction: To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

Methods: The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3-10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses.

Results: The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%.

Conclusion: The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

EPOS 2021 Free Paper Presentations 35

[FP3] THE EXPERIENCE OF SURGICAL TREATMENT OF POSTERIOR LENTIGLOBUS IN CHILDREN

Alexandra Vydrina1, Irina Trifanenkova2, Alexander Tereshchenko2, Margarita Tereschenkova1

1 The S. Fyodorov Eye Microsurgery Federal State Institution Kaluga Branch, Kaluga, Russian Federation 2 The S.Fyodorov Eye Microsurgery Federal State Institution Kaluga Branch, Kaluga, Russian Federation

Introduction: The purpose is to present the experience of surgical treatment of posterior lentiglobus in children.

Methods: There were 7 children (13 eyes) with congenital cataract in combination with the posterior lentiglobus in the study. The ages of children were from 3 months till 3 years. All patients were undergone ultrasound biomicroscopy (UBM) in addition to the standard ophthalmological examination. Phacoaspiration of congenital cataract with IOL implantation and 25g vitrectomy was performed. After corneal incisions, the anterior capsule was stained and the anterior capsulorexis was formed. Then, using a bimanual technique, an unclear lens was aspirated with help a Centurion Vision Sistem system (Alcon, USA). The next step was, an AcrySof Natural SN60AT IOL (Alcon, USA) with an optical power of 27 to 35 diopters was implanted in the capsule bag. After this, a 25g vitrectomy was performed, during which the sharply thinned central part of the posterior lens capsule protruding into the vitreous body was removed. The operation was completed by sealing the incisions. The observation period is up to 3 years.

Results: Intraoperative complications were not observed in any case. The postoperative period was quiet. According to UBM, the IOL was visualized behind the iris, centrally, intracapsularly, for one month after surgery. Haptic elements are tightly pressed to the optical part of the IOL due to the diameter of the capsular bag reducing and its fibrous changes. In the optical zone, a defect of the posterior lens capsule was detected with an increase in its thickness along the edge and an increase in acoustic density due to fibrotic changes. In the dynamics, the position of the IOL remained stable according to the data of UBM. Visual acuity at the end of the observation period in patients ranged from 0,2 to 0,5 without correction, with correction from 0,4 to 0,7.

Conclusion: Performing cataract surgery and 25g vitrectomy through corneal incisions is an effective and safe method of treating children having a combination of posterior lentiglobus with congenital cataract.

EPOS 2021 Free Paper Presentations 36

[FP4] EVALUATION OF THE CENTRAL AND PERIPHERAL RETINA IN PATIENTS WITH CICATRICIAL STAGES OF RETINOPATHY OF PREMATURITY BY SPECTRAL OPTIC COHERENCE TOMOGRAPHY

Margarita Tereschenkova1, Elena Erokhina2, Alexander Tereshchenko2, Irina Trifanenkova2

1 The S. Fyodorov Eye Microsurgery Federal State Institution Kaluga Branch, Kaluga, Russian Federation 2 The S.Fyodorov Eye Microsurgery Federal State Institution Kaluga Branch, Kaluga, Russian Federation

Introduction: The purpose is to evaluate the informative value of spectral optical coherence tomography (SOCT) in the diagnosis of retinal changes in patients with retinopathy of prematurity (ROP) in the cicatricial period.

Methods: There are 28 children (56 eyes) with spontaneous pH regression (2nd stage - 21 eyes, 3rd stage - 35 eyes) in the study. The ages of children were 5-18 years (9,6±2,8). The gestational ages were 25-32 weeks (28,3 ± 0,7). Weight of bodies were 710-1890 g. (1232 ± 121). All children were performed retinal SOCT in the central departments and on the periphery with device «Optical Coherence Tomographer «RTVue Avanti»» (Optovue, USA).

Results: In the outcome of spontaneous regression of 2nd stage, fovea ROP was formed in all patients. There was a smoothing of the foveal fossa in 14 eyes. There were the areas of compaction of the inner border membrane being determined within the perifocal region in 11 eyes. The isolated sites of epiretinal fibrosis were detected in 9 eyes. In the peripheral parts of the retina, at the border of the vascularized and avascular zones, preretinal opacities were visualized in 7 cases. These preretinal opacities were predominantly of low reflectivity without fixation to the sheaths. Zones of local compaction of the posterior hyaloid membrane (PHM) with areas of local fixation to the retina and single traction were determined in 15 eyes. In the outcome of spontaneous regression of the 3rd stage of ROP: epiretinal fibrosis was detected within the perifocal region and smoothing of the foveal fossa was noted, in 22 cases; hypoplasia of the macula was revealed in 6 cases; central retinoschisis was detected in 10 eyes. Peripheral traction retinoschisis of various heights was detected in 32 cases, in 6 eyes the retinoschisis was determined almost circularly, in 14 eyes single internal ruptures were visualized in the projection of the zones of traction retinoschisis, in 7 cases flat common retinal detachments (RD) of traction character were revealed.

Conclusion: Performing SOCT allows to detect and record the most minimal changes in the retina, often not visible with ophthalmoscopy. EPOS 2021 Free Paper Presentations 37

[FP5] PREVALENCE AND DISTRIBUTION OF OCULAR DISORDERS IN THE FIRST YEAR OF LIFE IN A WESTERN POPULATION

Brian Mohney1

1 Mayo Clinic, Rochester, United States

Introduction: The purpose of this population-based study was to describe the prevalence and distribution of eye diseases affecting children in the first year of life.

Methods: The medial records of all infants (≤1 year of age) residing within a well-defined geographic region of the United States diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were retrospectively reviewed.

Results: A total of 4403 infants were diagnosed with an ocular disorder, yielding an incidence of 21009/100,000 infants per year or 1 in 4.8 live births. The most prevalent diagnoses included nasolacrimal duct obstruction in 1254 (28.5%), conjunctivitis in 1061 (24.1%), pseudostrabismus in 170 (3.8%), retinopathy of prematurity in 74 (1.7%), infantile esotropia in 34 (0.8%) and preseptal eyelid cellulitis in 30 (0.7%). Vision was decreased in one or both eyes in 25 (0.6%) infants. A majority of the infants (3721, 84.5%) were initially diagnosed by a primary care provider, and 531 (12.1%) were evaluated by an eye care provider.

Conclusion: Understanding the prevalence and distribution of ocular diseases among newborns is useful to the distribution of clinical resources.

EPOS 2021 Free Paper Presentations 38

[FP6] POTENTIAL VISUAL OUTCOMES IN INFANTS WITHOUT EYE CONTACT.

Anna Chmielarz-Czarnocińska1, Patrycja Pijanka2, Marta Pawlak3, Anna Gotz-Wieckowska4

1 Poznan University of Medical Sciences, Department of Ophthalmology, Poznan, Poland 2 Poznan University of Medical Sciences, Poznań, Poland 3 Department of Ophthalmology University of Medical Sciences, Poznan, Poland, Poznan, Poland 4 Department of Ophthalmology University of Medical Sciences, Poznań, Poland

Introduction: The aim of this study was to analyze the causes of eye contact absence in infant patients of Pediatric Ophthalmology Outpatient Clinic of Poznan University of Medical Sciences.

Methods: This prospective study included children aged 6 weeks to 12 months who were examined in the Outpatient Clinic due to lack of eye contact between June 2014 and November 2019. The group of 65 consecutive children was analyzed, 40 met the inclusion criteria. Full ophthalmological examination was performed. Additional examinations necessary to make a diagnosis were also carried out and included: visually evoked potentials (VEPs), electroretinography (ERG), neuroimaging and genetic consultation.

Results: In 22 (55%) patients eye contact appeared on follow-up visits. Twenty-five (62,5%) patients had central nervous system (CNS) abnormalities. In 7 patients CNS problems resulted from prematurity. Twelve patients (30%) were premature and in 2 of them absence of eye contact was the consequence of retinopathy of prematurity (ROP) treatment failure. Other ophthalmological causes included congenital eye disorders such as microphthalmia, uveal coloboma, optic nerve hypoplasia, macular hypoplasia, retinal dystrophy and were present in 9 patients (22,5%). Average follow-up time was 28 months (range: 8-63 months).

Conclusion: In most of the cases CNS abnormalities were the cause of the absence of eye contact. Lack of eye contact on the first visit cannot forejudge the potential visual outcome.

EPOS 2021 Free Paper Presentations 39

[FP7] REDUCTION IN SCREENING FOR RETINOPATHY OF PREMATURITY IN THE NETHERLANDS WHILE MAINTAINING EFFECTIVENESS

Kasia Trzcionkowska1, Elske van den Akker-van Marle2, Nicoline Schalij-Delfos3

1 Leiden University Medical Center, Leiden, Netherlands 2 Leiden University Medical Center, Netherlands 3 Leiden University Medical Center, Leiden University Medical Center, Leiden, Netherlands

Introduction: Evaluate possibilities to reduce the number of infants screened for retinopathy of prematurity (ROP) and investigate costs and number of infants detected within the current and alternative screening strategies in the Netherlands.

Methods: Prospective population-based study including clinical data from all infants born in 2017 and referred for ROP-screening (NEDROP-2 study). Screening strategies were evaluated using (a combination of) criteria: gestational age (GA), birth weight (BW) and presence of one or more specific risk factor(s) obtained from the Dutch perinatal registry (Perined): mechanical ventilation, sepsis, necrotizing enterocolitis, postnatal corticoids and/or hypotension treated with inotropic agents.

Results: Inclusion of 1085 infants of which complete dataset obtained in 977 ROP in n=302, of which 255 mild (stage 1-2), 47 severe (stage≥3). Treatment (all panretinal laser-photocoagulation) in 39 infants. Total annual screening and treatment costs €529,228. Of the possible alternative efficient strategies, the annual costs varied from €128,312 (inclusion of BW<700, detection of 19/47 severe and 17/39 treated ROP) to €469,233 (GA<30 weeks and BW<1250 grams, together with infants with GA 30-32 and BW 1250-1500 grams with presence of one more RF, all severe and treated infants detected). The latter being the most effective strategy to detect all infants with severe ROP and reducing the number of screened infants to 744 and the overall annual costs by €59,995.

Conclusion: The Dutch ROP guideline can be improved by implementing new screening inclusion criteria. The most effective strategy reduces the number of screened infants with 24% compared to the current guideline. EPOS 2021 Free Paper Presentations 40

[FP8] SOCIO-ECONOMIC STATUS IN FAMILIES WITH CHILDHOOD CATARACT

Moug Al-Bakri1, Line Kessel2, Daniella Bach Holm3, Dorte Ancher Larsen4

1 Rigshospitalet, Glostrup, Denmark 2 Department of Ophthalmology. Rigshospitalet-Glostrup., Rigshospitalet, Glostrup, Denmark 3 . Rigshospitalet, ., Denmark 4 Department of Ophthalmology, Aarhus University Hospital, Aarhus University Hospital, Aarhus C, Denmark

Introduction: This study aimed to evaluate the socio-economic status in families of children with cataracts by comparing them to families unaffected by childhood cataract.

Methods: Children aged 0-10 years and diagnosed with cataract between 2000 and 2017 in Denmark were included. The parents’ civil status, employment, highest attained education and the yearly disposable income were obtained from Statistics Denmark. A control group was matched by age, sex, ethnicity and municipality.

Results: The odds ratio of having low yearly income and unavailable work status pre-diagnosis was higher (OR=1.6 and OR=1.72) for the case parents compared to the control parents. There was no significant difference in income one and three years after diagnosis (all p-values > 0.0001). There was 75.1% of the case parents in a relationship and 80% of the control parents. In the case group, 52.8% of the parents have attained high while it was 56.6% of the parents in the control group. In the case group 6.2 % of the children had ≥ 4 siblings while it was only 2.1% in control group. Multi-family residential was observed more often in case group (13.8%) than the control group (8%).

Conclusion: Patients were characterized by being in a higher risk for being a part of a low-income population with unavailable work status pre-diagnosis. However, there was no significant difference according to parental civil status, income and education in the two groups at the post-diagnosis time. The cataract diagnosis has therefore no negative effect on the families’ socio-economic status.

EPOS 2021 Free Paper Presentations 41

[FP9] RETROSPECTIVE COMPARISON OF THE G-ROP MODEL VS THE WINROP MODEL IN A PORTUGUESE COHORT

Margarida Brízido1, Beatriz Oliveira Lopes2, Melissa Figueiredo3, Constança Coelho4, Ana Rita Azevedo2, Ana Almeida5

1 Hospital Beatriz Angelo, Lisbon, Portugal 2 Hospital Beatriz Angelo, Portugal 3 Hospital São Francisco Xavier - Chlo, Portugal 4 Institute of Environmental Health (Isamb), Lisbon Medical School, Portugal 5 Hospital Beatriz Angelo / Hospital São Francisco Xavier - Chlo, Thea Portugal S.A Nif 507978358, Loures, Portugal

Introduction: A comparison was made between Weight and Insulin-Like Growth Factor-1 in Neonatal Retinopathy (WINROP) model to the Postnatal Growth and Retinopathy of Prematurity (G-ROP) model in a Portuguese cohort.

Methods: Clinical records of consecutive preterm infants who underwent Retinopathy of Prematurity (ROP) screening from April 2012 to May 2019, from two hospitals in Portugal, were retrospectively reviewed. Both WINROP and the recently proposed G-ROP models were accessed for sensitivity and specificity for treatment-requiring ROP (TR-ROP). A separate sensitivity and specificity analysis of both algorithms was performed in infants with gestational age (GA)<30 weeks.

Results: Of the 375 infants that underwent ROP screening and had information on ROP outcome and weight gain, 313 were eligible for G-ROP analysis and 311 for WINROP. In the G-ROP group, 22 infants required treatment. The G-ROP model reached a sensitivity 90.91% (95%CI 70.84%–98.98%) and specificity of 16.67% (95%CI 8.92%–27.30%) in TR-ROP. In the WINROP group, 23 infants needed treatment and 70 spontaneously regressed ROP. The WINROP model achieved a sensitivity of 86.96% (95%CI 66.41%–97.22%) and specificity of 12.86% (95%CI 6.05%–23.01%) in TR-ROP. Both models reached 100% sensitivity for TR- ROP if restricted to infants with GA of less than 30 weeks. No infant required any treatment for ROP before the date of risk determination.

Conclusion: Both models had similar sensitivities and specificities in a Portuguese population sample. None of the models has proven suitable as an alternative to clinical eye examination. If restricted to GA<30 weeks both models detected all TR-ROP.

EPOS 2021 Free Paper Presentations 42

[FP10] RETROSPECTIVE ANALYSIS OF DIGIROP FOR SIGHT THREATENING ROP REQUIRING TREATMENT IN A PORTUGUESE COHORT

Margarida Brízido1, Ana Almeida2, Melissa Figueiredo3, Beatriz Oliveira Lopes4, Constança Coelho5, Ana Rita Azevedo4

1 Hospital Beatriz Angelo, Lisbon, Portugal 2 Hospital Beatriz Angelo / Hospital São Francisco Xavier - Chlo, Thea Portugal S.A Nif 507978358, Loures, Portugal 3 Hospital São Francisco Xavier - Chlo, Portugal 4 Hospital Beatriz Angelo, Portugal 5 Institute of Environmental Health (Isamb), Lisbon Medical School, Portugal

Introduction: To determine the efficacy of the DIGIROP model in detecting treatment requiring retinopathy of prematurity (TR-ROP) in a Portuguese cohort.

Methods: Clinical records of consecutive preterm infants who underwent ROP screening from April 2012 to May 2019 were retrospectively reviewed. The DIGIROP algorithm provides percentage risk estimation for TR-ROP by using gestational age (GA), birth weight (BW) and sex. It requires a GA from 24 to 30 weeks at birth.

Results: Of the 431 infants that underwent ROP screening, 257 were eligible for DIGIROP analysis. Median GA was 29 (range 24-30) and BW was 1060 (range 408-2080). Twenty-four infants (9.3%) developed TR-ROP. The highest percentage of risk obtained in TR-ROP was 54.04% (95% CI 43,43-66.16) with a median achieved risk of 9.38% (range 0.16%- 54.04%). In the non-TR-ROP group, the highest obtained risk was 36.55% (95% CI 28.99-45.19) with a median of 0.39% (range 0.01%- 36.55%). The Youden index for TR-ROP was 11.7% with a sensitivity of 52.17% (95%CI 30.6-73.2) and a specificity of 85.90 (95%CI 76.2-92.7).

Conclusion: DIGIROP was validated on 7609 infants from both European and US cohorts. The reported sensitivity, specificity is at least as high as those obtained from CHOP-ROP, OMA-ROP, WINROP and CO-ROP. In our cohort, DIGIROP was unable to predict TR-ROP. As such, even algorithms that were validated in large cohorts can perform poorly when applied in different settings. It is essential that algorithms continue to be tested in different populations, especially in cohorts that include both younger and older GA infants.

EPOS 2021 Free Paper Presentations 43

[FP11] ANEMIA, THROMBOCITOPENIA AND RETINOPATHY OF PREMATURITY

Ana Almeida1, Filipa Cirurgião2, Margarida Brízido3, Beatriz Oliveira Lopes4, Constança Coelho5, Ana Rita Azevedo4

1 Hospital Beatriz Angelo / Hospital São Francisco Xavier - Chlo, Thea Portugal S.A Nif 507978358, Loures, Portugal 2 Hospital São Francisco Xavier - Chlo, Portugal 3 Hospital Beatriz Angelo, Lisbon, Portugal 4 Hospital Beatriz Angelo, Portugal 5 Institute of Environmental Health (Isamb), Lisbon Medical School, Portugal

Introduction: The authors wished to evaluate the influence of anaemia and thrombocytopenia in very preterm infants at risk of developing retinopathy of prematurity (ROP).

Methods: Clinical records of consecutive preterm infants who underwent Retinopathy of Prematurity (ROP) screening from April 2012 to November 2019, from two hospitals in Portugal, were retrospectively reviewed. The presences as well as the timing of anaemia, thrombocytopenia, red blood cell (RBC) and platelet transfusions (PT) were analysed. Birth characteristics and classic risk factors for ROP were also retrieved. Univariable logistic regression was used to examine risk factors for ROP followed by multivariate regression.

Results: A total of 431 infants were included in the study. The incidence of ROP and Severe ROP were 24.83% (n=107) and 13.22% (n=57). Risk factors for severe ROP identified in univariate logistic regression were higher number of RBC or PT transfusions (p<0,001), need of RBC transfusions in the first week of life (66.7% vs. 42.0% p=0,018), need of PT (43.89% vs. 16% no ROP p <0,001) and PT in the first week of life (33.3% vs. 8.2% in no ROP p<0,001). However, after multivariate logistic regression, only gestational age (p=0.029), oxygen for more than 28 days (p=0.026) and necrotizing enterocolitis (p=0.040) were linked to severe ROP.

Conclusion: Contrary to previous studies anaemia, thrombocytopenia and the need for RBC and platelets transfusions did not remain as independent risk factors for ROP when compared with the other classic risk factors for ROP.

EPOS 2021 Free Paper Presentations 44

[FP12] CONJUNCTIVAL SMALL B-CELL LYMPHOMA IN A PATIENT WITH TRISOMY 12

Nathalie Voide1, Francois Thommen2, Alexandre Moulin2, Ann Schalenbourg2

1 Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland 2 Jules Gonin Eye Hospital, Lausanne, Switzerland

Introduction: Mosaic trisomy 12 (T12), diagnosed postnatally, is extremely rare. Only 15 cases have been reported in the literature. Its clinical manifestations are variable, ranging from a mild developmental delay to severe congenital anomalies and neonatal death.

Methods: An 18-year-old man with mosaic T12 presented with a well-circumscribed pink tumor located on the conjunctival semilunar fold of his right eye. He was severely mentally and physically delayed, with dysmorphic signs such as: short stature, microcephaly, flat occiput, bitemporal narrowing with turricephaly, frontal bossing, alternating exotropia, high hyperopic astigmatism, depressed and wide nasal bridge, prominent widely spaced teeth, macroglossia and a short neck. Orbital MRI having excluded an orbital invasion, the conjunctival mass was excised in toto. Histopathology revealed a small B-cell lymphoma with gene mutations on MAP2K1, and also EP300.

Results: Until now, no malignancies have been associated with congenital mosaic T12. However, as a cytogenetic marker, T12 is used for the prognosis of chronic lymphocytic leukemia (CLL) and also in Wilms’ tumor. The fact that our congenital T12 patient developed a conjunctival B-cell lymphoma at a relatively young age raises the question whether congenital T12 mosaicism could be a predisposing factor to develop a lymphocytic neoplasm.

Conclusion: To our knowledge, this is the first case of conjunctival small B-cell lymphoma in congenital mosaic T12. The possibility of a causal relation is discussed.

EPOS 2021 Free Paper Presentations 45

[FP13] CHILDREN AND YOUNG PEOPLE LEARNING ABOUT AND INFLUENCING RESEARCH: THE FIRST YEAR OF THE YOUNG PERSON’S ADVISORY GROUP FOR EYE AND VISION RESEARCH

Annegret Dahlmann-Noor1, Jacqueline Miller2, Louca-Mai Brady1

1 Nihr Moorfields Biomedical Research Centre, London, United Kingdom 2 Nihr Moorfields Biomedical Research Centre, London, United Kingdom

Introduction: Actively involving children and young people (CYP) leads to research, services and policy that better reflect their priorities and concerns. We have set up a Young People’s Advisory Group for research, a group of 12 children with different eye conditions who met four times over the past year. Here we present our evaluation of what was learnt, and by whom.

Methods: Tertiary children’s eye hospital in London, UK. Each meeting has a pre-planned agenda which balances learning and advisory content. Researchers meet the group facilitator to learn about child-friendly presentation methods, interactive approaches to illustrating complex topics, and asking questions that the group can help with. At the end of each meeting, we collect feedback from group members and researchers. At the end of the first year, we evaluated our work using questionnaires and peer interviews.

Results: Motivations for joining included meeting other young people with eye conditions, learning about eyes and conditions, meeting researchers, and influencing research to make it child-friendly and meaningful. CYP enjoyed learning about the lifecycle of research projects, confidentiality, data anonymity and consent, using creative and hands-on approaches. Researchers learnt about children’s perspectives and made changes to their protocols, test designs, grant applications and consent/assent forms.

Conclusion: Children aged 7-15 years enjoy contributing to research agenda and design and can advise researchers on how to develop child-friendly and meaningful projects. Children and young people feel that their contribution is valued and gain confidence and communication skills.

EPOS 2021 Free Paper Presentations 46

[FP14] CENTRAL RETINAL ARTERY AND VEIN OCCLUSION AS THE COMPLICATION OF PERSISTENT HYALOID ARTERY - THE FIRST REPORT

Mirjana Bjeloš1, Mladen Bušić1, Biljana Kuzmanović Elabjer1, Ana Križanović2

1 Department of Ophthalmology, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, University Hospital “sveti Duh”, Zagreb, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Zagreb, Croatia 2 Department of Ophthalmology, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, University Hospital “sveti Duh”, Zagreb, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Zagreb, Croatia

Introduction: To present central retinal artery (CRAO) and vein occlusion (CRVO) as complication of persistent hyaloid artery (PHA) – the first report.

Methods: In August 2019 six-year-old boy manifested RE excessive tearing, conjunctival injection and pain. On examination, RE VA was light perception and intraocular pressure measured 36 mmHg. Diagnosis of neovascular glaucoma, CRVO and CRAO were established as affirmed with fluorescein angiography (FFA). The patient was treated with antiglaucoma drugs topically, panretinal photocoagulation, ranibizumab intravitreally and cyclophotocoagulation. PHA was not reported. Extensive work-up and family history were unremarkable. The child was born at term, after uncomplicated twin pregnancy. In December he was referred to our Centre.

Results: Transillumination revealed fully dilated, non-reactive RE pupil and a tubular remnant of HA containing blood cells in the lumen and freely rotating in the anterior vitreous. Intravitreal hemorrhage obscured the fundus visualization.

Conclusion: PHA results from failure of apoptosis during the seventh month of gestation. It can easily be observed during the red reflex screening at neonatal wards. We postulate that PHA twisting lead to torsion of the residual primordial common bulb, branching off to central retinal artery and HA, and central retinal vein. As torsion itself leads to irreversible ischemic injury, neovascular glaucoma ensues. Liquid vitreous appears as early as 4 years of age enabling PHA to whirl more freely. Thus, in case of PHA we advocate FFA to be performed and if connection with retinal artery is proved parents should be advised of possible devastating complications and offered prompt surgical treatment.

EPOS 2021 Free Paper Presentations 47

[FP15] EFFICACY AND SAFETY OF TACROLIMUS 0.1% EYE DROPS FOR SEVERE VERNAL KERATOCONJUNTIVITIS IN A PAEDIATRIC POPULATION

Elisa Marziali1, Cinzia de Libero2, Neri Pucci2, Laura Di Grande2, Gioia Danti2, Gianni Virgili3, Roberto Caputo4

1 Aou Meyer Children Hospital, Firenze, Italy 2 Aou Meyer Children Hospital 3 Eye Clinic, University of Florence, Aou Careggi, Florence, Italy 4 Aou Meyer Children Hospital, Italy

Introduction: To evaluate safety and efficacy of Tacrolimus 0.1% eye drops in paediatric patients affected by refractory vernal keratoconjunctivitis (VKC).

Methods: A non-randomized study was performed at Meyer Children Hospital. VKC was classified into three groups: limbal, tarsal and mixed form. Patients received Tacrolimus eye drops twice daily during follow up (3 months). Clinical signs such as conjunctival hyperemia, limbal and giant papillae were evaluated according to the following grading score: 0(normal), 1+ (mild), 2+(moderate), or 3+(severe). This clinical assessment was carried out at baseline (M0) and after 3 months (M3).

Results: 862 eyes of 431 children (345 males -80,05%, 86 females-19,95%) were enrolled. The mean age was 8,58±2,4 yrs (range 3-17 yrs). 404/862 eyes (46,9%) had limbal form, 292/862 eyes (33,9%) had mixed form and 166/862 eyes (19.2%) had tarsal form. The mean limbal papillae score was 1.90±0.85 at M0 and 0.08±0.31 at M3 (P<0,001) in limbal form whereas it was 1.32±1.05 at M0 and 0.69±0.30 at M3 (P<0,001) in mixed form. The mean giant papillae score was 2.10±1.06 at M0 and 0.79±0.95 at M3 (P<0,001) in tarsal form whereas it was 1.92±0.95 at M0 and 0.41±0.72 at M3 (P<0,001) in mixed form. The mean conjunctival hyperemia score was 0.53±0.74 at M0 and 0.03±0.12 at M3 (P<0,001) in tarsal form whereas it was 1.22±0.72 at M0 and 0.05±0.17 at M3 (P<0,001) and 1.17±0.73 at M0 and 0.09±0.26 at M3 (P<0,001) in limbal and mixed form, respectively.

Conclusion: Tacrolimus eye drops were effective and safe in the management of refractory VKC.

EPOS 2021 Free Paper Presentations 48

[FP16] TESTS OF INTEROCULAR DIFFERENCE AND SUPPRESSION/BALANCE TO MONITOR AMBLYOPIA TREATMENT

Annegret Dahlmann-Noor1, Doaa ElFadaly1, Pete Jones2, Clare Roberts3, Peter Thomas4, Steven Dakin5, John Greenwood6

1 Nihr Moorfields Biomedical Research Centre, London, United Kingdom 2 Ucl Institute of Ophthalmology, Ec1v 9el, United Kingdom 3 Nihr Moorfields Biomedical Reseach Centre, London, United Kingdom 4 Nihr Moorfields Brc 5 University of Auckland 6 University College London

Introduction: Amblyopia is associated with interocular differences (IOD) in acuity, contrast sensitivity, crowding, and reduced/absent stereovision. With new dichoptic treatments now in clinical trials, we need tests which detect improvement in all aspects of visual function. This work aims to determine the agreement of a range of new, computer-based tests with standard crowded acuity testing in children with amblyopia.

Methods: We tested children undergoing amblyopia treatment at a tertiary children’s eye hospital, London. Monocular: best-corrected visual acuity (BCVA, crowded logMAR), computer-based acuity (VacMan acuity) and crowding (VacMan crowded acuity), and a quick iPad contrast sensitivity (qCSF). Binocular: computer-based interocular suppression (VacMan suppression). We calculated IOD in BCVA, VacMan and crowded acuity and quickCSF. Descriptive analysis; Bland-Altman-Limits-of-Agreement method.

Results: 42 (23 girls) children, mean age 5.7 (SD1.2) years: 12 anisometropic, 14 strabismic, 16 combined mechanism amblyopia; median (IQR) spherical equivalent amblyopic eye (AE) +4.88 (+0.75 to +6.56) DS, fellow eye (FE) +3.00 (+1.38 to +5.50) DS; 35 occlusion and 6 atropine treatment. Interocular differences (IoD) in monocular tests:Median (IQR) BCVA 0.37 (0.22 to 0.65) logMAR; VacMan acuity 0.29 (0.21 to 0.56) logMAR; mean (SD) VacMan crowded acuity 0.49 (0.44) logMAR; qCSF -0.2 (0.28) dB. Binocular test: Median VacMAN suppression 0.6 (0.07 to 0.94), with 0.5 indicating perfectly symmetrical visual processing. Agreement: VacMan acuity and Crowding have good, and qCSF and VacMan suppression moderate agreement with BCVA.

Conclusion: New tests which measure cortical resolution, integration, suppression and contrast sensitivity agree well with logMAR acuity and could be developed into home-monitoring applications.

EPOS 2021 Free Paper Presentations 49

[FP17] WHAT DOES PLUSOPTIX SAY WHEN A CHILD IS SILENT?

Igor Plisov1

1 S.N. Fyodorov Irtc “eye Microsurgery” Fsai of the Ministry of Health Care of the Russian Federation, Novosibirsk Branch, Novosibirsk, Rus- sian Federation

Introduction: Diagnosis of the visual system in children of preverbal age is of great importance. The purpose of the study is to determine the capabilities of a distant refractor Plusoptix in pediatric ophthalmology.

Methods: Over 1000 preverbal children with hyperopia were included in the study. Refractometry was performed in binocular and monocular modes under physiological accommodation and after cycloplegia using a Plusoptix. The measurements were carried out repeatedly until a reliable stable result was obtained.

Results: When examining in the binocular mode, hyperopia less than 1 diopters, orthoposition: child has visual acuity in accordance with age. Glasses are not prescribed regardless of the magnitude of hyperopia after cycloplegia. Binocular mode, hyperopia exceeds 1 diopters, there is no strabismus – the risk of refractive amblyopia. Correction with glasses equal to uncompensated ametropia. Binocular mode, hyperopia of one eye less than 1 diopters, other more than 1 diopters (in monocular mode – less than 1 diopters), orthoposition. Correction of more hyperopic eye with glasses equal to anisometropia under physiological accommodation. Binocular mode, hyperopia of one eye less than 1 diopters, other more than 1 diopters (in monocular mode – there is no significant decrease the value of hyperopia), orthoposition. Correction of more hyperopic eye with glasses equal to anisometropia, occlusion of sound eye on 1-2 hours (the patient has amblyopia).

Conclusion: Plusoptix makes it possible to assess the state of accommodation balance and the level of development of the visual system of the preverbal child.

EPOS 2021 Free Paper Presentations 50

[FP18] THE TWO-STAGE SCREENING OF VISION OF SCHOOLCHILDREN.

Ksenya Belousova1, Igor Plisov1

1 S.N. Fyodorov Irtc “eye Microsurgery” Fsai of the Ministry of Health Care of the Russian Federation, Novosibirsk Branch, Novosibirsk, Rus- sian Federation

Introduction: The purpose of the study is to evaluate the effectiveness of liquid crystal glasses in the treatment of anisometropic and strabismic amblyopia.

Methods: 25 patients were treated in anisometropic and 12 in a strabismic group. Amblyopia was unilateral in all cases. The central fixation of the amblyopic eye was diagnosed in all patients. Glasses with liquid crystal lenses were used for treatment. Depending on the degree of amblyopia, the lens opposite the dominant eye was darkened by 20, 30 or 40 seconds for a period of 60 seconds. The design of the glasses makes it possible to install optimal optical lenses. For patients with strabismus, elastic Fresnel prisms were additionally applied to optical lenses. The time of wearing glasses was at least 2 hours a day, the treatment period lasted from 2 to 6 months.

Results: Positive pleoptic results were achieved in all patients. In anisometropic group, average monthly increase of visual acuity was 0.09±0.02 line, in strabismic group – 0.08±0.02 line. During the whole period of treatment and observations, visual acuity increased by 0.36±0.14 line and 0.29±0.13 line, respectively. Functional eye equality was achieved in 26 of 37 patients (70.3%). 3 patients in the anisometropic group and 2 in the strabismic group categorically refused from traditional occlusion before applying this method.

Conclusion: Liquid crystal glasses are significantly effective in the treatment of anisometropic and strabismic amblyopia. Glasses with liquid crystal lenses make it possible to exclude the negative subjective factor of the child’s perception of traditional occlusion.

EPOS 2021 Free Paper Presentations 51

[FP19] ANTERIOR CHAMBER IRIS-CLAW INTRAOCULAR LENS IMPLANTATION IN YOUNG PATIENTS WITH NON-TRAUMATIC LENS DISLOCATION.

Nicoline Schalij-Delfos1, Elsbeth van Zeeburg2, Marije Sminia3

1 Leiden University Medical Center, Leiden University Medical Center, Leiden, Netherlands 2 Leiden University Medical Center, Netherlands 3 Noorwest Ziekenhuisgroep, Alkmaar, Netherlands

Introduction: Report of the results of lensectomy with primary anterior chamber aphakia iris-claw lens implantation in ≤ 18-year-old patients, with non-traumatic ectopia lentis.

Methods: Data of 49 eyes of 27 patients operated on since September 2007 up until April 2019, with a minimum follow up of 6 months, were retrospectively reviewed. Age at intra ocular lens (IOL) implantation, indication for surgery, time between surgeries, visual acuity, refractive errors, visual gain, amblyopia, endothelial cell count (ECC) and complications were evaluated.

Results: Indication for surgery (eyes): unstable, high refractive error (21), pupil dissection by lens edge (17), aphakia due to severe dislocation of the natural lens (8), development of amblyopia (3). Mean value preoperative correction was S-3.5 (range S-20.0 - S+23.5) and C-4.8 (range C-0.00 - C-11.5). Median age at IOL implantation was 65 (13-225) months, with a median interval between eyes of 4 (range 1-28) months. Mean best corrected visual acuity was 0.68±0.40 LogMAR preoperatively and 0.13±0.37 LogMAR at the last postoperative visit with a mean vision gain of -0.6±0.38 LogMAR. Amblyopia treatment in 18 and strabismus in 11 patients. Mean annual ECC decline after surgery was 1.6% ± 3,7% (SD). Complications (eyes): immediate postoperative fibrinous reaction (3), retinal detachment (2), traumatic IOL-luxation (4) and posttraumatic acute glaucoma due to hyphaema blocking the peripheral iridectomy (1).

Conclusion: Anterior chamber iris-claw IOL implantation results in excellent visual outcome with an acceptable number of complications. The mean endothelial cell loss was within normal limits compared to normative data from the literature. EPOS 2021 Free Paper Presentations 52

[FP20] RASCH ANALYSIS OF THE REVISED STUDENT REFRACTIVE ERROR AND EYEGLASSES QUESTIONNAIRE IN CHILDREN AND YOUNG PEOPLE WITH MYOPIA IN LONDON

Annegret Dahlmann-Noor1, Srujitha Marupuru2, Terri Warholak2

1 Nihr Moorfields Biomedical Research Centre, London, United Kingdom 2 University of Arizona College of Pharmacy, United States

Introduction: There is no tool to measure the impact of myopia on children and young people (CYP). This study aims to evaluate and refine the Student Refractive Error and Eyeglasses Questionnaire (SREEQ), which measures the impact of uncorrected and corrected refractive error on vision-related quality of life (VRQoL), for use in CYP with myopia.

Methods: We collected data in optometry practices in London and Bedford, UK; analysis was carried out at a university. CYP 6 to 18 years with myopia completed the SREEQ, a 20-item-questionnaire with two sections (perceptions without and with glasses). Using Rasch analysis we explored the psychometric performance of the questionnaire and scale.

Results: 125 CYP, mean age (SD) 12.7 (2.9). All items fit the Rasch model and were retained, and the scale was unidimensional. Without glasses, the item that bothered CYP least was “feeling dizzy”, and the one that affected them most was “problems seeing the board, at the movies or other things far away”. With glasses, CYP found the same item “feeling dizzy” to be the least bothering, and “I get headache, or my head or eyes hurt when I read” to be the biggest problem. As per Rasch analysis, the person-reliability-coefficient and item reliability for the without-glasses section were 0.84 and 0.99, respectively, and for the with-glasses section, 0.91 and 0.80. Differential item analysis did not demonstrate differences between children under or over 12 years, nor between different ethnic backgrounds.

Conclusion: The SREEQ could be used in studies to monitor VRQoL in progressive myopia.

EPOS 2021 Free Paper Presentations 53

[FP21] THE AUCKLAND OPTOTYPES: PERFORMANCE OF A NEW PICTORIAL ACUITY TEST IN CHILDREN WITH AMBLYOPIA

Annegret Dahlmann-Noor1, Siobhan Ludden2, Emma McVeigh2, Sahra Mohamed3, Padraig Mulholland2, Nilpa Shah2, Steven Dakin4

1 Nihr Moorfields Biomedical Research Centre, London, United Kingdom 2 Nihr Moorfields Biomedical Research Centre, United Kingdom 3 Cambridgeshire Community Services NHS Trust, United Kingdom 4 University of Auckland, Optometry, New Zealand

Introduction: The accuracy of acuity assessment in pre-literate children is limited: picture charts overestimate acuity compared to letter optotypes. The Auckland Optotypes (TAO), a new, psychometrically robust optotype test, compares well with gold-standard letter tests in healthy children. This study evaluates TAO in amblyopic children.

Methods: We tested amblyopic children aged 5-8 years at secondary and tertiary eye clinic on handheld and wall-mounted digital displays of TAO and crowded letters. We calculated interocular difference (IoD), carried out descriptive analysis and tested agreement using the Bland-Altman limits of agreement method.

Results: 42 children, mean age 6.33 (1.08 SD) years. Wall-mounted displays (n=26): crowded letters mean (SD) acuity amblyopic eye (AE) 0.53 (0.06); TAO 0.53 (0.07) logMAR. Mean interocular difference (IoD) was higher on TAO than on letters 0.49 (0.07) vs 0.34 (0.07) logMAR. Findings were similar for handheld displays (n=16). Bland-Altman plots show good agreement.

Conclusion: Preliminary results suggest that in amblyopic children assessment TAO elicit similar visual acuity as standard crowded logMAR letter, both on wall-mounted and handheld displays. TAO may be more accurate than other picture-based tests in assessing visual acuity in pre-literate children. EPOS 2021 Free Paper Presentations 54

[FP22] TRACKAI PROJECT. VISION SCREENING IN EARLY CHILDHOOD.

Victoria Pueyo1, Jason Yam2, Immaculada Gonzalez3, Victoria Balasanyan4, Alvaro Fanlo5, Juan Pinilla5, Marta Ortin6

1 Hospital Universitario Miguel Servet., Iis Aragon, Ophthalmology Department., Zaragoza, Spain 2 Hong Kong Eye Hospital 3 Iis Aragon. Hospital Universitario Miguel Servet., Zaragoza. Spain., Spain 4 Yasny Vzor Ltd, Russian Federation 5 Iis Aragon. Hospital Universitario Miguel Servet., Spain 6 Iis Aragon., Instituto de Investigacion En Ingenieria de Aragon, Universidad de Zaragoza, Spain

Introduction: There is solid evidence supporting vision screening programs to detect visual disorders in school-aged children. However, there are three main constrains with children younger than 3-4 years of age: training required to perform it, lack of accurate tools and poor collaboration from young children. The main goal of the TrackAI project is to develop an accurate tool to identify children with abnormal visual development, from 6 months of age, by means of a portable device which does not require any special training to be used.

Methods: We developed a digital test for assessing visual function assisted with eye tracking technology (DIVE AI Screener). Every child underwent a complete ophthalmological examination and was labelled as havingNormal visual functionor Abnormal visual function. Binocular and monocular gaze data from oculomotor control, visual acuity, contrast sensitivity, and colour perception tests were obtained using a DIVE AI Screener. Supervised neural network models were designed and trained to provide the probability of a child to have abnormal visual development.

Results: A total of 2253 children have been recruited in five paediatric ophthalmology units in Spain, Hong Kong, Vietnam, Mexico and Russia. Ages ranged from 6 months to 14 years. Only 8.6% of them were unable to fulfil the clinical protocol. 1213 had normal visual development and 1040 abnormal visual development. Clinical validation outcomes will be presented.

Conclusion: It is feasible to run a vision screening in most children from 6 months of age, using DIVE AI Screener, an easy-to-use and objective tool. EPOS 2021 Free Paper Presentations 55

[FP23] EFFICACY OF LOW DOSE ATROPINE IN MYOPIA CONTROL IN INDIANPOPULATION.

Shweta Chaurasia1, Seema negi2, Sushmita Kaushik2, Surishti Raj3

1 Pgimer, Ophthalmology, Chandigarh, India 2 Post Graduate Institute of Medical Education and Research, Chandigarh, India 3 Pgimer, Chandigarh, India

Introduction: Role of 0.01% atropine in progressive myopes of Indian population between the two eyes compared to placebo has not been studied.

Methods: All participants underwent cycloplegic refraction, measurement of axial length and photopic pupil size during recruitment and 4-montly follow-up. Accommodation and vergence parameters were measured. Questionnaire was filled regarding family history of myopia, number of hours of near work, mobile use & outdoor activity. Participants were asked to put 0.01% atropine drops in right eye (treatment) and placebo 0.5% CMC in left eye(control) for one year.

Results: This study included 80 eyes of 40 children of progressive myopia (baseline mean 0.77 D/year) with mean age 11.85 years. Total myopia progression after one year of study was 0.26 ± 0.23 D and 0.72 ± 0.29 D in treatment and control group respectively (P-value0.000). Mean axial length elongation was 0.20 ± 0.20mm and 0.36 ± 0.24mm in treatment and control group respectively (P-value0.000). There was difference in myopia progression between youngest (6-9) and oldest (13-16) age group in control eyes (P-value0.033). Low accomodation facility (9cpm) was found. 52.5% of children were orthophoric, 47.5% exophoric. No adverse effects were noted. Our study didn’t find any association of family history of myopia. 0.01% atropine was effective in all irrespective of duration of near work and despite use of near gadgets. Outdoor activity has protective role in myopia progression if atropine is used along.

Conclusion: 0.01% atropine is safe and effective in retarding myopia progression (63.89%) and axial growth (44.44%) in Indian eyes. EPOS 2021 Free Paper Presentations 56

[FP24] ANATOMICAL AND FUNCTIONAL RESULTS OF SURGERY FOR CICATRICIAL STAGES 4B AND 5 OF RETINOPATHY OF PREMATURITY

Pascal Dureau1, Ismael Chehaibou1, Florence Metge1, Georges Caputo1

1 Fondation Rothschild, Paris, France

Introduction: Surgery for advanced stages of retinopathy of prematurity (ROP) is still controversial. Functional results, although limited, can lead in some cases to ambulatory vision, superior to natural evolution towards no light perception. The aim of this study was to describe the anatomical and functional outcomes of lensectomy-vitrectomy for cicatricial stages 4B and 5 ROP.

Methods: We retrospectively studied infants with stage 4B or 5 ROP referred and operated between January 2009 and January 2018. The following data were noted: Gestational age, birthweight, age at surgery, preoperative anatomy, type of surgery, final anatomy and vision.

Results: A total of 177 eyes of 118 infants were included. Mean gestational age was 28 weeks, mean birthweight was 1211g, mean age at surgery was 56 weeks. Thirty-three patients (41 eyes) had a stage 4B with a large adherence between the retina and the lens, while 85 patients (136 eyes) hade a stage 5. All infants underwent lensectomy-vitrectomy through a limbal approach. After a mean 22-month follow-up, 85% of stage 4B and 67% of Stage 5 eyes had a retina partially or totally attached. Infants were able to fix and follow an object in 62% of stages 4B and 55% of stages 5.

Conclusion: Although technically demanding, surgery for advanced cicatricial stages of ROP is feasible. The natural history is generally evolution towards absence of light perception with anatomical complications as corneal opacity or phtisis bulbi. Surgery can provide a limited but useful vision to these children with a long-life expectancy.

EPOS 2021 Free Paper Presentations 57

[FP25] VISUAL AND ANATOMICAL OUTCOMES FOLLOWING SURGERY FOR PERSISTENT FETAL VASCULATURE DURING THE FIRST YEAR OF LIFE

Ilham Alaoui1, Rizlene Ettayeb1, Gilles Martin2, Olivier Berges1, Pascal Dureau3, georges caputo4

1 Rothschild Ophthalmological Foundation, Paris, France 2 Rothschild Ophtalmological Foundation, Paris, France 3 Hôpital-Fondation A. de Rothschild, Paris, France 4 Fondation Ophtalmologique Adolphe de Rothschild, Fondation Adolphe Rothschild

Introduction: Without an appropriate treatment, persistent fetal vasculature (PFV) can evolves towards major amblyopia in mild forms, and retinal detachment, glaucoma or phthisis bulbi in severe forms. The aim of this study was to report clinical forms, treatment, anatomical and visual outcomes of children operated for PFV during the first year of life.

Methods: We retrospectively studied children with anterior, mixed or posterior PFV diagnosed and operated during the first year of life from 1999 to 2020. The following points were noted: age at surgery, PFV type, surgical technique, follow-up, complications, anatomical and visual outcomes.

Results: A total of 52 infants were included. The average age at surgery was 6 months. 38% had an anterior PFV, 6% a posterior and 56% a mixed form. 18 eyes were treated by phacovitrectomy with IOL implantation, 29 without implantation and 5 had only a vitrectomy. The average follow-up was 52 months. 25% of patients developed a glaucoma during the follow-up. Other complications included one retinal detachment and 10 retinal folds. Mean final visual acuity was 0,6 logMAR (0,5 for anterior forms, 0,7 for mixed forms). 12 patients had no patching therapy because of poor visual prognosis.

Conclusion: The visual prognosis of PFV is better in anterior forms. Early treated mixed PFV or isolated posterior forms have good anatomical results, but major amblyopia is commonly associated. The goal of surgery in these forms is to avoid phthisis bulbi and other complications.

EPOS 2021 Free Paper Presentations 58

[FP26] ATYPICAL RETINOPATHY OF PREMATURITY RECURRENCE AFTER ANTI-VEGF TREATMENT

Cristina Nitulescu1, Irina Stamatian2

1 Marie Curie Children’s Clinical Hospital, Bucharest, Romania 2 Institute for Mother and Child Health, Bucharest, Romania

Introduction: Anti-VEGF became a treatment of choice for salvage of the eyes with ROP zone I and aggressive forms, but ROP may recur after this treatment.

Methods: In our practice, the protocol for the eyes treated with anti-VEGF includes regularly follow-up every 2 weeks until the vessels reach zone II and every 3-4 weeks afterwards, until the vascularization is complete or the ROP recurs. The outcome after anti- VEGF treatment in terms of the type of ROP reactivation was analyzed in a cohort of eyes treated between 2013 and 2019.

Results: There were treated 182 children with intraocular anti-VEGF, from which 33 recurred and needed another treatment. During the follow-up we found 3 cases which developed epipapillary vitreous contraction, 1 case at 10 weeks after anti-VEGF, 1 case at 4 weeks after second dose of anti-VEGF, both cases at both eyes, and 1 case at one eye after incomplete laser therapy for ROP reactivation after anti-VEGF. After carefully laser therapy the condition regressed as an epipapillary fibrosis and was stable for at least 6 months.

Conclusion: Even if the anti-VEGF treatment could save the sight, appropriate follow-up examinations are mandatory for successful clinical management. We have to follow close these eyes until the vascularization is complete or ROP recurs and needs another treatment. Epipapillary vitreous contraction represents an uncommon, atypical recurrence and must be recognized and treated very quickly by laser.

EPOS 2021 Free Paper Presentations 59

[FP27] PROGNOSTIC VALUE OF BIRTH WEIGHT IN RETINOPATHY OF PREMATURITY IN TWINS

Pınar Bingöl Kızıltunç1, Orxan Abbaslı2, Huban Atilla3

1 Ankara University School of Medicine Department of Ophthalmology, Ankara, Turkey 2 Ankara University School of Medicine, Department of Ophthalmology, Ankara, Turkey 3 Ankara University, School of Medicine,Department of Ophthalmology,Ankara;turkey, Ankara, Turkey

Introduction: To evaluate whether low birth weight is associated with the delayed vascularization or development of retinopathy in twin babies who were followed for retinopathy of prematurity (ROP).

Methods: Babies with low birth weight of the twins were included into Group 1 and those with high birth weight were included into Group 2. Progression of retinal vascularization and final examination findings were compared between two groups.

Results: A total of 14 twins (28 babies) were included. The median mother age was 31 (22-43) years and median age at birth was 31 (26- 32) weeks. Babies were followed up for a median of 12 months (7-72). The median birth weight in Group 1 was 1542 gr (800- 2090), and 1685 gr (870-2320) in group 2. The median time for completion of vascularization in Group 1 was 41 (38-47) weeks and 41 (38-55) weeks in Group 2. In both groups, stage 3 ROP was observed in two patients, stage 2 ROP in one patient, and stage 1 ROP in two patients. In Group 1, retinal vascularization was more posterior in three babies in comparison to their twins at the first examination and also, in group 1, retinal vascularization completed later in 3 babies in comparison to their twins. At the last examination, there was no difference between the two groups in terms of refractive errors, however one baby had esotropia in Group 1.

Conclusion: Low birth weight might be associated with a delay in retinal vascularization in twin babies. EPOS 2021 Rapid Fire Presentations 60

[RF1] RETINOPATHY OF PREMATURITY SCREENING IN EXTREMELY PREMATURE CHILDREN: EPIPAGE 2 STUDY

Thibaut Chapron1, georges caputo2, véronique pierrat3, jean christophe roze4, elsa kermorvant5, amandine barjol6, Mélanie DUROX7, Pierre-Yves ANCEL7, heloise torchin8

1 Fondation Rothschild, Paris, France 2 Fondation Ophtalmologique Adolphe de Rothschild, Fondation Adolphe Rothschild 3 1inserm Umr 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Dhu Risks in Pregnancy 4 Service de Néonatologie, Cic 004, Inserm, Nantes University Hospital, Nantes, France 5 Necker Hospital 6 Fondation Ophtalmologique Adolphe de Rothschild 7 Epidemiology and Statistics Sorbonne Paris Cité Reserach Center, Inserm, U1153, Paris, France 8 Inserm, Aphp

Introduction: Retinopathy of prematurity (ROP) is a severe blinding disease whose screening is framed by recommendations but is rarely evaluated. The objective was to study the prevalence of fundus in very preterm infants as well as the individual factors and characteristics of the centers associated with the screening.

Methods: Our data were extracted from the Epipage-2 cohort, a national prospective population based study of births occurring between 22 and 34 completed weeks’ gestation (WG) in 2011. Children <32 WG without severe malformation alive at the recommended age for ROP screening were included. We performed two separate analyzes using nested mixed models; we studied 1) the achievement of the fundus and 2) its achievement on time according to the French recommendations in force in 2011.

Results: At the end, 70.5% (2169/3077) of children eligible for screening received a fundus. This rate decreased with the WG from 96.4% at 24 WG to 49.9% at 31 WG. The infant characteristics associated with fundus examination were a small gestational age (p <0.001), a low birth weight (p <0.001), presence of a severe bronchodyspasia (p <0.01) or severe neurological lesions (p <0.01) as well as a transfer of the child during the screening period (p <0.001). Children hospitalized in units using Retcam imaging were better screened (OR 2.65 [1.17-6.01] p <0.001). The other characteristics of the centers (level, administrative status, volume of activity) were not significant. Of the children screened, 75.7% (1641/2169) were on time. Factors associated with a fundus on time were a high gestational age (p <0.001), a use of the Retcam (OR 2.20 [1.06-4.58], p <0.01); while a low birth weight (p <0.001), a presence of severe bronchodysplasia (p <0.001) or a necrotizing enterocolitis (p <0.001) were associated with a delay of the examination.

Conclusion: Children the most at risk of ROP were the best screened but the latest. A better compliance of the units using the Retcam imaging system supports the benefit of its deployment and the setting of a sharing process between neonatal units regarding its cost. EPOS 2021 Rapid Fire Presentations 61

[RF2] PSEUDO-HYPOPYON WITH NO RETINAL MASS IN THE POSTERIOR POLE

Edouard Malandain1, Livia Lumbroso - Le Rouic2, Nathalie Cassoux2, Marc Muraine3, Julie Gueudry4, Robert Matthieu5

1 Rouen University Hospital, Rouen University Hospital, Rouen, France 2 Institut Curie, Paris, France 3 Rouen University Hospital, France 4 Rouen University Hospital, Rouen, France 5 .Necker-Enfants Malades University Hospital, .Paris, France

Introduction: Invasion of the anterior segment by retinoblastoma is a well-known complication and a significant source of misdiagnosis, because it may simulate ocular inflammation. Late-onset retinoblastomas can occur in the retinal periphery should not be overlooked. However, even the absence of any retinal mass does not preclude the diagnosis, as the malignancy can occur solely in the anterior chamber of the eye, with no apparent retinal tumor.

Methods: Case report of 2 patients and photo essay

Results: Case 1: A 5 year-old child was referred for uveitis. Slit lamp examination revealed a convex pseudo-hypopion and fundus examination confirmed a peripheral endophytic retinoblastoma. Case 2: A 8 year-old child was referred for elevated intra-ocular pressure without associated symptoms. Clinical assessment revealed a mobile pseudo-hypopyon in anterior chamber, and round-shaped cellular deposits on corneal endothelium. Retinal examination was normal without vitreous seed. Examination under general anaesthesia revealed fine white deposits on the ciliary process and two millimetric nodules of the pars plana. A first aqueous sampling was normal, but a second into the hypopyon itself confirmed the diagnosis of retinoblastoma.

Conclusion: Pseudo-hypopyon in childhood may be the revealing sign of a retinoblastoma (uveitic masquerade syndrome). Even when fundus examination does not reveal a retinal involvement, the diagnosis of retinoblastoma remains possible. Ophthalmologists should be aware of this possibility. A single negative aqueous sampling is not sufficient to exclude the diagnosis and multiple sampling in a specialised setting are then encouraged. In those cases, globe salvage and visual preservation are possible. EPOS 2021 Rapid Fire Presentations 62

[RF3] NON SURGICAL OPTIONS FOR THE MANAGEMENT OF THREATENING FIBROVASCULAR STALKS IN CHILDREN WITH PERSISTENT FETAL VASCULATURE

Robert Matthieu1, Celine Faure2, Flore Salviat3, Alejandra Daruich4, Dominique Bremond-Gignac5

1 .Necker-Enfants Malades University Hospital, .Paris, France 2 Clinique Saint Martin, 1979, Caen, France 3 Necker-Enfants Malades Hospital, Ophthalmology Department., Paris, France 4 Necker-Enfants Malades Hospital 5 Necker-Enfants Malades Hospital, Paris, France

Introduction: Unextensible fibrovascular stalks between the optic disk and a circumscribed nasal posterior subcapsular cataract are one of the numerous presentations of persistent fetal vasculature. It often results in tractional peripapillar retinal detachments in childhood due to the anterio-posterior growth of the eye. Conventional surgery in such cases includes lensectomy or lens- sparing vitrectomy -which is nevertheless often followed by cataract development. When the cataract does not affect the visual axis, the best timing for this surgery is a matter of debate.

Methods: Retrospective case series of patients having presented a spontaneous detachment of their fibrovascular stalks before the surgery was performed, or having been treated with a specific new (Nd):YAG technique

Results: Three patients presented a spontaneous detachment of their fibrovascular stalk from the lens, with no further opacification of the lens in one case and a complete clearing of the lens in two cases. One patient benefitted from a non-surgical, lens-sparing, (Nd):YAG procedure to cut its fibrovascular stalk behind the lens. This was successful, allowing for secondary retinal reattachment and the preservation of a quantifiable vision with the help of an amblyopia therapy but no without further intervention.

Conclusion: Clinicians should be aware that fibrovascular stalks of persistent fetal vasculature can spontaneously detach from the lens, or, in selected cases, be cut by using (Nd):Yag laser. EPOS 2021 Rapid Fire Presentations 63

[RF4] NEUROTROPHIC KERATITIS IN CHILDREN

Yasmine Bachir1, Clemence Le Pape2, Yann Maucourant2, Pierre Antoine Aymard3, frederic Mouriaux2, Dominique Bre- mond-Gignac4, Robert Matthieu5

1 Chu Rennes Service D’ophtalmologie, Rennes, France 2 Rennes Hospital, France 3 Necker Hospital, France 4 Necker-Enfants Malades Hospital, Paris, France 5 .Necker-Enfants Malades University Hospital, .Paris, France

Introduction: Neurotrophic keratitis is a rare condition in children, mainly resulting from trigeminal nerve abnormalities. The diagnosis is often delayed.

Methods: We report 3 pediatric cases of neurotrophic keratitis. The first case is an 11-month-old patient with a right severe keratitis found to be due to a bilateral, isolated trigeminal nerve agenesis. The second case is an 11-month-old patient with recurrent right keratitis secondary to right trigeminal dysfunction, secondary to a brainstem hemorrhage in the context of a familial cavernomatosis. The third case is a 3-year-old patient with a chronic left keratitis secondary to a Goldenhar syndrome.

Results: In these 3 cases, despite an appropriate treatment, the evolution was unfavorable with large amblyogenic stromal scarring.

Conclusion: A neurotrophic origin should always be suspected in front of any chronic keratitis without an obvious mechanical cause. In the absence of a specific clinical orientation, the possibility of an isolated trigeminal nerve agenesis should be known and confirmed or ruled out by performing a cerebral MRI.

EPOS 2021 Rapid Fire Presentations 64

[RF5] REFRACTIVE ERROR IN FORMER PREMATURES WITH AND WITHOUT RETINOPATHY OF PREMATURITY

Margarida Brízido1, Beatriz Lopes2, Ana Rita Azevedo2, Margarida Miranda2, Ana C. Almeida2

1 Hospital Beatriz Angelo, Lisbon, Portugal 2 Hospital Beatriz Ângelo, Portugal

Introduction: The authors report on the incidence and degree of refractive error in a cohort of former prematures at ages of one, two and three.

Methods: Retrospective chart review of all former premature infants followed at our institution between 2012-2019. We included all children with at least one eye examination between the first and third years of life. Information on refractive status under cycloplegia was analysed. Infants were divided in 2 groups according to the presence or absence of previous retinopathy of prematurity (ROP).

Results: Seventy-four children met the inclusion criteria. Data was available in 69% (n=51) at 1-year, 62% (n=46) at 2-years and 66% (n=49) at 3-years. Nineteen patients had previous history of ROP (26%); of these, eight required treatment (11%). The median spherical equivalent (SE) was +0,75D (range -4,1 to +3,5), +0,63D (-5,1 to +4,75) and +0,63D (-7,3 to +3,6) at ages of one, two and three years old, respectively. In infants without ROP, median SE was +0,75D, +0,69D and +0,59 at each consecutive year, compared to a median SE of +1,16D, +0,19D and +0,88D in infants with ROP. Twelve infants (24%) were diagnosed with myopia at 1-year follow-up, (4 with and 8 without ROP). At age of two, 7 infants (15%) had myopia (5 with versus 2 without ROP) and at 3-year follow-up, fourteen infants (29%) were myopes: 6 with and 8 without ROP.

Conclusion: In our cohort, infants were mostly low hyperopes, both in ROP and non-ROP groups. Myopia rates were higher in infants with RO P.

EPOS 2021 Rapid Fire Presentations 65

[RF6] LONG AND SHORT TERM NEURODEVELOPMENTAL AND OPHTHALMIC OUTCOMES OF ROP TREATED INFANTS IN NORTH-ESTONIA 2007-2018. COMPARISON OF INTRAVITREAL BEVACIZUMAB AND LASER TREATMENT.

Katrin Eerme1, haide põder2, reelika part3, kertu kallaste4, marika tammaru5

1 East Tallinn Central Hospital Eye Clinic, Tallinn, Estonia 2 Tallinn Children`s Hospital, Estonia 3 Tallinn Children´s Hospital, Estonia 4 Tallinn Secondary Science School 5 East-Tallinn Central Hospital, Estonia

Introduction: Purpose of the study was to evaluate the ophthalmic and neurodevelopmental outcome of patients treated with type1 ROP. Since 2008 intravitreal bevacizumab (IVB) has been treatment option for ROP in Estonia.

Methods: In retrospective study infants were classified into 3 groups: laser only, IVB only (received 0.625mg) and a combination of IVB and laser treatment. The resolving of ROP after treatment and need for additional treatment was evaluated. At the age 12months cycloplegic refraction was measured and ocular motility was evaluated. At age 2years neurodevelopmental evaluation was assessed by the Bayley Scales of Infant Development(III).

Results: 140 patients (280eyes) data was analysied: 19 patients (38eyes) IVB only, 19 patients (35 eyes) combined therapy and 102 patients (208eyes) laser treatment. Only in laser treatment grup 16 eyes (7,3%) developed 4 or 5 stage ROP and additional surgical treatment was performed. Although there was no statistical difference between treatment grups (p=0,058). The evaluation of refractive errors at the age 1 year was done in 234 eyes. Hypermetropia >3,0sph or myopia >3,0sph showed higher incidence in laser treatment grup (56,3%>26,9%). There was no statistical difference between grups in strabismus. Neurodevelopmental assessment using Bayley-III showed no significant difference among bevazizumab (mono or combined therapy) and laser treatment groups in any aspect after adjusting for GA, brochopulmonary dysplasia, intraventricular hemorraghia, periventriculat leucomalacia, necrotizing enterocolitis, sepsis. EPOS 2021 Rapid Fire Presentations 66

[RF7] DEVELOPMENT OF OCULOMOTOR CONTROL THROUGHOUT CHILDHOOD

Teresa Pérez1, Olimpia Castillo2, Adrián Alejandre3, Marina Vilella Cenis2, María Romero Sanz4, T. M. Chau Pham5, Belén Masiá2

1 Iis Aragon. Hospital Universitario Miguel Servet, Zaragoza, Spain 2 Iis Aragon 3 Iis Aragon, Instituto de Investigación En Ingeniería de Aragon 4 Iis Aragon, Spain 5 Vietnam National Institute of Ophthalmology

Introduction: The aim of this study was to assess oculomotor performance outcomes throughout childhood, using eye tracking technology in healthy children. A second goal was to evaluate the influence of different perinatal events, such as prematurity.

Methods: A total of 847 healthy children were recruited. All subjects underwent a complete ophthalmological examination, including best-corrected visual acuity, stereoacuity, ocular motility, refraction and funduscopy and an assessment of their oculomotor performance, using a DIVE (Device for an Integral Visual Examination), assisted with eye tracking technology. Oculomotor behaviour examination included fixational and saccadic performance.

Results: Fixational outcomes improved throughout childhood, with a median bivariate contour ellipse area (BCEA) ranging from 2.02 deg2 in children younger than 1 year to 0.69 deg2 in older than 13 (p= 0.00). Adult outcomes were reached around 4 years for fixational parameters and 7 years for saccadic performance, with main improvement during the first 2 years. Early preterm children showed more unstable fixations than late preterm and control groups (3.01 vs 1.89 and 1.79 deg2 respectively, p = 0.02). These differences kept displayed at 0-2 years (4.01 vs 2.48 and 2.50 deg2, p=0.03), and for 3-5 years (2.09 vs 1.27 and 1.44 deg2 p=0.04).

Conclusion: Fixations tend to be more stable with increasing age, specially, during the first four years of life. Children born preterm present oculomotor deficits, affecting fixational skills at ages under 5 years.

Financial disclosure: There are no financial conflicts of interest to disclose.

EPOS 2021 Rapid Fire Presentations 67

[RF8] STUDY OF FIXATION STABILITY IN AMBLYOPIA. TRACKAI PROJECT

Esther Prieto1, Eduardo Esteban-Ibáñez2, Ivan Ketzal-Gutiérrez3, Xian Pan4, Diego Gutiérrez5, Marta Ciprés Alastuey1

1 Iis Aragon. Hospital Universitario Miguel Servet. Ophthalmology Department 2 Instituto de Investigacion Sanitaria de Aragon (Iis Aragon) 3 Hospital Luis Sánchez Bulnes - Apec, Mexico 4 Instituto de Investigación Sanitaria de Aragón (Iis Aragon) 5 Instituto de Investigación En Ingeniería de Aragón, Universidad de Zaragoza

Introduction Amblyopia develops during a critical period in early visual development and is characterized by impaired visual sensory functions beside visual acuity.

Purpose: A quantitative analysis of fixation stability features in children with amblyopia and comparison with those obtained in children with normal visual development.

Methods: The present study was performed in children from five different hospitals covering Europe, Asia and America, as part of the TrackAI project. A total of 174 children (aged 3 - 13 years old) were included in the study: 84 with varying severity of amblyopia due to strabismus, anisometropia or both; and 90 aged-matched healthy control children. Oculomotor control was tested using a digital device for integral visual examination with remote eye-tracking technology incorporated (DIVE). We compared the characteristics of fixational eye movements during the presentation of several 3-second visual stimuli test.

Results: Children with amblyopia showed greater fixation instability for amblyopic eyes (BCEA= 4.14 deg2) than fellow eyes (2.91 deg2) and right eyes of controls with normal visual function (3.03 deg2). Saccadic peak velocity decreased in amblyopic eyes (125.04 deg2/s) compared with fellow (131.65 deg2/s) and control eyes (127.06 deg2/s), in the same way as reaction time increased (SRT= 0.261, 0.274 and 0.295 seconds for fellow, control and amblyopic eyes, respectively).

Conclusion: The characteristics of fixational eye movements are not significantly different between the fellow eyes of amblyopes and controls, while amblyopic eyes exhibit impaired oculomotor control. Fixation instability could be a useful marker for amblyopia screening.

EPOS 2021 Rapid Fire Presentations 68

[RF9] MR IMAGING CHARACTERISTICS OF OPTIC PATHWAY ENLARGEMENTS ASSOCIATED WITH MORNING GLORY DISC ANOMALY

Adrien HENRY1, Ana Clement1, agustin lecler1, georges caputo2, guillaume poillon1

1 Fondation Adolphe Rothschild, France 2 Fondation Ophtalmologique Adolphe de Rothschild, Fondation Adolphe Rothschild

Introduction: Morning Glory Disc Anomaly (MGDA) is a rare ophthalmic disease with a severe visual loss due to a funnel-shaped excavation of a markedly enlarged optic disc opening. Since it may be associated with other intracranial abnormalities a cerebral MRI is highly recommended. In some cases, radiologists report concurrent enlargements of the ipsilateral optic nerve, termed « low grade glioma », a terminology that, albeit hypothetical, often leads to repeated consults and serial MRI follow up. The aim of this study was to describe and assess the frequency of these optic nerve or chiasm thickenings in patients with MGDA and to report their evolution over time.

Methods: Clinical and radiological parameters of all patients with MGDA who received cerebral MRI at the Fondation Rothschild were collected retrospectively.

Results: From January 2011 to November 2019, a total of 30 patients with MGDA were given a cerebral MRI. Median age at first MRI was 3 years. The average best corrected visual acuity was 1.57 logMAR. Most cases were unilateral (n=28/30), and no syndromic association was found. Retinal detachment was found in 12. Nine patients (30%) had MRI evidence for optic pathway enlargement. In the three patients for whom an MRI follow-up was available, no evolutive thickening was observed over time.

Conclusion: This retrospective cohort seems to comfort the idea that MGDA is frequently associated with an ipsilateral enlargement of the optic nerve and/or of the chiasm that is non-evolutive, an argument that challenges the usefulness of serial MRI scans follow- up. EPOS 2021 Rapid Fire Presentations 69

[RF10] ONE YEAR OF PEDRIATIC VISION SCREENING AMONG VILA NOVA DE GAIA’S POPULATION

Joana Fernandes1, Sidnei Barge2, Joana Braga2, Filipe Neves2, Ricardo Soares2, Catarina Ferreira2, Rosário Varandas2

1 Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal 2 Centro Hospitalar Vila Nova de Gaia/Espinho

Introduction: The national screening for children’s visual health, with the purpose of identifying amblyopia and patients with risk factors, started in the second semester of 2018. In the Centro Hospitalar Vila Nova de Gaia, the ophthalmological evaluation of the referred children began in February 2019. Our aim was to evaluate the results of the nationally implemented screening at our institution after one year and the impact in children visual health.

Methods: The screening was aimed at all 2-year-old children enrolled in the community health centre and extended to the 4-year- old children posteriorly. If the results were abnormal or non-measurable, they were referred to a paediatric ophthalmology consultation that took place monthly at our ophthalmology department.

Results: During one year, in Vila Nova de Gaia community health centres, the paediatric vision screening was performed in 2885 children. To date, 115 of the 600 children with positive criteria was evaluated at our department. We analysed the clinical data of these 115 children, with 2-3 years of age. Astigmatism was the most frequent reason for hospital referral (58.41%), followed by anisometropia (23.01%) and strabismus (20.35%). Cycloplegic retinoscopy was performed in 60.18%; 30.97% had glasses prescription; and 41.60% required follow-up. The diagnosis was consistent with the screening in 74.34%.

Conclusion: Simple screening unables the detection of significant visual abnormalities at this critical age. Despite evidence that early detection and intervention may decrease the complications of strabismus and high refractive errors, the ideal age of screening is yet to be determined.

EPOS 2021 Poster Presentations 70

[P1] SURGERY OF THE POSTERIOR FORM OF THE PRIMARY PERSISTENT HYPERPLASTIC VITREOUS BODY USING THE DATA OF PREOPERATIVE FLUORESCENCE ANGIOGRAPHY

Michael Plakhotniy1, Irina Trifanenkova2, Alexander Tereshchenko2

1 The S. Fyodorov Eye Microsurgery Federal State Institution Kaluga Branch, Kaluga, Russian Federation 2 The S.Fyodorov Eye Microsurgery Federal State Institution Kaluga Branch, Kaluga, Russian Federation

Introduction: The purpose is optimization of surgical treatment of the posterior form of the primary persistent hyperplastic vitreous body (PPHVB) using preoperative fluorescence angiography (FAG).

Methods: A clinical case is presented for a patient with a diagnosis of primary persistent hyperplastic body of the 4th stage, posterior form, tractional retinal detachment of the right eye; weak degree myopia of the left eye. The age of patient is two years. A 3-port 27g vitrectomy was performed according a standard technique. A fibro-vascular cord was cut with vitreous scissors in the avascular zone, detected according to preoperative fluorescence angiography. After it, a mobile fold of the retina formed, being include of the macular zone. A rupture of the retina from the nasal side of the optic nerve was revealed, during the operation. Transvitreal drainage of subretinal fluid was performed during gas-liquid exchange. The rupture zone is surrounded by two rows of laser coagulates. After sealing scleral punctures, 1.0 ml of 20% SF6 was injected intravitreally.

Results: The presence of an active vascular network in persistent fibrous cord was revealed according to the results of preoperative FAG. However, functioning hyaloid vessels were not found a whole length. The portion of the fibrous cord attached to the posterior pole of the lens was avascular. This allowed the portion of the fibrous cord to be cut off from the posterior lens capsule without intraoperative hemorrhagic complications. Being examined on the 3rd day, gas remained in the vitreous cavity, the fibrous cord and the retinal fold freely moved, the height and prevalence of retinal detachment decreased slightly. At the 10th day, complete resorption of the gas-air mixture, complete attachment of the retina with fixation of the retinal fold in the upper nasal segment were noted. This was also confirmed by data of retinoscopy and ultrasound B-scanning at the 21st day.

Conclusion: Performing preoperative FAG allowed to clarify the form of the disease and conduct surgical treatment with minimal trauma to the intraocular structures. Further research is needed to study the effect of preoperative FAG on the results of surgical treatment of PPH. EPOS 2021 Poster Presentations 71

[P2] A PROGRAM PACKAGE TO HELP ACCOMPANY BABIES AT RISK FOR THE DEVELOPMENT OF RETINOPATHY OF PREMATURITY

Natalya Fomina1, Prof. Elvira Saidasheva1, Prof. Ernest Boiko, Dr. Shakir Kudlachmedov 1, Yulia Givolupova2, Roman Uvarov1

1 North-West State Medical University named after I.I. Mechnikov, ophthalmology, Saint Petersburg, Russian Federation 2 Saint Petersburg Electrotechnical University, Russian Federation

Introduction: In Russia all premature babies less than 35 weeks gestational age and birth weight under 2000 grams should be observed by the experience ophthalmologist as babies with high risk of ROP. The first screening examination and follow up examinations are conducted according the National Guideline (“The Federal Clinical Recommendations”). The purpose is creating a computer algorithm that is compatible with the general database of premature babies at risk of ROP and allows automatic generation of ophthalmic examinations in accordance with the Federal Clinical Recommendations.

Methods: NET Framework, WPF for the graphical interface, Entity Framework 6.2 и SQL Express for storing, searching and editing data were used by programmers. The software package is installed in the Neonatal Unit and is undergoing further development.

Results: Initial screening in accordance with the National Guideline are calculated automatically by the program. The ophthalmologist records the examination data of premature babies and appoints the next exam. The software package shows a list of babies who are eligible for screening are scheduled on time for initial and follow up ROP eye examinations. This program helps to make an ophthalmologic examinations plan for a working week.

Conclusion: Timeliness and frequency of an ophthalmic examination is the key to success in preventing the development of severe stages of ROP leading to disability of premature babies at risk. The computer algorithm helps to do ophthalmological exams in a timely manner. EPOS 2021 Poster Presentations 72

[P3] ORBITAL RHABDOMYOSARCOMA PRESENTING WITH PTOSIS.

Simon Neary1

1 Queensland Children’s Hospital, Brisbane, Australia

Introduction: Rhabdomyosarcoma (RMS) is a malignant mesenchymal tumour and is an important potentially fatal condition that may first present to the ophthalmologist. It is the most frequent soft-tissue sarcoma of childhood, with 10% of cases occurring in the orbit. The main aim of this case is to present a subtle presenting feature of orbital RMS in a child. We will provide an overview of lesions clinically simulating RMS.

Methods: Herein we describe the presentation of an asymptomatic 3-year-old girl with new unilateral ptosis, incidentally picked up by her mother. A small, fleshy coloured lesion over the supero-nasal palpebral conjunctiva extending from the upper eyelid was found. A diagnosis of lymphoma was suspected. MRI scan revealed a right sided medial intraorbital soft tissue lesion involving the intra- conal, exra-conal, pre- and post-septal spaces. Biopsy confirmed the diagnosis of embryonal RMS.

Results: Interestingly, there was no proptosis, ophthalmoplegia or vision loss at initial presentation. However, there was rapid progression to unilateral ptosis, proptosis and ophthalmoplegia while the patient awaited chemotherapy. Simulating lesions are described in table 1.

Conclusion: This case highlights the subtle presentation of orbital RMS in a child. Initial clinical presentation simulated features of lymphoma – a unilateral, fleshy coloured, “salmon patch” lesion with intra- and extra-conal involvement. The classic presentation of orbital RMS is rapidly progressive painless proptosis, followed by ptosis and a subconjunctival fleshy mass1. The role of the ophthalmologist in this case included prompt clinical diagnosis with histological confirmation, which lead to a good outcome for the patient.

EPOS 2021 Poster Presentations 73

[P4] INFLUENCE OF EARLY POSTNATAL NUTRITION ON RETINOPATHY OF PREMATURITY

Ana Almeida1, Filipa Cirurgião2, Margarida Brízido3, Beatriz Oliveira Lopes4, Constança Coelho5, Ana Rita Azevedo4

1 Hospital Beatriz Angelo / Hospital São Francisco Xavier - Chlo, Thea Portugal S.A Nif 507978358, Loures, Portugal 2 Hospital São Francisco Xavier - Chlo, Portugal 3 Hospital Beatriz Angelo, Lisbon, Portugal 4 Hospital Beatriz Angelo, Portugal 5 Institute of Environmental Health (Isamb), Lisbon Medical School, Portugal

Introduction: To evaluate the influence of early postnatal nutrition on retinopathy of prematurity (ROP) in very preterm infants.

Methods: Clinical records of consecutive preterm infants who underwent ROP screening from April 2012 to November 2019, from two hospitals in Portugal, were retrospectively reviewed. Nutrition data was collected regarding type of milk feeding, days of parental feeding, enteral feeding, nil per os and day of autonomous oral feeding (AOF). Univariable logistic regression was used to examine risk factors for ROP followed by multivariate regression.

Results: A total of 431 infants were included. The incidence of ROP and Severe ROP were 24.83% (n=107) and 13.22% (n=57). Risk factors for severe ROP in univariate analysis were: delayed terminus of parental feeding (p=0,005), later full enteral feeding (p=0,005) and delay of AOF (p<0,001). After multivariate regression, only delay of AOF (p=0,002) remained a risk factor for severe ROP.

Conclusion: In our cohort, delayed AOF was associated with risk for severe ROP. Human milk feeding is indicated since birth, as it provides unique nutrients including insulin-like growth factor-I required for normal vascularization of retina. Very preterm infants often require more nutrients than can be provided by enteral feeding during the first postnatal weeks and total parenteral nutrition is initiated. Full enteral feedings are generally delayed due to the morbidity associated with prematurity. Whether lack of appropriate nutrition is directly involved in ROP development or is an indirect marker reflecting the severity newborns’ morbidity conferring a higher risk for ROP, remains to be fully elucidated.

EPOS 2021 Poster Presentations 74

[P5] BLOODY TEARS (HAEMOLACRIA)

Salwa Bakhurji1

1 Military Airbase Hospital, Dahran, Saudi Arabia

Introduction: Haemolacria is a rare condition in which a person bleeds from the eyes. The condition was first described by Dodanaeus in 1581, who noticed haemolacria in a 16-year-old non menstruating girl. Haemolacria is usually benign and a self-limiting.

Methods: We report a case of A 4-month-old healthy, agitated female child was brought by her parents to the emergency department with a complaint that she had bloody tears of three days duration. There was also intermittent yellowish discharge since birth and a history of flu like symptoms a week prior to presentation. Extensive investigations revealed no infection or other possible aetiologies. The patient was treated with antibiotic eye drops and her condition resolved within a few days.

Discussion: In the literature, 15 cases with haemolacria of undermined source were reviewed; the median age of onset (12 years), bilateral involvement and female gender were more commonly encountered, and the most common associated illnesses were headache and epistaxis. The condition is self-limiting and spontaneous resolution is seen in majority of cases.

Conclusion: Idiopathic haemolacria is a rare condition that can be presumed in patients presenting with blooding tears when all work up turns to be negative. the condition is self-limiting with spontaneous resolution.

EPOS 2021 Poster Presentations 75

[P6] CONGENITAL LACRIMAL GLAND AGENESIS OR HYPOPLASIA - A RARE CAUSE OF DRY EYE SYNDROME IN CHILDREN

Adina Grigorescu1, Daniela Cioplean2

1 Oftapro Cinic, Bucharest, Romania 2 Oftapro Clinic, Bucharest, Romania

Introduction: Dry eye syndrome is much rare in children than in adults. But, when it occurs, it must be treated extremely seriously due to its long-term implications on the ocular surface. Of the many possible causes, we will talk about a rare congenital cause – lacrimal gland agenesis or hypoplasia.

Methods: We will present the case of a child with severe dry eye syndrome. Clinical aspects, investigations for etiologic and differential diagnosis, and treatment regimen will be discussed.

Results: The patient underwent MRI examination and the diagnosis of congenital lacrimal gland agenesis with contralateral lacrimal gland hypoplasia was clearly estabished.

Conclusion: Although is very rare, congenital agenesis or lacrimal gland hypoplasia should be considered as a possible cause of dry eye syndrome in children, especially in the absence of systemic manifestations and normal serology. MRI examination can confirm the diagnosis.

EPOS 2021 Poster Presentations 76

[P7] OUR FIRST EXPERIENCE OF TREATING ANISOMETROPIC AND STRABISMIC AMBLYOPIA USING LIQUID CRYSTAL GLASSES.

Igor Plisov1, Ksenya Belousova1

1 S.N. Fyodorov Irtc “eye Microsurgery” Fsai of the Ministry of Health Care of the Russian Federation, Novosibirsk Branch, Novosibirsk, Rus- sian Federation

Introduction: The purpose of the study is to evaluate the effectiveness of liquid crystal glasses in the treatment of anisometropic and strabismic amblyopia.

Methods: 25 patients were treated in anisometropic and 12 in a strabismic group. Amblyopia was unilateral in all cases. The central fixation of the amblyopic eye was diagnosed in all patients. Glasses with liquid crystal lenses were used for treatment. Depending on the degree of amblyopia, the lens opposite the dominant eye was darkened by 20, 30 or 40 seconds for a period of 60 seconds. The design of the glasses makes it possible to install optimal optical lenses. For patients with strabismus, elastic Fresnel prisms were additionally applied to optical lenses. The time of wearing glasses was at least 2 hours a day, the treatment period lasted from 2 to 6 months.

Results: Positive pleoptic results were achieved in all patients. In anisometropic group, average monthly increase of visual acuity was 0.09±0.02 line, in strabismic group – 0.08±0.02 line. During the whole period of treatment and observations, visual acuity increased by 0.36±0.14 line and 0.29±0.13 line, respectively. Functional eye equality was achieved in 26 of 37 patients (70.3%). 3 patients in the anisometropic group and 2 in the strabismic group categorically refused from traditional occlusion before applying this method.

Conclusion: Liquid crystal glasses are significantly effective in the treatment of anisometropic and strabismic amblyopia. Glasses with liquid crystal lenses make it possible to exclude the negative subjective factor of the child’s perception of traditional occlusion.

EPOS 2021 Poster Presentations 77

[P8] KIMURA DISEASE: FAMILIAL AND OCULAR OCCURRENCE

Denis Georgelin1, Matthieu Robert1, Dominique Bremond-Gignac1

1 Necker-Enfants Malades Hospital, Paris, France

Introduction: Kimura disease is a sporadic disease of unknown etiology, that mostly affects young Asian males. Major signs are subcutaneous nodules and parotitis, but cases can be revealed by lid or caruncle swelling. We report the case of a child with a caruncle lesion that results from Kimura disease.

Methods: A 12-year-old boy born to a Caucasian father and a Vietnamese mother was referred for a bilateral caruncle swelling developing over 18 months. Family history revealed a Kimura disease in father’s history. The ophthalmological examination showed a painless bilateral salmon-colored swelling of the caruncles. The pediatric examination only found an ongoing parotitis and biology showed an increased level of total blood IgE. A surgical removal of the lesions was performed. Anatomopathological analysis was consistent with a Kimura disease: a follicular lymphoid hyperplasia with germinal centers and fibrosis. A few months later, the child developed a nephrotic syndrome.

Results: Besides the problem of the complex diagnosis raised by this case, the other issue is the pathophysiology of this condition, so far known as sporadic. Indeed, the present two cases in a father and his child may suggest a genetic predisposition.

Conclusion: Major signs of Kimura disease are dermatological, but uncommon sites can be seen, such as the caruncle. An accurate diagnosis is essential due to its possible association with nephrotic syndrome, but is difficult and supported by the anatomopathological analysis. The familial cases we report challenge the formerly postulated hypothesis of a sporadic condition.

EPOS 2021 Poster Presentations 78

[P9] ORBITAL HIDROCYSTOMA IN AN 8 YEAR OLD CHILD

Hans-Georg Geiger1, Peter Karl Bode2, Muriel Brada2, Karla Chaloupka3, Christina Gerth-Kahlert3

1 University Hospital Zurich, Zurich, Switzerland 2 Institute of Surgical Pathology, University Hospital Zurich 3 Department of Ophthalmology, University Hospital Zurich

Introduction: Periorbital swelling in childhood can pose a challenge in differentiating benign from malignant entities. Correct diagnosis and initiation of targeted treatment modalities in these cases requires collaboration with orbital surgical teams and histopathology workup. Hidrocystoma is an adenoma originating from sweat glands. These benign cutaneous cystic lesions of the skin occur predominantly in the head and neck regions.

Methods: Case report of a 8 year old boy presenting at our clinic, description of histopathological results, and discussion of differential diagnoses of periorbital swelling in childhood.

Results: The patient presented with a painless lower eyelid swelling which had enlarged over the previous 6 months. He did not complain of diplopia or visual disturbances. A comprehensive eye examination revealed no further abnormalities. The mass was mobile and painless on palpation. Magnetic resonance imaging revealed a 15x13x10mm well-circumscribed cystic lesion with no contrast enhancement, compatible with a lymphangioma. Surgical removal was performed delicately, avoiding capsular rupture. Histopathological examination revealed a hidrocystoma of 15mm in diameter without any malignant cells.

Conclusion: Hidrocystoma is a rare cystic lesion which should be included in differential diagnosis of slowly growing orbital masses in childhood.

EPOS 2021 Poster Presentations 79

[P11] MANAGEMENT OF BILATERAL CONGENITAL CORNEAL ANAESTHESIA.

Simon Neary1, Sarah Chan2, Shaheen Shah2

1 Queensland Children’s Hospital, Brisbane, Australia 2 Queensland Children’s Hospital, South Brisbane, Australia

Introduction: Congenital corneal anaesthesia is a rare disease that poses significant diagnostic and management dilemmas to the ophthalmologist. It may occur in isolation, with multiple somatic abnormalities or as part of a syndrome. Vision loss can result from microbial keratitis, corneal scarring, corneal lysis and perforation.

Methods: Herein we describe the case of an 8-month-old boy who was referred to our tertiary care hospital with a right non-healing corneal ulcer and 1mm hypopyon. Bilateral corneal anaesthesia was noted. The patient had no past medical history. A corneal scrape was performed under general anaesthesia (GA), however there was no microbial growth. Swabs for HSV, VZV and adenovirus PCR were also negative. The ulcer failed to heal despite intensive topical ofloxacin and preservative free (PF) lubrication and so it was decided to perform an amniotic membrane transplant (AMT) under GA. The ulcer healed well postoperatively, however there was residual central scarring. Regular PF topical lubrication was continued.

Results: A vasculitis screen was negative. An MRI brain revealed bilateral hypoplastic trigeminal nerves. The patient subsequently developed a right esotropia with amblyopia. Spectacles were prescribed and left occlusion therapy for 2 hours a day was commenced.

Conclusion: This case outlines the many challenges faced in managing CCA. Given that presentation is usually between 8 and 12 months, prevention of self-harm and accidental corneal injury is difficult. AMT is useful for epithelial defects that fail to heal despite copious topical lubrication. Prompt diagnosis and management are paramount in retaining useful vision for affected children.

EPOS 2021 Poster Presentations 80

[P12] ANTERIOR-SEGMENT OPTICAL COHERENCE TOMOGRAPHY IS A USEFUL TOOL FOR THE DIAGNOSIS OF MUCOLIPIDOSIS TYPE IV

Gilles Martin1, Pascal Dureau2, Sabine Derrien2, Augustin Leclerc2, Eric Gabison2, Pascale De Lonlay3, Odile Boespflug-Tan- guy4, georges caputo5

1 Hôpital-Fondation Rothschild, Paris, France 2 Hôpital-Fondation A. de Rothschild, Paris, France 3 Necker-Enfants Malades, Hôpital Universitaire Necker-Enfants Malades, Metabolic Diseases, Paris, France 4 Hôpital Universitaire Robert Debré, Paris, France 5 Fondation Ophtalmologique Adolphe de Rothschild, Fondation Adolphe Rothschild

Introduction: Mucolipidosis type IV (ML IV) is a rare autosomal recessive lysosomal storage disease characterized by psychomotor retardation and visual impairment, related to a progressive corneal clouding and retinal degeneration. We report here two cases of ML IV diagnosed thanks to anterior-segment optical coherence tomography (AS-OCT).

Methods: Case 1 is a 6 year-old boy followed since the age of 1 for a corneal dystrophy and a severe psychomotor retardation. Case 2 is a 7 year-old girl with normal psychomotor development, referred for visual impairment and bilateral corneal clouding. Both cases were children of consanguineous unions.

Results: In both cases, the slit-lamp examination showed a diffuse bilateral corneal opacity, appearing as small translucent epithelial vesicles, associated with curving superficial lines like incornea verticillata. Fundus was not visible in case 1. In case 2, the optic nerves were pale, and autofluorescence and OCT showed some signs of retinal dystrophy. On AS-OCT, the epithelium appeared highly hyper-reflective with a normal thickness, and no abnormalities of the other corneal layers. Corneal confocal microscopy found an hyperreflectivity of the cytoplasm of epithelial cells. Brain imaging showed an hypoplasic corpus callosum and a cerebellar atrophy, consistent with ML IV. Both cases were found with homozygous mutations of the MCOLN1 gene, that had not been previously reported in the litterature.

Conclusion: Despite the rarity of ML IV, children with bilateral corneal epithelial infiltration appearing hyperreflective on AS-OCT, in a context of consanguinity, should be ruled out for brain abnormalities andMCOLN1 mutation.

EPOS 2021 Poster Presentations 81

[P13] IDIOPATHIC CHOROIDAL NEOVASCULARIZATION IN CHILDREN

Tamás Zeffer1, Eszter Vizvári2, Edit Tóth-Molnár1

1 University of Szeged, Faculty of Medicine, Department of Ophthalmology, Szeged, Hungary 2 Department of Ophthalmology, Szeged, Hungary

Introduction: Choroidal neovascularization (CNV) is uncommon in childhood, and it can be caused by several ophthalmological conditions. Herein we present a case of an idiopathic CNV in a teenage patient, the imaging modalities, which can confirm the diagnosis and the treatment of this condition.

Methods: case report.

Results: A 10-year-old girl was referred to our clinic with a presumptive diagnosis of chorioretinitis on her left eye. Best corrected visual acuity on her left eye was 20/50 and on her right eye 20/20 by ETDRS chart. The anterior segment was without any pathological sign. On the left fundus we noticed a circumscribed greyish lesion near to the fovea, with a slight elevation of the neuroretina. There was no sign of vitritis in either eye. The right fundus was without significant change. The diagnosis of an occult CNV membrane was established with fluorescein angiography. We initiated the treatment with the administration of ranibizumab (0,05 ml; 10 mg/ml) intravitreally. After receiving the first dose of treatment, the lesion was reduced in size on optical coherence tomography images. After one month, a second intravitreal injection was administered. The patient’s visual acuity improved to 20/15 without any side effect after injections.

Conclusion: The patient did not had any predisposing condition to develop CNV. According to these, we consider the lesion idiopathic. Novel imaging modalities can help in the correct diagnosis of retinal changes. In the era of intravitreal injections, the condition can be treated with good efficacy and tolerability.

EPOS 2021 Poster Presentations 82

[P14] NON-ANIRIDIA PHENOTYPE OF PAX6 MUTATION.

Eva Roomets1

1 Tallinn Children´s Hospital, Tallinn, Estonia

Introduction: Defects in PAX6 gene, the master regulator of the eye, can affect eye development and result in a broad range of clinical phenotypes, with the most common being aniridia and foveal hypoplasia. Missense mutations in PAX6 gene, are rare and usually associated with atypical ocular phenotypes, like microphthalmia, optic nerve anomalies, coloboma, isolated foveal hypoplasia, and anterior segment dysgenesis. Most PAX6 mutations are sporadic or autosomal dominant, with significant phenotypic variability.

Methods: Case report

Results: Patient presented with nystagmus since birth. At the age of 3mo, MRI imaging showed nonelliptic globe morphology with focal convexity of the posterolateral margins and no brain abnormalities. Ophthalmological examination revealed normal appearing anterior segments (including the iris), pale optic discs, hypopigmented fundi with absence of macular reflexes in both eyes, with the vessels passing over the area of incipient fovea in the left eye. At the age of 14mo, the child was able to follow only close objects and cycloplegic refraction was: od=-7.75-2.25ax161, os=-7.5-1.0ax141. Genetic testing revealed PAX6 missense mutation: c.382C>T, p.Arg128Cys and ~12,8Mb duplication at 16p13.11-p11.2. The unaffected mother had the same chromosomal duplictation but was negative for the PAX6 mutation; the child’s father, known to have high myopia and poor sight, was not available for investigations.

Conclusion: In rare cases, pathogenic variants in the PAX6 gene cause atypical non-aniridia phenotypes. Our patient with PAX6 missense mutation had an unusual nonelliptic globe morphology, high (congenital) myopia, and distinct retinal findings consistent with macular dysplasia.

EPOS 2021 Poster Presentations 83

[P15] EVALUATION OF CLINICAL UTILITY OF OPHTHALMIC ELECTRODIAGNOSTIC TESTING (EDT) IN INFANTS UNDER THE AGE OF TWO USING THE GREENWICH GRADING SYSTEM

Fiona Mason1, Bhamy Shenoy1, Neil Parry1

1 Manchester Royal Eye Hospital, United Kingdom

Introduction: Electrodiagnostic tests (EDTs) provide an objective assessment of retinal and visual pathway function. They contribute to diagnosis and provide prognostic information in various ophthalmic conditions within the paediatric ophthalmology service. EDTs, however, are expensive and can be difficult to perform in infants. In this study we utilise a structured grading system to assess the value of EDTs to the diagnosis of ocular conditions in this age group.

Methods: This study was carried out at Manchester Royal Eye Hospital, a tertiary referral centre in the UK. A retrospective review of patient records was conducted. All infants <2 years undergoing EDTs over a 2-year period were included. The Greenwich Grading System was used to quantify the value of EDTs to the overall diagnosis and management of each patient and was calculated by 2 practitioners independently.

Results: A total of 90 infants underwent EDTs over this period. The mean age was 10.1 +/-5.5 months (range 1-24). The most common indications were nystagmus, suspected cortical visual impairment and poor visual behaviour. EDTs were found to be of value in 88% of infants and considered essential to the overall management in 41% of cases.

Conclusion: These findings support the continued use of EDTs and demonstrate that they have an important role in our investigation of infants with ocular disease. Despite the young age of the infants being tested, meaningful results were obtained in the majority of cases. EDTs also have the advantage of offering more immediate results and therefore reassurance to parents. EPOS 2021 Poster Presentations 84

[P16] CHOROIDAL DETACHMENT WITH EXUDATIVE RETINAL DETACHMENT IN STRUGE- WEBER SYNDROME.

ANA MORALES1, Juan Manuel Cubero1, Beatriz Pérez1, Diego José Torres1

1 Hospital La Arruzafa, Córdoba, Spain

Introduction: Sturge-Weber syndrome (SWS) is a sporadic syndrome with neuro-oculocutaneous involvement. Ophthalmic manifestations may be present in 30—70% of cases. Choroidal hemangiomas (CHs) are usually diffuse (DCH) and is reported in approximately 50% of cases. Those patients are most likely to develop secondary retinal detachment with shifting of the subretinal fluid and stimulation by vascular endothelial growth factors (VEGFs)

Case report: 11 years old male, with personal history of Struge Weber that shows up for sudden vision loss in the right eye (RE). Ocular examination disclosed corrected visual acuity of RE: 20/200 and left eye: 20/20. Ocular motility, pupillary responses and biomicroscopy of both eyes were unremarkable. Funduscopy of the left eye was unremarkable, and in the right eye can be seen exudative inferior retinal detachment with macular affectation secondary to choroidal vascular malformation located after performing the fluorescein angiography. Magnetic angioresonance is performed to rule out orbital affectation. Treatment with intravitreal anti-angiogenesis is decided due to the patient characteristics. One injection shows a slight improvement of the visual acuity of RE: 20/100 with a small decrease of the subretinal liquid although he is still under treatment.

Conclusion DCHs associated with SWS are uncommon but require aggressive treatment to prevent visual loss. Treatment for this type of patients remains controversial: photocoagulation, photodynamic therapy (PDT), external beam radiotherapy, brachytherapy, and anti-vascular endotelial growth factor (VEGF). Therefore, it is very important to personalize the treatment to the characteristics of the injury, the patiente and the potential consequences, as in our case.

EPOS 2021 Poster Presentations 85

[P17] BLINDNESS IN A 12 YEARS OLD BOY AFTER EXPOSURE TO A LASER POINTER

ANA MORALES1, Consuelo Spinola1, Javier Cano1, Beatriz Pérez2, Diego José Torres3

1 Hospital La Arruzafa, Córdoba, Spain 2 Hospital La Aruuzafa, Spain 3 Hospital La Arruzafa, Spain

Introduction: Eye injuries resulting from laser exposure are a concern because optical radiation from 380 to 1400 nm penetrates into various ocular structures. The blink reflex and aversion response restrict the duration of laser exposure to 0.15 to 0.25 seconds.

Case report: A 12-year-old boy requested examination, concerned that he may have injured both his eyes with a green laser-pointing (532 nm+/- 10) device and he had a central scotoma. Ocular examination disclosed corrected visual acuity for both eyes (20/200) . Ocular motility, pupillary responses and biomicroscopy of both eyes were unremarkable. Funduscopy of both eyes presents hypopigmented scar in the fovea, autofluorescence shows a hypofluorescent injury compatible with ERP atrophy. Optical coherence tomography (TCO) shows a disruption of the IS/OS line (photoreceptors) with consevation of the outer limiting membrane and irregularity of the foveal retinal pigment epithelium (RPE). Two months after the incident, the patient has shown no visual aquity improvement.

Conclusion: In conclusion, powerful handheld laser devices represent an extreme hazard to the eyes. Lasers can affect the retina through several mechanisms. The wavelength, duration of exposure, spot size, power, and location determine the severity of retinal damage. For this reason, controlling the sales of these devices is very important because of the potential hazard due to improper uses. Government actions such as banning the importation of these devices, laws for assault or malicious intent and a general public awareness campaign may be warranted. .

EPOS 2021 Poster Presentations 86

[P18] FEATURES OF STEREO VISION IN PREMATURE WITH AND WITHOUT RETINOPATHY BY 6-7 YEARS OF LIFE

Iryna Boichuk1, Kate Zaichko1, Sergey Katsan1

1 Filatov Institute of Eye Diseases and Tissue Therapy, Odessa, Ukraine

Introduction: The visual outcome after retinopathy of prematurity (ROP) treatment is less favorable than the structural outcome after correction of traction retinal detachment in ROP such as poor vision, including optic atrophy, cortical (cerebral) visual impairment, amblyopia, subclinical retinal abnormalities. Purpouse: to study stereoacuity in prematurity children with and without ROP who achieved 6 -7 years old.

Methods: 56 prematurity children, among them 30 had no ROP and 26 with ROP who had laser therapy. Except ophthalmological observation binocular vision by Wort test, stereoacuity by test Lang II and Titmus Stereo fly were conducted.

Results: In premature infants without ROP stereoscopic vision was almost normal in 76,2% of the examined by Titmus Stereo and in 80,4% by Lang II test. The stereo threshold was not detected only in 2 children (3,8%). In the premature babies with ROP who had laser treatment, reduced stereo vision was found in 21 patients (35%), thresholds were not determined by the Titmus Stereofly test in 38,8% of cases, and only 26,8% had normal stereo vision.

Conclusion: Premature infants without ROP achieving 6-7 y.o. had normal stereoacuity by Titmus Stereo fly in 76, 2% cases and by Lang II test in 80,4%. In premature babies with ROP who had laser treatment, stereovision at 6-7 y.o was normal in 26,8%, lower in 35% and was absent in 38,8% of cases.

EPOS 2021 Poster Presentations 87

[P19] EPIDEMIOLOGY AND CLINICAL CHARACTERISTICS OF CONGENITAL CHORISTOMAS IN THE EYE REGION: DERMOLIPOMAS, DERMOID AND EPIDERMOID CYSTS.

Nathali Turanzas Jensen1, Line Kessel2, Sarah Linnea Von Holstein3, Steffen Heegaard3

1 Rigshospitalet, Denmark, Department of Ophthalmology, Copenhagen, Denmark 2 Department of Ophthalmology, Rigshospitalet, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark 3 Department of Ophthalmology

Purpose: To investigate the epidemiology and clinical characteristics of infants presenting with conjunctival and periorbital congenital choristomas (dermolipomas, epidermoid and dermoid cysts) and children undergoing surgery for congenital choristomas in the orbital region.

Methods: We reviewed the medical files of conjunctival or periorbital congenital choristomas in children seen during a 5-year period (2014-2018). Children (<18 years of age) were divided into two groups: those referred <1 year of age (Group I) and those undergoing surgery to remove the lesion (Group II). The first group was used to calculate a population-based incidence of conjunctival and periorbital congenital choristomas by comparing to birth statistics from the Danish Medical Birth Registry.

Results: A total of 97 children were included, 43 in Group I and 70 in Group II. The incidence of congenital choristomas (conjunctival + periorbital) was 1 in 2537 live born children (39 per 100.000 births) with no difference between genders (p=0.44). The majority of lesions were periorbital dermoid cysts (26/43, 60.5%) located in the superotemporal region (17/26, 65.4%), followed by superonasal region (7/26, 26.9%). The main reasons for surgical removal of a congenital choristoma were growth (28/70, 40%) or cosmesis (25/70, 35.7%). A minority of 14.3% (10/70) experienced discomfort from their lesion before surgery and 1 patient experienced sequelae from a symblepharon after surgery.

Conclusion: This retrospective study is one of the first to report on the total incidence of congenital choristomas in the orbital area in infants, including conjunctival and periorbital dermolipomas and dermoid cysts. We found the incidence of dermoids to be 1 in 2537 live born children including both conjunctival and periorbital congenital choristomas. A periorbital dermoid cyst is most commonly located in the superotemporal region but is frequently found elsewhere, why dermoids are an important differential diagnosis to masses found in the orbital area. EPOS 2021 Poster Presentations 88

[P20] EFFECTS OF CONGENITAL CATARACT EYE AXIAL LENGTH ON EYE REFRACTION CHANGES POST IOL IMPLANTATION.

Sandra Valeina1

1 Riga Children’s University Hospital, Children’s Eye Diseases Clinic, Riga, Latvia

Introduction: Congenital cataract is one of the most serious problem in pediatric ophthalmology. For the best possible vision development for congenital cataract eye the time and type of congenital cataract treatment is more than important.

Methods: A retrospective chart review of 85 children (137 eyes) who underwent foldable posterior chamber intraocular lens implantation at the Clinical University Hospital in Riga, Latvia, from 1 January 2006 until 31 December 2016 was performed. We compared refraction changes- myopic shift in the eyes with different axial length during lens extraction and IOL implantation surgery.

Results: In the analysis of Spearman’s correlation coefficient between the eye’s axial length and myopic shift there were found medium, positive and statistically significant correlation. The eyes with the axial length below19 mm had the myopic shift median of -7,5 D [-5,37- -14,25], but the eyes with the axial lengths above or equal 19 mm, had myopic shift median of -0,25 D [0 - -2,00 D]. Similar results are demonstrated by an analysis of the myopic shift dispersions.

Conclusion: Shorter axial length and earlier patient age at the time of a cataract surgery with IOL implantation affects the amount and dispersion of the pseudophakic eye refraction changes. If, at the time of a cataract surgery, the axial length of congenital cataract eye is until 19 mm, unpredictable dispersion of a refraction will appear, while the patient is growing. If the operated congenital cataract eyeball’s length is 19 mm or more, the refraction changes are more predictable.

EPOS 2021 Poster Presentations 89

[P21] FIRST REPORT OF INTRACAMERAL MYDRANE USE DURING LENS SURGERY IN CHILDREN

Maria Concepcion Guirao Navarro1, Eoghan McNelis1, Goran Darius Hildebrand 1,

1 John Radcliffe

Introduction: Adequate pupil dilation is necessary for safe lens surgery. For this purpose, intracameral mydriatics are used in in adults and are also used in children. We here report our experience of the use of Mydrane® in children.

Methods: Retrospective case series at a single institution of children in whom intracameral Mydrane® was used during intraocular surgery between Jan-2018 and Dec-2019. Patients were identified by searching the electronic patient records for a single surgeon. Identified records were then reviewed for ophthalmic, intraoperative and cardiovascular findings.

Results: 9 eyes of 9 children aged 1 month to 3 years had intracameral Mydrane®. Two of these 9 children had additional second eye surgery without Mydrane® and served as controls. The first child (age 2) had an adult dose of Mydrane® (0.2ml) and developed an unexpected rapid rise in HR and systolic BP immediately after administration of Mydrane®. This response lasted more than 1h 30 minutes. As a further precaution, the following safety modifications were taken in all subsequent patients:(1) application of viscoelastic to the ocular surface (2) clear corneal incision (3) use of no more than 0.1ml, and (4) dilution with BSS during injection and washout of Mydrane®. With these 4 precautionary steps, we found no more rapid spikes in HR or BP.

Conclusion: We report that intracameral use of Mydrane® can be associated with an immediate and sustained rise in blood pressure and heart rate. Therefore, it should be used with caution, close monitoring and the above precautionary measures.

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