Tuesday 31 October

Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP) and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes) and are collectively termed “minimally invasive glaucoma surgery (MIGS).” The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold) and ab externo (canaloplasty, Stegmann Canal Expander, s...

Minimally invasive glaucoma surgery (MIGS) has become increasingly popular as a step in the management pathway of open angle glaucoma. Due to the relative novelty of these devices, there remains some paucity of evidence relating to their long-term efficacy and safety, and this can make comparison between these techniques somewhat complex. This review article aims to guide clinical decision making by providing the latest evidence on the comparative efficacy of current iterations of minimally invasive glaucoma surgery. A literature review was conducted to identify the most significant recent evidence to support the safety and efficacy of the various forms of minimally invasive glaucoma surgery. Included studies provided efficacy and safety data on a variety of minimally invasive glaucoma surgery methods. The PubMed database was searched and a total of 484 studies, published between 2015 and 2020 were identified, of which 27 were included. The studies indicate that most available forms of minimally invasive glaucoma surgery show statistically significant efficacy in terms of intraocular pressure reduction and improvement in medication burden, while maintaining an acceptable safety profile.

Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 doi: 10.1111/ceo.13051 Tuesday 31 October 0645–0800 Allergan Hosted Morning Symposium Title: New Advances in Glaucoma Venue: Bellevue Ballroom 1 Chair: Prof Bob Casson 0830–1000 P08 – PLENARY SYMPOSIUM: Minimally Invasive Glaucoma Surgery Chairs: Dr Colin Clement and Dr David Manning Email: colinandkylie@me.com Venue: Riverside Theatre Abstract: Minimally invasive glaucoma surgery (MIGS) is a new and exciting class of treatment for patients with glaucoma. It potentially lowers intra-ocular pressure and reduces dependence on medication with a quick and safe intervention. It may be administered by any ophthalmologist familiar with anterior segment surgery and therefore is of relevence and interest to the broader ophthalmic community. There are many MIGS devices available and more are on the way. This symposium aims to address our current understanding of MIGS by examining such issues as efﬁcacy, patient selection and technique. It will draw on the extensive experience of local surgeons with a contribution from invited speak Dr Anne L Coleman who has published a review on this topic in past 24 months. Speakers and Topics: Dr David Manning - What is the rationale for angle-based glaucoma surgery? Dr Colin Clement - Does MIGS work? An appraisal of current evidence for trans-trabecular stents. Dr Herbert Reitsamer: Does MIGS work? An appraisal of current evidence for supra-choroidal and subconjunctival stents A/Prof Graham Lee - My tips for achieving success with MIGS Dr Frank Howes - Who is suitable for MIGS? Dr Mark Chiang - Is there a role for MIGS in complex glaucoma? A/Prof Michael Coote - Why I don’t use MIGS. Dr Anne L Coleman - What is the future of MIGS? 1000–1030 MORNING TEA 1030–1100 L06 – Oculoplastic Update Lecture Prof Don O Kikkawa Topic: Finding New Solutions to Vexing Problems in Oculoplastics Chair: Prof Nigel Morlet Venue: Riverside Theatre Synopsis: The ﬁeld of oculoplastics encompasses a myriad of pathology affecting the ocular adnexa with a variety of causes and solutions. The shift towards personalized medicine is occurring on a widespread basis with individualized treatment rapidly being recognized as the new norm. Complex problems in oculoplastics provide the greatest opportunity for customized treatment. This talk will focus on updating the ophthalmologist on the latest surgical and medical therapy for some of these multifaceted problems. 1100–1130 L07 – Dame Ida Mann Lecture Prof Trevor Sherwin Topic: The Premise and the Promise of Regenerative Medicine Chair: Dr Heather Mack Venue: Riverside Theatre Synopsis: The eye has long represented an accessible and accommodating organ in which to trial and establish new technologies, from the ﬁrst corneal transplant to the pioneering use of medical lasers. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 55 Tuesday 31 October The eye is also at the forefront of the current race towards regenerative medicine. Clinical trials are being conducted around the world on stem cell transplantation and gene therapy for eye conditions. The presentation will highlight some of the technologies that are becoming available whilst also giving insights into the current work from my own laboratory. Our laboratory aims to deﬁne new therapies for the treatment of corneal disorders and we have been working towards the use of corneal stem cell spheres to regenerate the limbus tissue following stem cell deﬁciency caused by chemical injuries. Furthermore, in collaboration with Prof Colin Green (a previous Ida Mann lecturer) and Dr. Carol Green we are applying cellreprogramming technology to successfully regenerate the corneal stroma in keratoconus by inducing the stromal keratocytes to produce a collagen molecule that is usually only expressed in utero. Careful research is required to advance the promising regenerative technologies towards the clinic. The presentation will highlight some of the obstacles to be navigated on the road to clinical trials but will also illustrate the requirement for measured application of these alluring new therapies. 1130–1230 P09 – RANZCO: VTP Plenary - Year in Review Chairs: Dr Catherine Green AO and Dr Justin Mora Venue: Riverside Theatre With the 2017 year now mostly behind, the Censor in Chief Dr Justin Mora and newly appointed Dean of Education Dr Catherine Green AO report on a number of milestones that have been achieved in the Vocational Training Program. Join this plenary to hear about the following initiatives: • Review of Selection Processes • Launch of Curriculum 2020 • Introduction of Multi-source Feedback in the VTP • Standard setting across the exams and work based assessment • Revised Training Post Accreditation standards (including policies to support anti-bullying and harassment) Including the increased resources planned for 2018: • Online exams • Surgical Log Book tool 1230–1400 LUNCH 1400-1530 CONCURRENT SESSIONS 1400-1530 S26 – CPD Audit Session Chair: Dr Sukhpal S Sandhu Panel: Dr Bonnie An Henderson, Dr Heather Mack, Dr Sam Lerts and Dr Peter Macken Venue: Bellevue Ballroom 1 S2601 1. TELE-CONNECTING REGIONAL HOSPITALS WITH A TERTIARY OPHTHALMIC CENTRE: THE RVEEH ’EYECONNECT®’ EXPERIENCE Shivesh Varma, Nathan Wong, Monica Hu, Kristen Wells, Carmel Crock Email: shivesh.varma@gmail.com Royal Victorian Eye and Ear Hospital, East Melbourne, Australia Purpose: To describe use of eyeConnect®, a telehealth service linking the Royal Victorian Eye and Ear Hospital (RVEEH) to other Emergency Departments in Victoria. eyeConnect® consists of proprietary machines capable of clinical data collection and anterior segment photography, with software relaying information for review to RVEEH. Methods: The ﬁrst 89 eyeConnect®consultations (June 2016 - June 2017) were reviewed for presenting complaint, telehealth data ﬁelds (symptoms, ocular history, visual acuity [VA], Amsler grid, intraocular pressure [IOP] screening-device measurement, photos), response time, and consultation outcome. Patients advised to present to RVEEH were reviewed for VA, IOP, and diagnosis. Results: 69 (78%) consultations arrived from a single trial site (peripheral metropolitan), with 5 additional sites established during the study period (20 consultations, 22%). Predominant presenting Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 56 Tuesday 31 October complaints were “eye pain” (58, 65%), “decreased/ loss of vision” (38, 43%), and “red eye” (38, 43%), often in combination. Median machine-measured VA was 6/18. 60% had IOP screening; two patients registered high IOP, and nine registered borderline IOP. Photo packages were of high enough quality to be clinically useful in 66 (74%) consultations. Median response time was 29 minutes. 47 patients (53%) were advised to present to RVEEH, of which 42 attended. 70% of remeasured VAs were within two lines of referral. Seven patients required admission at RVEEH, while 28 were followed up in RVEEH outpatients. Conclusion: The eyeConnect® telehealth service provides a direct, structured avenue of communication between Victorian Emergency Departments and RVEEH. With a total of 15 regional sites planned to receive this service, there is opportunity to improve the current format and technology to promote emergency-based and remote ophthalmic care. S2602 2. WORK-RELATED EYE INJURIES IN VICTORIA: ROOM FOR IMPROVEMENT? Varun Chandra, Jonathan Kam, Kristen Wells, Carmel Crock Email: varun.chandra@hotmail.com Royal Victorian Eye and Ear Hospital, East Melbourne, Australia Purpose: To analyse trends of work-related eye injury presentations to the Royal Victorian Eye and Ear Hospital (RVEEH) ED over the past 10 years, and determine any potential areas for improvement in current personal protective equipment (PPE) guidelines. Methods: A retrospective audit of all new ophthalmic WorkCover presentations to the RVEEH ED from 1997 to 2016. Results: 5201 cases were identiﬁed. The mean age was 35, and 92.5% of workers were male. The most common injuries were corneal foreign body (CFB) (26.9%), corneal abrasion (18.4%), and chemical injury (14.6%). There was a progressive decline in WorkCover cases from 2008 (n=788) to 2016 (n=386). However, the numbers of serious eye injuries including penetrating and chemical injuries have remained unchanged. In the most recent year, compliance rates with PPE in workers presenting with CFBs was 77%. Furthermore, grinding and hammering were responsible for 21% and 14% of penetrating eye injuries respectively. Discussion: The results reﬂect a shortcoming in factors other than adherence to PPE, such as type of PPE used. Although a seemingly innocuous injury, workplace CFB injuries have a signiﬁcant impact on the Australian economy, with the AIHW calculating median time off work as 1.5 weeks. Despite the severity of potential injuries, Australian workplace eye protection guidelines recommend PPE as only optional for hammering, and safety glasses (not goggles) are considered adequate for grinding. Conclusion: The authors hope that the results of this audit inspire the development of better eye protection options and guidelines for our workers. S2603 3. MICROBIOLOGICAL SPECTRUM AND ANTIBIOTIC SENSITIVITY OF ENDOPHTHALMITIS IN WAIKATO, NEW ZEALAND: 10-YEAR REVIEW Moaz Alshaikhi, Eugene Micháel, Stephen Guest Email: moaz.nz16@gmail.com Waikato DHB, Hamilton, New Zealand Purpose: To describe the microbiological isolates and antibiotic sensitivity of culture-positive endophthalmitis in New Zealand and study their microbial proﬁle according to the type of endophthalmitis. Methods: Retrospective analysis of all endophthalmitis cases presented to Waikato Hospital between 2004 and 2014. The following information was collected: source of infection, time to presentation, microbiological results and antibiotic sensitivity. Results: Fifty-eight percent of endophthalmitis cases yielded positive cultures (n=45) of which 3 cases exhibited a growth of more than one organism. Coagulase negative staphylococci (CNS) were the most prevalent organisms (40%), followed by streptococcus species (17%), staphylococcus aureus (11%) and bacillus species (11%). CNS were identiﬁed in 30% of cataract-related endothphalmitis and in all cases occurred after intravitreal Bevacizumab injections (100%). Other Gram positive bacteria were more common in endogenous endophthalmitis (66%), post-traumatic endophthalmitis (66%) and belbitis-related endophthalmitis (80%). Gram negative bacteria and fungi accounted for 9% and 4% of all isolates, respectively. The antibiotics sensitivity of gram positive bacteria was as follows: Vancomycin (100%), Cefuroxime (81%), Ciproﬂoxacin (100%), Moxiﬂoxacin (90%) and Amikacin (83%). Ceftazidime, Ciproﬂoxacin and Amikacin were sensitive in all gram negative isolates. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 57 Tuesday 31 October Conclusion: Although coagulase negative staphylococci remain the major cause of endophthalmitis, the prevalence of other gram positive bacteria is increasing. The combination of vancomycin and Ceftazidime offer an excellent empiric antibiotic choice for bacterial endothphalmitis. Microbial resistants to Cefuroxime is seen in about 20% of cases. Systemically, ciproﬂoxacin was not inferior to a fourth generation ﬂuoroquinolone agent, moxiﬂoxacin, in covering both gram positive and negative bacteria. A report was developed to allow bi-annual surveillance reporting. Conclusion: Gram-positive bacteria were most commonly isolated from cases of bacterial keratitis; the majority was resistant to penicillin. Emerging resistance was noted to ciproﬂoxacin in gram-negative bacteria. The surveillance program will assist in guiding initial therapy, antimicrobial stewardship and the detection of emerging resistance. S2605 S2604 4. ESTABLISHMENT OF A BACTERIAL KERATITIS SURVEILLANCE PROGRAM IN A TERTIARY REFERRAL HOSPITAL Maria Cabrera-Aguas1,2, Monica Lahra3, Pauline Khoo1,2, Ryanbi Pratama3, Barrie Gatus3, Trine Gulholm3, Jasmin El-Nasser3, Stephanie Watson1,2 Email: mcab3563@uni.sydney.edu.au 1 Save Sight Institute, University of Sydney, Sydney, Australia, 2Sydney Eye Hospital, Sydney, Australia, 3South Eastern Area Laboratory Services, Department Microbiology, Sydney, Australia Purpose: To determine the spectrum and resistance patterns of bacteria isolated from cornea scrapings/ biopsies in bacterial keratitis, and establish a surveillance program at a tertiary referral eye hospital. Methods: A retrospective analysis of bacteria isolated from cornea scrapings/biopsies from patients with a clinical diagnosis of bacterial keratitis at Sydney Eye Hospital from January to December 2016 was conducted. All specimens were processed at the SEALS Department of Microbiology. A literature review of ocular surveillance studies and consultation with microbiologists were undertaken to design a surveillance program for prospective reporting of bacterial resistance in keratitis cases. Results: 157 organisms were grown on 224 plates (70% positive culture rate). Of the 157 organisms, 130 (83%) were gram-positive and 27 (17%) were gram-negative. Coagulase-negative staphylococci (CoNS) 58% (75/130), staphylococcus aureus 12% (15/130), including one methicillin resistant staphylococcus aureus (MRSA), streptococcus pneumoniae 6% (8/130) and pseudomonas aeruginosa 56% (15/27) were the most common isolates. Resistance was found for: methicillin sensitive staphylococcus aureus (MSSA) to penicillin in 79%, chloramphenicol 18% and gentamicin 6%; CoNS to penicillin 60%, gentamicin 9%, and cephalothin 7%; and streptococcus pneumoniae to cephalothin 25% and penicillin 25% and pseudomonas aeruginosa to ciproﬂoxacin 6%. 5. EMERGENCY DEPARTMENT INITIATION OF SECONDARY PREVENTION FOR RETINAL ARTERY OCCLUSION/AMAUROSIS FUGAX FOLLOWING ADAPTATION OF AN EVIDENCEBASED TREATMENT PATHWAY AT A SPECIALIST EYE HOSPITAL John Rocke1, Lauren Sanders2,1, Carmel Crock1, Lisa Qu3, Neil Shuey2,1 Email: johnrossrocke@gmail.com 1 Royal Victorian Eye and Ear Hospital, Melbourne, Australia, 2St. Vincent’s Hospital, Melbourne, Australia, 3 St. Vincent’s Clinical School, University of Melbourne, Melbourne, Australia Purpose: Retinal Artery Occlusion (RAO) and Amaurosis Fugax (AmF) are ophthalmological emergencies. No speciﬁc secondary prevention guidelines exist for these conditions, with consensus opinion to follow Stroke/Transient Ischaemic Attack (TIA) management recommendations. We adapted the evidence-based Monash TIA pathway (M3T) to guide investigations and initiation of secondary prevention from the Emergency Department (ED) of a specialist eye hospital. Follow-up occurs in the afﬁliated hospital’s TIA clinic with urgency triaged according to underlying CRAO/AmF mechanism (Carotid stenosis: 2 days, atrial ﬁbrillation: 1 week, other: 2 weeks). Our primary objective was to determine the effectiveness of the ﬁrst year of the pathway on patient management and referral. Method: Audit was performed for all ED presentations coded as RAO or AmF from December 2015 to January 2017. Data regarding investigations and follow-up were prospectively collected. Additional ED presentation and initial management information were retrospectively extracted from medical records. Statistical analyses were then performed with SPSS and Stata 12. Results: There were 197 initial diagnoses of RAO/AmF, with 100/197 (50.8%) referred to the TIA clinic for follow-up. Pathway use was signiﬁcantly associated with increased initiation/adjustment of medical therapy: antiplatelets 78.6% Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 58 Tuesday 31 October (66/84) vs 35.1% (27/77), p<0.001; statins 67.0% (61/91) vs 16.2% (12/74), p<0.001. Increased proportions of patient discharged/transferred on any antiplatelet/anticoagulant were observed with pathway use (96.0%, 95/99) compared with no pathway use (69.0%, 58/84, p<0.001) and similarly for statins (84.8%, 84/99 vs 47.6%, 39/82, p<0.001). Median time to clinic: 8 days (IQR 4-12). Conclusion: Pathway use for RAO/AmF is associated with improved initiation of appropriate secondary prevention. Differences in success may be related to complexity of cases. Improvement in long-term outcome documentation is needed in the use of ANZSRS surgical registry. S2606 Uday Bhatt, Amanpreet Kaur Email: uday.bhatt@gmail.com Vision Eye Institute, Melbourne, Australia 6. A PROSPECTIVE AUDIT OF PRIMARY RETINAL DETACHMENT REPAIR OUTCOME IN A TERTIARY HOSPITAL: CONSULTANT VERSUS FELLOWS Sarah L Mason1, Fred K Chen1,2 Email: drsarahmason@gmail.com 1 Royal Perth Hospital, Perth, Australia, 2Lions Eye Institute, Perth, Australia Purpose: To compare surgical outcomes of retinal detachment repair surgery between consultant and fellows. Methods: Data from the Australian and New Zealand Society of Retinal Specialists (ANZSRS) surgical registry was examined. Patients operated at Royal Perth Hospital between 2013 and 2015, with a 3 month follow-up data entry where eligible. In addition to reattachment success rate with or without oil tamponade, the time taken for the surgical procedure, preand post-operative visual acuity and complications were reviewed. These variables were compared between cases operated by a consultant and a fellow. Results: Data from a total of 204 recorded operations were analyzed. A total of 143 cases were completed by fellows as primary surgeon, the remaining 61 cases we performed by consultants. The average median operating time was 64 minutes for fellows and 68 minutes for consultants. Initial (3 month) success rate for fellows was 85% (16% under oil and 69% without oil). Similarly, the success rate for consultants was 79% (13% under oil and 66% without oil). Complication rates varied and documentation was incomplete. Only 13% of the cases had 12 month follow up outcome documented. Conclusion: Grade of primary operating surgeon did not signiﬁcantly impact on operating time. S2607 7. COMPARISON OF PTERYGIUM EXCISION AND CONJUNCTIVAL AUTOGRAFT SURGERY USING ARTISS FIBRIN GLUE VERSUS VICRYL SUTURES Background: Traditional method of attaching the conjunctival autograft following pterygium surgery involves surturing with Vicryl. This means the patients will have to endure discomfort from the suture ends at least for a couple of weeks. In this audit, outcome measures of surgical time, patient discomfort, complications and recurrence rates of the Artiss glue technique were compared with Vicryl sutures. Twenty consecutive patients having standard conjunctival autograft placed with Artiss ﬁbrin glue are compared with 20 having surgery with the autograft with Vicryl sutures. Patients were followed up to 6 months following surgery. Benchmarking/Standard: Pterygium surgery with conjunctival autograft attached with sutures. Results: Mean surgical time for the glue group was signiﬁcantly shorter at 16 mins compared with the suture group at 28 min (P < 0.001). Postoperative pain was signiﬁcantly less at day 1 (P < 0.001) and day 4 (P < 0.05) but was not signiﬁcantly different following removal of sutures on day 4 in the suture group. Complications in the glue group included one patient with an absent graft at day 4 that required further intervention. There were 1 recurrence each in the glue and suture group at 6 months follow up. Recommendations: Attachment of conjunctival autograft following pterygium surgery with Artiss glue is safe and effective method. The glued autograft recurrence rate at 6 months was similar to that of sutured grafts. Conjunctival autograft with Artiss glue in pterygium surgery have the advantage of decreased surgical time and less postoperative pain in the ﬁrst few days. However, this group had higher risk of graft loss. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 59 Tuesday 31 October S2608 S2609 8. ANTIMICROBIAL STEWARDSHIP. COLLABORATIVE AUDIT OF ANTIMICROBIAL USE BY RANZCO FELLOWS 9. A LONG TERM SINGLE SURGEON, SINGLE FACILITY CLINICAL AUDIT OF IOL GLISTENINGS Josephine Richards1, Jessica Ong2, Nigel Morlet1,3, Simon Janda4 Email: diastella@iinet.net.au 1 Royal Perth Hospital, Perth, Australia, 2Fiona Stanley Hospital, Perth, Australia, 3University of Western Australia, Perth, Australia, 4RANZCO, Sydney, Australia Philip House1, Josephine Richards2, Anmar AbdulRahman3 Email: philhh@ozemail.com.au 1 UWA, Perth, Australia, 2Royal Perth Hospital, Perth, Australia, 3Counties Manukau DHB, Auckland, New Zealand Background: Antimicrobial stewardship is a priority in our region . Antibiotics of last resort have an important place in ophthalmology and drug resistance is a concern. This audit is part of a comprehensive program of self evaluation and reﬂection, comparison with available benchmarks and education followed by re- audit to promote desirable changes in prescribing behaviour. Benchmarking / Standard: Participants were asked to select from 27 possible clinical scenarios in which antimicrobials might be used and submit 10 prospective or retrospective cases. For each scenario, they were required to state the benchmark or standard from which their prescribing practise was derived. Options included: AAO benchmarks, AAO EyeWiki, Australian Medicines Handbook, Cochrane Review, Common sense, EMedicine, ESCRS guidelines 2013, Experience and training, Google search Kanski, Moorﬁelds Microguide, Research papers and published reviews, Wills Eye Manual, Other. Results: Submissions received by 30 September will be analysed on the basis of evidence based vs expert opinion based vs “common sense” prescribing. Use of antibiotics of last resort (ﬂuoroquinolones) and perceptions of the risk of antimicrobial resistance in each case, will be analysed across all 27 scenarios Subgroup analysis will include pre and post-operative antimicrobial use in cataract surgery and antimicrobial prophylaxis for injections. Recommendations: Scenarios in which antibiotics of last resort are being used unnecessarily will be highlighted (post-operative management following cataract surgery being the most important) and participants will be directed to evidence based information which will give them the conﬁdence to change prescribing patterns. Important evidence based resources will be highlighted. Background: Vacuole formation in IOLs, particularly hydrophobic lenses, is a well-documented issue. Alcon introduced a program of incremental manufacturing improvements between 2003 and 2013 aimed at reducing these changes. This audit examines changes in the incidence of glistenings over a 20 year period. Benchmarking/Standard: The review article by Liliana Werner includes a glistening density scale with example photos which was used for the slit lamp assessment. (J Cataract Refract Surg 2010; 36:1398–1420). All consecutive patients, with at least one IOL with more than one year since insertion, were audited. After 200 eyes only those with more than ﬁve years were assessed. 243 eyes were assessed of which 233 were of Acrysof material. No lenses from manufacturers other than Alcon had glistenings. Results: Of the 233 Acrysof lenses analysed, 63% showed glistenings. When the Alcon lenses were grouped by date of insertion little change in incidence was found when patients treated prior to 2006 were compared with recent insertions. Glistening Density Grade (Patient Numbers by Grade as Percentages) Insertion Date 0 1 2 3 4 10/16 to 01/14 49 28 17 7 0 N = 72 12/13 to 01/07 27 38 24 8 4 N = 112 12/06 to 12/96 43 24 12 16 4 N = 49 Recommendations: IOL glistenings still occur in patients with lenses inserted after Alcon’s improvement program. Surgeons need to consider this issue when choosing an IOL for their patients Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 60 Tuesday 31 October 1400-1530 S27 – SYMPOSIUM: Oculoplastics Practice – International perspectives Co-sponsors: RANZCO International Development Committee (IDC), Australia and New Zealand Society of Ophthalmic Plastic Surgeons (ANZSOPS), Asia Paciﬁc Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS) Co-Convenors: Dr Brian Sloan and Dr Catherine Green AO Chairs: Dr Anthony Bennett Hall and Dr Adam Gadjatsy Email: sloanbh@gmail.com Venue: Riverside Theatre Part 1: Doing - update on common oculoplastics conditions Prof Don O Kikkawa - Lacrimal and ptosis surgery: contextual differences in the developed versus developing setting Dr Brian Sloan - Lid malpositions: Dr Brian Sloan - assessment, surgical techniques, resource constraint Part 2: Teaching - making the most of clinical opportunities Dr Charles Su - Teaching a surgical skill Dr Catherine Green AO - Assessment of surgical competence Dr Justin Mora - How to give effective feedback and remediation of underperformance Part 3: Training - driving enduring change Dr Anthony Bennett Hall - Opportunities for development: in-country vs external training, the importance of effective partnerships, stakeholder engagement, the role of telemedicine Questions/ discussion 1400-1530 S28 – SYMPOSIUM: Postoperative Endophthalmitis: Prevention, Diagnosis and Treatment Chairs: Prof Nigel Morlet and Dr Jonathon Ng Email: jonathon.ng@uwa.edu.au Venue: MR 1 & 2 Synopsis: Endophthalmitis is one of the most serious and feared complication of cataract surgery. In the last 10 years, routine use of intracameral antibiotics has greatly changed chemoprophylactic strategies but its use is not without risk or controversy. This symposium will be relevant to any ophthalmologist that performs cataract surgery, undertakes intravitreal injections or who will potentially see patients with acute endophthalmitis. The aim will be to provide a practical, and up-to-date evidence-based approach to the prevention, diagnosis and treatment of postoperative endophthalmitis. This session, together with the course “Bugs and Drugs”, comprises the didactic teaching component for the Antimicrobial Stewardship Audit, which has been approved for 30 audit points by the RANZCO CPD committee for all Fellows. Speakers and Topics: Dr Jonathon Ng - Clinical epidemiology and chemoprophylaxis for endophthalmitis after cataract surgery Dr Tat-Keong Chan - Diagnosis of endopthalmitis and its differentiation from Toxic Anterior Segment Syndrome Dr Kenneth Fong - Management and outcomes of endophthalmitis Dr Chee-Yiong Kang - Endophthalmitis after intravitreal injections Panel discussion and audience questions 1400-1530 S29 – COURSE: Cataract Surgery, IOL Calculations and Corneal disease Chair: Dr Elsie Chan Email: elsiec@med.usyd.edu.au Venue: Bellevue Ballroom 2 Synopsis: This course will provide an overview on how to maximise outcomes in patients with corneal conditions who undergo cataract surgery. Topics that will be covered include optimising IOL calculations and toric IOL outcomes in the presence of ocular surface disease, previous refractive laser surgery, corneal scars, keratoconus, Fuchs’ endothelial dystrophy and corneal transplants. Management options following post-operative refractive surprises will also be covered. Speakers and Topics: Dr Ross MacIntyre - How to optimise IOL calculations Dr Andrea Ang - Managing astigmatism Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 61 Tuesday 31 October Dr Jacqueline Beltz- IOL choices in patients with corneal disease Dr Dermot Cassidy - Management options following post-operative refractive surprises Dr Elsie Chan - Case discussions 1400-1530 S30 – FREE PAPERS Rapid Fire Presentations - Genetics, Ocular Oncology, Cornea and Retina Chairs: A/Prof Andrea Vincent and A/Prof Samantha Fraser-Bell Venue: MR 3 S3001 1. DETECTION OF CHROMOSOMAL ABERRATIONS ASSOCIATED WITH PROGNOSIS OF UVEAL MELANOMA USING CIRCULATING TUMOUR CELLS Timothy Isaacs1,2, Aaron Beasley3,4, Richard Allcock5, Adnan Khattak6, Tersia Vermeulen7, James Freeman3, Fred Chen1,4, Jacqueline Bentel7, Leslie Calapre3, Michelle Pereira3, Kyle Yau5, Bob Mirzai5, Wendy Erber5, Melanie Ziman3,5, Elin Gray3,4 Email: tim@isaacs.net.au 1 Centre for Ophthalmology and Visual Science, University of Westrn Australia, Crawley, WA, Australia, 2Perth Retina, West Leederville, Australia, 3School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia, 4Lions Eye Institute, Nedlands, WA, Australia, 5 School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia, 6Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, WA, Australia, 7Anatomical Pathology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia Purpose: To validate a method of isolating single circulating tumour cells (CTCs) in patients with primary uveal melanoma (UM) as a viable and minimally-invasive source of tumour genetic material to determine patient prognosis. Methods: We analysed 23 patients with a clinical diagnosis of UM for the presence of CTCs, targeting a single cell surface marker (MCSP). Immunohistochemistry (IHC) analysis of a UM tissue microarray and 5 primary UM cell lines was performed to identify potential markers to improve CTC isolation. Subsequently, a second group of primary UM cases were analysed for CTCs targeting four markers (ABCB5, sgp100, MCAM, and MCSP). Single UM cells were whole genome ampliﬁed using the PicoPlex Kit, followed by low coverage whole genome sequencing (WGS) on the Ion PGM System. Results: IHC of tumours and cell lines demonstrated the phenotypic heterogeneity of UM. The multimarker approach improved UM CTC capture, with CTCs detected in 83% of patients compared to 65% when using MCSP alone. We validated our protocol for single cell WGS, deriving the correct ploidy in all three UM cell lines tested. Using the multimarker approach we isolated and sequenced CTCs from a metastatic UM patient and compared them to the corresponding primary tumour. Numerous chromosomal aberrations, including gains of chromosome 6 and 8, which are associated with UM prognosis, were observed in the CTCs as well as the primary tumour. Conclusion: Herein we offer a viable minimallyinvasive methodology to analyse single CTCs in patients with primary UM to detect chromosomal changes associated with prognosis. S3002 2. THE AUSTRALIAN INHERITED RETINAL DISEASE REGISTRY AND DNA BANK John DeRoach, Terri McLaren, Jennifer Thompson, Ling Hoffmann, Isabella Campbell, Tina Lamey Email: john.deroach@health.wa.gov.au Sir Charles Gairdner Hospital, Perth, Australia Purpose: To collect DNA samples and clinical and family history information from participants affected with an inherited retinal disease (IRD) and from family members. To genetically analyse the DNA to establish the prevalence of IRD-causing mutations in Australia, to identify suitable clinical trial candidates and to inform patient management. Methods: Written consent was obtained from participants. Their clinical and family histories were gathered and DNA was collected. Genetic analyses carried out included Sanger sequencing, microarray analysis, Array CGH analysis and NGS gene-panel analysis. Pedigree and individual participant information was stored in a Progeny database. Results: Since 2009, details of 7820 participants sourced from 2650 families were recorded in the registry. DNA was stored for 5980 participants. More than 500 ophthalmologists provided a clinical diagnosis for 3630 affected participants. 3240 analyses were carried out for 2260 participants, including targeted sequencing (1130 analyses), NGS gene-panel analysis (951), microarray analysis (480), single-gene Sanger sequencing (450) and Array CGH analysis (24), establishing 810 different Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 62 Tuesday 31 October pathogenic or possibly pathogenic variants distributed over 175 genes. Of these variants, 50% were established in the ABCA4, USH2A, RPGR, RP1, RS1, CRB1 and CHM genes. 508 reports of these research ﬁndings have been provided to 60 ophthalmologists or clinical genetics services to inform patient management, particularly for family planning or the management of syndromic disease. Conclusion: A sustainable, rigorous and widely used Australian IRD registry and DNA bank has been established, providing valuable information regarding the Australian IRD mutation spectrum, which has proven beneﬁcial to clinicians and participants. Conclusion: Morpholino and CRISPR/Cas9 systems can successfully knockdown PDE6B gene function in a zebraﬁsh retinal degeneration model, causing phenotypic and morphological changes in embryonic zebraﬁsh retinas. No obvious effect on functional vision was observed with the morpholino model. Utilizing the CRISPR/Cas9 system to create a stable PDE6B zebraﬁsh model will permit characterization of the degenerative process of the retina including assessment of cGMP levels, and allow therapeutic drug screening. S3004 4. EPIDEMIOLOGY OF PRIMARY OCULAR AND ORBITAL LYMPHOMA IN VICTORIA S3003 3. GENE EDITING IN ZEBRAFISH FOR FUNCTIONAL CHARACTERISATION OF A PDE6B FOUNDER MUTATION CAUSING AUTOSOMAL RECESSIVE ROD-CONE RETINAL DYSTROPHY IN M aORI 1 1,2 Micah E.J. Rapata , Andrea L. Vincent , Verity F. Oliver1, Alec L. Hou1 Email: micahrapata91@gmail.com 1 Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, 2Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand Purpose: To create, and phenotype, a zebraﬁsh model of a novel founder PDE6B mutation (c.2197G>C; p.Ala733Pro) in the Maori population causing rod-cone dystrophy, to enable high throughput screening of novel therapeutics targeting cyclic GMP. Methods: Transient morpholino knockdown of PDE6B was performed on zebraﬁsh embryos, with validation by RT-PCR. CRISPR gRNA-Cas9 complexes were injected into zebraﬁsh embryos to create a stable PDE6B mutant. Phenotypic analysis of morpholino and CRISPR/Cas9- edited zebraﬁsh was performed using light microscopy imaging, OCT, histology and cGMP expression by immunohistochemistry. Functional vision was , with visual acuity assessed via the optokinetic response. Results: RT-PCR conﬁrmed temporary knockdown of PDE6B, while CRISPR/Cas9 mutants are currently awaiting validation. Gross morphological changes were observed in day 5 embryos, including decreased ocular pigmentation. In day 7 embryos, no structural differences on histology, nor reduction in the optokinetic response were seen. Enis D Kocak1, Jose F Gonsalves2, Anthony J Hall1 Email: edkocak@gmail.com 1 Department of Ophthalmology, The Alfred, Melbourne, Australia, 2Department of Haematology, St Vincent’s Hospital Melbourne, Melbourne, Australia Purpose: Ocular lymphoma can arise from the adnexal, orbital or intraocular tissues. The latter can be classiﬁed as either uveal or vitreoretinal. We describe the demographics, incidence and survival in patients with primary ocular and orbital lymphoma in Victoria, Australia. Method: A retrospective study of cases of primary ocular and orbital lymphoma reported to the Victorian Cancer Registry from 1 January 1986 to 31 December 2015. Cases were included where a histological diagnosis of lymphoma was conﬁrmed on biopsy or cytology. Incidence rate was calculated using a dynamic population model. Results: 250 cases of primary ocular and orbital lymphoma were identiﬁed over the 30-year study period. 118 cases involved ocular adnexa, 94 cases involved the orbit, and 26 cases were uveal or vitreoretinal intraocular lymphoma. The overall incidence rate was 1.7 cases per 1,000,000 person-years, and appeared to increase with time. Median age at diagnosis was 66 years. 52% of patients were female. Marginal zone B-cell lymphoma was the most common diagnosis (55%), followed by follicular lymphoma (13%), and small cell B-cell lymphoma (12%). Median survival was 75.3 months over the study period. There was no signiﬁcant difference in survival between orbital/adnexal lymphomas and intraocular lymphomas (P=0.124). Survival worsened with a later decade of diagnosis. Conclusion: This ﬁrst registry-wide study of primary ocular and orbital lymphoma in an Australian population demonstrates a similar incidence and survival to that reported in international studies. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 63 Tuesday 31 October Despite advances in treatment, there was no survival advantage associated with diagnosis in more recent years. opportunities for monitoring patients affected with sun-related ocular conditions. S3006 S3005 5. A NOVEL METHOD OF MEASURING CONJUNCTIVAL ULTRAVIOLET AUTOFLUORESCENCE AREA 6. CURRENT PRACTICE PATTERNS OF THE AUSTRALIA AND NEW ZEALAND CORNEA SOCIETY (ANZCS) IN PREVENTION AND MANAGEMENT OF CORNEAL GRAFT REJECTION Gareth Lingham1, Alex Burton1, Holly A Brown1, Emily Huynh1, Minas T Coroneo2, Seyhan Yazar1,3, David A Mackey1 Email: garethlingham@lei.org.au 1 Lions Eye Institute/University of Western Australia, Perth, Australia, 2University of New South Wales, Sydney, Australia, 3Institute of Genetic and Molecular Medicine/ University of Edinburgh, Edinburgh, United Kingdom Harrison Bennett1, Peter Beckingsale2, Andrew Apel3,4, Sing-Pey Chow1,2,5 Email: harrisonbennett@live.com 1 School of Medicine, University of Queensland, Brisbane, Australia, 2Terrace Eye Centre, Brisbane, Australia, 3 Princess Alexandra Hospital, Brisbane, Australia, 4The Eye Health Centre, Brisbane, Australia, 5Royal Brisbane and Women’s Hospital, Brisbane, Australia Purpose: Conjunctival ultraviolet autoﬂuorescence (CUVAF) is a method of detecting pre-clinical sunlight-induced conjunctival damage. CUVAF photos are currently captured using a digital camera and ﬂash system. We investigated whether CUVAF can be reliably measured with blue laser autoﬂuorescence (BAF) imaging using a more frequently available confocal scanning laser ophthalmoscope (cSLO) (Spectralis HRA+OCT, Heidelberg Engineering, Heidelberg, Germany). Method: Nasal and temporal CUVAF images were taken of 78 eyes of 39 participants; ﬁrst using a Nikon D100 camera with 105mm f/2.8 lens and ultraviolet transmission ﬁlters, followed by BAF imaging using a cSLO focussed at +27.50D. CUVAF area was measured by two graders using semiautomated specially-designed software. BlandAltman plots were used to calculate the limits of agreement (LOA) between the two methods, and intra- and inter-grader reliabilities. Results: Intra-grader and inter-grader reliabilities using BAF imaging were -0.46 (95% LOA: -4.17, +3.25) and +0.39 (95% LOA: -4.23, +5.82), respectively. The mean differences in CUVAF area between BAF imaging and the digital camera were +1.74 mm2 (95% LOA: -5.46, +8.94) for examiner 1 and +1.56 mm2 (95% LOA: -5.87, +8.99) for examiner 2. Pearson’s correlation between the two methods was 0.87 (95% CI: 0.83, 0.91) and 0.84 (95% CI: 0.79, 0.88) for examiners 1 and 2, respectively. Conclusion: Mean CUVAF area as measured by BAF imaging was higher than that measured using the digital camera, but still showed good agreement. A cSLO with BAF can reliably detect CUVAF without requiring additional equipment and provides Purpose: The uptake of lamellar keratoplasty over the last decade has changed the landscape of corneal transplantation. Immunosuppression regimes following keratoplasty are largely based on consensus as evidence remains sparse. We characterised current practice patterns of Australian and New Zealand corneal surgeons in the prophylaxis and management of graft rejection in comparison to similar surveys of the Bowman Club (UK) and Cornea Society (USA). Method: A paper and online survey was distributed to all ANZCS surgeons at the 2017 annual meeting. Results: Response rate was 38.7% (n=24/62). Respondents were evenly distributed in surgical experience. Topical corticosteroids (most commonly prednisolone) remain the predominant form of immunosuppression for penetrating (PK) and endothelial (EK) keratoplasty prophylaxis. Surgeons used the same topical therapy for low-risk PK and EK, with great variability in post-operative duration. For high-risk grafts, most surgeons (PK 88%; DSEK 73%) continued topical therapy long-term. Adjunctive oral immunosuppression was used by 58% following PK, 27% following high-risk DSEK, and was not used following DMEK or DALK. 67% of respondents changed their steroid regimen in phakic patients. All respondents added an oral anti-viral in eyes with previous herpetic disease. Intensive topical steroid therapy was the mainstay of treatment for all scenarios of possible and probable keratoplasty rejection; use of oral immunosuppression was limited. This was comparable to previous surveys in the UK and USA. Conclusion: Topical corticosteroids remain the predominant therapy in routine prophylaxis and management of corneal graft rejection in both Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 64 Tuesday 31 October penetrating and lamellar keratoplasty, with wide variation in duration of post-operative use. S3007 7. A SURVEY OF CORNEAL FOREIGN BODIES Tracey Phan1,2, Christopher Go2,1, Stephanie Watson2,1 Email: tracey.v.phan@gmail.com 1 Sydney Hospital, Sydney, Australia, 2Save Sight Institution, University of Sydney, Sydney, Australia Purpose: Corneal foreign bodies (CFB) represent a signiﬁcant proportion of emergency department presentations. To optimise patient outcomes and inform preventative strategies, this study examined CFB presentations to a tertiary referral eye care centre. Methods: A retrospective case series was conducted. Patients with CFB at the Sydney Eye Hospital Emergency from January to December 2016 were included. Data collected from medical case records included; demographic details, clinical ﬁndings, time until presentation, protective eyewear use, management, and complications. Results: 723 patients [SW3] were included with median age of 34 years (range 11 to 85); there were a predominance of males (92%). From these patients, 730 eyes had a CFB; 7 patients had bilateral CFBs. Most injuries occurred at work (46%) where only 30% of patients reported wearing safety eye wear, compared to 11% of CFB occurring outside of work. Around half of patients presented within 24 hours of the initial injury (54%). Keratitis complicated 65 cases; the risk of which was increased with presentation after 24 hours (RR 3.16). However, time to presentation was not associated with the presence of a rust ring. A needle technique was preferred by clinicians for CFB removal (71%), sometimes in conjunction with a burr (17%). The method of removal had no bearing on the incidence of keratitis, nor the incidence of scarring. Almost all patients were prescribed antibiotics (98%), most receiving chloramphenicol (88%). Conclusion: CFB commonly occurred in the work place, where protective eyewear was not routinely worn. Keratitis may complicate CFB, particularly if presentation is delayed S3008 8. A SYSTEMATIC REVIEW ON STEM CELL THERAPY FOR OCULAR DISEASE Samantha Bobba1, Nick Di Girolamo2, Megan Munsie3, Stephanie Watson4,1 Email: samantha.bobba@gmail.com 1 Prince of Wales Hospital Clinical School, Sydney, Australia, 2 School of Medical Sciences, University of New South Wales, Sydney, Australia, 3Stem Cells Australia, Melbourne, Australia, 4Save Sight Institute, Sydney Eye Hospital, Sydney, Australia Purpose: To review approaches to ocular stem cell therapy based on current progress in clinical trials and professional practice standards. Method: A systemic literature review was conducted (Ovid MEDLINE, PubMed and EMBASE databases searched, January 1989 – June 2017) and clinical trial registries reviewed (ClinicalTrials.gov, The World Health Organisation International Clinical Trials Registry Platform and Cochrane Central Register of Controlled Trials). Guidelines and codes of conduct from organisations including the Therapeutic Goods Administration, Royal Australian and New Zealand College of Ophthalmologists and Australian Medical Association were reviewed. Data was extracted and collated on progress in corneal and retinal stem cell therapy, the clinical trial process and ethical considerations. Results: Forty-one clinical trials of ocular surface stem cell transplantation used to treat limbal stem cell deﬁciency were identiﬁed. Only fourteen studies had greater than two years follow-up, with an average success rate of 72%. Whilst clinical trial registries listed additional studies, only four Phase I/II clinical trials had been published on retinal cell transplantation with a mean success rate of 77% in 22 patients. These studies utilised induced or pluripotent human embryonic stem cell sources. Alternative approaches utilising trabecular, neural, ciliary body and iris pigment stem cells require further animal/in vivo studies prior to human trials. Conclusion: Ocular stem cell therapy is experimental and should operate within formal clinical trial frameworks. This is the ﬁrst review to encompass both corneal and retinal cell transplantation, providing a comprehensive overview that could provide the basis for a Position Statement on ocular stem cell therapy. S3009 9. THE INCIDENCE OF OCULAR TUBERCULOSIS IN AUSTRALIA OVER THE PAST 10 YEARS (2006–2015) Erica Darian-Smith1,2, Ming-Lee Lin1,3, Lyndell L Lim3,4, Peter McCluskey5, Anthony J Hall1,6 1 Department of Ophthalmology, Alfred Hospital, Melbourne, Australia, 2School of Medicine, University of Tasmania, Hobart, Australia, 3Royal Victorian Eye and Ear Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 65 Tuesday 31 October Hospital, Melbourne, Australia, 4Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia, 5 Save Sight Institute, Discipline of Ophthalmology, University of Sydney, Sydney, Australia, 6Department of Surgery, Monash University, Melbourne, Australia Purpose: To determine the incidence and clinical phenotype of ocular tuberculosis (OTB) in Australia based on the mandatory jurisdictional health notiﬁcation records for TB. Methods: A whole population retrospective case series (Australia). Patients diagnosed with OTB were identiﬁed over the past 10 years (1st January 2006 to 31st December 2015) as recorded by individual Health Department jurisdictions per mandatory health notiﬁcations. The incidence rates were calculated based on the available Australian census data. Incidence rates were age and sex standardised. Results: 162 cases of OTB were identiﬁed across Australia over a 10- year time period. Of these, 156 participants were overseas born. The ten-year Australian incidence of OTB was 0.77 per 100,000 people. While there has been a downward trend in overall TB annual incidence rates from 2010-2015, over the same period the annual incidence of ocular TB has increased compared to the four previous years. Descriptive clinical data regarding the ocular manifestations of TB was available in 73/157 patients. In these 73 patients the commonest manifestations of OTB were unspeciﬁed uveitis (50.1%), focal, multifocal or serpiginous choroiditis or chorioretinitis (12.3%) and retinal vasculitis (11.0%). Of patients with OTB, 4/162 (2.47%) had associated pulmonary TB and 8/162 (4.94%) had associated systemic (non-pulmonary) TB. Systemic anti-TB therapy was administered to 161 patients. Conclusions: The annual Australian incidence of OTB was 0.077 per 100, 000 people. Increasing notiﬁcations in the past six years may demonstrate increased awareness and changing diagnostic criteria of the disease in the Australian population. S3010 10. A NOVEL PARAMETER TO ASSESS CHOROIDAL VASCULATURE FOR THE DETECTION PACHYCHOROID DISEASE Cheng Sim Anna Tan1, Kelvin Teo1, Kavya Devarajan2, Xian Hui Lim1, Zhang Yu2, Gavin Tan1, Marcus Ang1, Tien Yin Wong1, Gemmy Cheung1 Email: annacstan@gmail.com 1 Singapore National Eye Center, Singapore, Singapore, 2 Singapore Research Eye Institute, Singapore, Singapore Purpose: To validate a novel quantiﬁcation of mean choroidal vessel width index (MCWI) measured on en face structural optical coherence tomography (OCT). Background: OCT B-scans may not fully measure choroidal vessel width in the assessment of pachychoroid disease (e.g. polypoidal choroidal vasculopathy and central serous chorioretinopathy). Methods: En face structural OCT images at the Haller’s layer in the choroid were obtained from patients with pachychoroid disease and a control group of normal eyes. Control eyes had OCT images taken on 3 different OCTA platforms. 20 and 50 micron slabs were captured in all eyes. The MCWI was calculated based on the ratio of total pixel area of the overall choroidal vessels to the skeletonised branch length of the same image. Results: Preliminary data of 5 eyes in each group, after adjusting for difference in resolution showed that there was a signiﬁcant difference between MCWI calculated in normal versus eyes with pachycohoroid disease (20 microns:7.44 vs 18(p<0.05), 50 microns:7.93 versus 20.13(p<0.05). Normal eyes measured with the 3 different OCT platforms showed consistent values with no signiﬁcant difference between readings in the same eye between each different OCT platform (p=0.36). Conclusions: MCWI measured on en face OCT was signiﬁcantly higher in eyes with pachychoroid disease compared to normal controls. MCWI may be a useful measure of the overall choroidal vascular thickness on en face OCT, even on different OCT platforms, and may allow assessment of pachychoroid and other retinal-choroidal diseases. Cheng Si S3011 11. 12-MONTH OUTCOMES OF RAINBOW (REAL-LIFE USE OF INTRAVITREAL AFLIBERCEPT IN FRANCE: OBSERVATIONAL STUDY IN WET AGE-RELATED MACULAR DEGENERATION) Florence Coscas1, Laurent Kodjikian2, Michel Weber3, Hassiba Oubraham-Mebroukine4, Isabelle Aubry5, Salomon-Yves Cohen6 Email: sarah.simpson@parexel.com 1 Centre Odéon, Paris, France, 2CHU LA Croix Rousse, Lyon, France, 3CHU Hôtel-Dieu, Nantes, France, 4Cabinet libéral, Montargis, France, 5Centre Ophtalmologique des Arceaux, Montpellier, France, 6CIL, Paris, France Purpose: To monitor treatment-naïve wet agerelated macular degeneration (wet AMD) patients being treated with intravitreal aﬂibercept (IVT-AFL) in France. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 66 Tuesday 31 October Methods: RAINBOW is an ongoing, observational, retrospective, prospective 4-year study to monitor outcomes following IVT-AFL treatment in wet AMD patients. The primary endpoint is mean change in best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study letters) from baseline to 12 months. We report 12-month outcomes. Results: Safety data were analysed from 586 patients (safety analysis set); effectiveness data were analysed from 502 patients with at least 1 follow-up (full analysis set [FAS]) and from 353 patients with visual acuity data at baseline and Month 12. Mean (SD) BCVA was 56.7 (18.2) letters and mean (SD) central retinal thickness (CRT) was 395.6 (140.5) μm at baseline. Most patients (76.9%) received a loading dose (ﬁrst 3 injections within 90 days). Mean (SD) number of IVT-AFL injections 1400-1530 over 12 months was 6.0 (2.1; all patients) and 6.6 (1.8; patients who received a loading dose). Mean (SD) change in BCVA was 5.5 (15.0; all patients) and 6.8 (14.5; patients who received a loading dose) letters at Month 12 (P<0.001 vs baseline). Mean (SD) CRT reduction was –108.7 (146.8; all patients) and –116.4 (150.4; patients who received a loading dose) μm at Month 12 (P<0.001 vs baseline). Overall, 118 (20.1%) patients experienced at least 1 treatment-emergent adverse event (TEAE), 1.2% experienced ocular TEAEs, and 3.9% experienced serious AEs. Conclusion: This 12-month analysis showed that IVT-AFL was associated with sustained improvements. RAINBOW results are consistent with the VIEW clinical studies. S31 – FREE PAPERS Rapid Fire Presentations - Epidemiology and Uveitis Chairs: A/Prof Lyndell Lim and Prof Paul Mitchell Venue: Riverview 4 S3101 1. SHARPENING THE FOCUS: OPHTHALMOLOGY EDUCATION AT AUSTRALIAN MEDICAL SCHOOLS Helen Zhang1, Jenny Lauschke2,1, Ashish Agar2,1 Email: helen.zhang96@gmail.com 1 University of New South Wales, Sydney, Australia, 2Prince of Wales Hospital, Sydney, Australia Purpose: Ophthalmic presentations constitute a signiﬁcant proportion of hospital admissions, yet ophthalmology teaching for medical students is being reduced. This study aims to evaluate the current state of ophthalmology education at Australian medical schools. Methods: A national cross-sectional survey of ﬁnal phase medical students (MSs) across Australia, and Junior Medical Ofﬁcers (JMOs) working in NSW/ACT hospitals in 2017. Data collected include the type and amount of ophthalmology teaching received and self-rated conﬁdence in ophthalmic skills and knowledge. Results: Currently 818 surveys have been received (52.8% JMOs, 47.2% MSs), with all AMCaccredited medical schools represented. Amongst both groups, lectures were the most common form of teaching received (74% JMOs, 66.1% MSs), while hospital tutorials were most preferred (44.4% JMOs, 65.7% MSs). Overall conﬁdence levels for ophthalmic knowledge were low, with higher levels for topics including diabetic retinopathy and cataract, and lowest levels for orbital cellulitis, with 4.4% of MSs never having heard of it. Both groups were more conﬁdent with skills such as testing visual ﬁelds, acuity and pupils, and less conﬁdent with eyelid eversion and direct ophthalmoscopy. Overall, undergraduate MSs were more conﬁdent than postgraduate MSs in skills (P<0.05). This difference normalised for JMOs. Both groups believe ophthalmology is important for the general doctor (97.2% JMOs, 95% MSs), and provided a range of constructive comments. Conclusions: Both JMOs and MSs believe ophthalmology is important for prevocational doctors. However, both groups show low levels of overall conﬁdence in basic ophthalmic knowledge and skills, including direct ophthalmoscopy. The results from this study will provide valuable insight for future tertiary ophthalmic curriculum improvements. S3102 2. A REVIEW OF CLINICAL REGISTRIES IN OPHTHALMOLOGY Jeremy Tan1, Mark Gillies1, Stephanie Watson1,2 Email: tckjeremy@hotmail.com 1 Save Sight Institute, University of Sydney, Sydney, Australia, 2Sydney Eye Hospital, Sydney, Australia Purpose: To evaluate the structure and research outcomes of clinical registries in ophthalmology reported in the medical literature. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 67 Tuesday 31 October Method: We performed a systematic literature search in the PubMed database. We included clinical registries speciﬁc to ophthalmic conditions/diseases, or ophthalmic complications of a systemic disease. Results: A total of 81 clinical eye registries were identiﬁed, including blind, cataract, corneal transplantation, endophthalmitis, glaucoma, trauma, retinal and miscellaneous registries. The majority of these registries were initiated since the 1980s and has been steadily increasing in number since. Registry-based studies have been used to study real-world clinical outcomes, quality measurement and improvement and to inform the development of new guidelines and standards, particularly in the areas of macular degeneration, cataract surgery and corneal transplantation. Contributions to epidemiology and outcomes of blindness and low-vision, disease, adverse events have also been made. Conclusion: There has been strong growth in numbers and research outcomes of clinical eye registries in the last few decades. These registries will continue to drive improvements in quality and ﬁll important evidence gaps in ophthalmic research. S3103 3. VISION CENTRE : A NOVEL TELE OPHTHALMOLOGY CONCEPT FOR PRIMARY EYE CARE DELIVERY! Rodney John Morris1, Narendran V1, Vignesh Raja2 Email: rodneyjmorris@gmail.com 1 Aravind eye hospital, Coimbatore, India, 2Sir Charles Gairdner eye hospital, Perth, Australia Purpose: A novel technique using Tele Ophthalmology for primary eye care delivery in a rural population. Method : India’s rural population accounts for 70% of the total population. The access to quality health care for the rural masses is very poor. The concept of vision centre (VC)was thus born, to cater to the rural masses, by using Tele Ophthalmology. One centre caters to a minimum population of 50,000 situated in a village. All patients undergo visual acuity assessment, intra ocular pressure measurement, slit lamp examination and fundus photo with non-mydriatic camera. Results: The 8 VCs in 2016 screened 62,922 persons, advised cataract surgery in 3106 individuals of which 2026 persons underwent sight restoring cataract surgeries at the base hospital. 31,600 refractions were done and 6550 spectacles dispensed. 6246 blood sugar estimations were done of which 381 individuals were newly detected with diabetes mellitus. Conclusion: In developing nations like India, with a sizable rural underserved population, the concept of vision centre for primary eye care delivery is a boon for the community and helps in reducing the burden of blindness on the society. These individuals would have never travelled to the city for their eye ailments, for want of knowledge and ﬁnances. They would have to forego their daily wages to visit an eye hospital in the city, in addition to the expenses for their accomplice. In conclusion, vision centre concept for primary eye care delivery is the way forward for serving the under privileged rural community. S3104 4. CLINICAL OUTCOMES OF REAL-TIME TELEOPHTHALMOLOGY VERSUS FACE-TOFACE CONSULTATION: A MASKED COMPARISON TO A GOLD STANDARD STUDY Irene Tan, Stephen Bartnik, Lucy Dobson, Hessom Razavi, Josephine Muir, Angus Turner Email: irenetan9@gmail.com Lions Outback Vision, Lions Eye Institute, Nedlands, Australia Purpose: Advances in imaging capabilities and the evolution of real-time teleophthalmology have the potential to provide increased coverage to areas with limited ophthalmology services. However, there is limited research assessing the diagnostic and management agreement of real-time teleophthalmology consultation. The purpose of this study is to determine the agreement in diagnosis and management of real-time teleophthalmology when compared to face-to-face consultation. Methods: This study is a prospective masked cohort study of referrals from rural optometrists for real-time teleophthalmology consultation. Patients were seen by one of two ophthalmologists via videoconsultation, supplemented by store-and-forward imaging submitted with the referral. Patients were seen within four weeks by the second ophthalmologist in a standard face-to-face consultation. Data collected from each consultation included primary diagnosis, requested further investigations, surgical and procedural waitlisting and follow-up urgency, disposition and timing. Results: 39 patients were enrolled into this study. Primary diagnosis agreement was 79%, with kappa = 0.73. Primary management agreement was 82.1%, with kappa = 0.73. Diagnostic agreement was highest for cataracts (k = 0.73). Management concordance Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 68 Tuesday 31 October was highest for surgical (k = 0.73) or procedural waitlisting (k = 0.86. Conclusions: Diagnosis and management outcomes of real-time teleophthalmology were shown to have high agreement with standard face-to-face consultation. There was greatest agreement for the diagnosis of cataract, and surgical and procedural waitlisting. Conclusion: This custom DLA achieves clinicallysound accuracy on classifying common sightthreatening disorders that would potentially improve the efﬁciency and accessibility of screening service. S3106 6. VALIDATION OF A DEEP LEARNING ALGORITHM FOR REFERABLE DIABETIC RETINOPATHY: A PILOT STUDY S3105 5. A DEEP LEARNING ALGORITHM FOR DETECTING COMMON EYE DISEASES BASED ON FUNDUS PHOTOGRAPHY Mingguang He1,2, Zhixi Li2, Stuart Keel1, Yifan He3, Wei Meng3 Email: mingguang.he@unimelb.edu.au 1 Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia, 2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China, 3Guangzhou Healgoo Interactive Medical Technology Co.Ltd, Guangzhou, China Purpose: To access the performance of a custom deep learning algorithm (DLA) on detecting referable diabetic retinopathy (DR), glaucoma suspect, late age-related macular degeneration (AMD) andretinal arteriosclerosis. Method: A cloud-sourcing clinical labeling system was established to grade approximately 150,000 retinal images, including a training set (56,095 images for DR, 32,000 for glaucoma suspect, 24,000 for AMD and 44,815 for atherosclerosis) and an independent validation set (9,372 for DR, 15,150 for glaucoma suspect, 18,128 for AMD and 7,334 for arteriosclerosis). These datasets were used to develop a custom DLA. A sample of 4,000 images was randomly selected from an independent validation set for each disease condition respectively. Referable DR was deﬁned as R2 or worse using the English NHS Classiﬁcation; glaucoma suspect was deﬁned as vertical CDR ≥ 0.7 and other changes of glaucomatous optic neuropathy; late AMD was deﬁned including late wet and late dry AMD; arteriosclerosis was deﬁned as AVR less than 0.5 and arteriovenous nicking, focal arteriolar narrowing. Results: In this independent validation assessment, the sensitivity, speciﬁcity and the area under curve (AUC) were 92.6%, 94.3% and 0.934, respectively among 2817 negative and 1183 positive referable DR images. These numbers were 94.5%, 94.1% and 0.943 among 3279 negative and 721 positive glaucoma suspect; 90.1%, 88.2% and 0.891 among 3732 negative and 735 positive late AMD images; and 87.0%, 88.2% and 0.876 among 3839 negative and 161 positive retinal arteriosclerosis images. Stuart Keel1, Pei Ying Lee1, Andreas Mueller1, Mohamed Dirani1, Mingguang He2,1 Email: stuart.keel@unimelb.edu.au 1 Centre for Eye Research Australia, Melbourne, Australia, 2 Melbourne University, Melbourne, Australia Purpose: To assess the diagnostic accuracy of an artiﬁcial-intelligence based, deep learning algorithm for the detection of referable diabetic retinopathy (DR) in an Australian population-based sample of retinal images. Methods: Using a random selection of 100 macular centered (right or left eye) retinal images (National Screening Committee classiﬁcation; R0 n=50, R1 n=13, R2 n=31, R3 n=6) from 100 participants examined in the Australian National Eye Health Survey (DRS non-mydriatic fundus camera), we evaluated the Deep Learning Algorithm for referable DR. Referable DR was deﬁned as pre-proliferative DR (Level R2) or worse. The performance of the deep learning algorithm was evaluated using professional graders’ assessment as the reference standard. Area under curve (AUC), sensitivity and speciﬁcity were the key outcome measures. Results: The AUC, sensitivity and speciﬁcity of the deep learning algorithm for referable DR were 0.886, 94.6% and 82.5%, respectively. In total, 13 retinal images were misclassiﬁed by the deep learning algorithm. Of these, 8 were false positives (12.7%, 8/63) due to a misclassiﬁcation of R1 manual grading outcomes and the remaining 5 images (5%, 5/100) were labelled as ‘ungradable’ by the algorithm, despite being gradable manually. Conclusion: This artiﬁcial-intelligence based, deep learning algorithm shows robust performance for the detection of referable DR in a sample of images that closely mirror the Australian screening setting. Further work to investigate the diagnostic accuracy of this algorithm in multi-ethnic populations is ongoing. This technology offers countless potential to increase the efﬁciency, accessibility and affordability of DR screening programmes. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 69 Tuesday 31 October S3107 7. COLLECTIVE INFLUENCE OF LIFESTYLE RISK FACTORS ON THE PREVALENCE AND 15-YEAR INCIDENCE OF AGE-RELATED MACULAR DEGENERATION Bamini Gopinath1, Gerald Liew1, George Burlutsky1, Victoria Flood2, Paul Mitchell1 Email: bamini.gopinath@sydney.edu.au 1 Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia, 2Faculty of Health Sciences, University of Sydney, Sydney, Australia Purpose: The magnitude of risk reduction associated with multiple healthy or unhealthy lifestyles, considered jointly, may be greater than the magnitude associated with individual healthy or unhealthy lifestyle factors. We aimed to establish the collective inﬂuence of four lifestyle practices (physical activity, diet, smoking and alcohol consumption) on the prevalence and incidence of AMD. Methods: At baseline, 2428 participants aged 49+ with complete lifestyle and AMD data were examined, and of these, 1903 participants were reexamined 15 years later. AMD was assessed from retinal photographs. A lifestyle behaviour score was calculated, allocating 1 point for each lifestyle risk factor: current smoking; fruits and vegetables consumed <4 serves daily; <3 episodes of physical activity per week; and >2 alcoholic drinks per day. Results: Cross-sectional analysis showed that participants who engaged in all 4 poor lifestyle practices (n=29) versus those who did not engage in these unhealthy lifestyle practices (reference group; n=677) had greater odds of any and late AMD: multivariable-adjusted OR, 5.14 (95% CI, 1.0425.45) and OR 29.53 (95% CI 2.72-321.16), respectively. A marginally non-signiﬁcant association was observed between increasing number of lifestyle risk factors and 15-year incidence of early AMD (multivariable-adjusted P-trend=0.08). Conclusion: Our data suggests that motivating patients with AMD to eat better, exercise more, limit alcohol intake and avoid smoking seems advisable to decelerate the development or worsening of existing AMD. S3108 8. EPIDEMIOLOGY OF EPISCLERITIS AND SCLERITIS IN METROPOLITAN MELBOURNE Louisa P. Thong1, Sophie L. Rogers2, Colby Hart3, Anthony J. Hall3, Lyndell L. Lim2 Email: lptho1@student.monash.edu 1 Monash University, Melbourne, Australia, 2Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia, 3Department of Ophthalmology, Alfred Health, Melbourne, Australia Purpose: Population-based studies of episcleritis and scleritis are sparse. The aim of this retrospective study was to determine the incidence and prevalence of episcleritis and scleritis in a well-deﬁned population of metropolitan Melbourne. Methods: All patients with episcleritis or scleritis seen at the Emergency Department and Ocular Immunology Clinic of the Royal Victorian Eye and Ear Hospital were identiﬁed from November 2014 through to October 2015. Retrospective chart review was conducted to conﬁrm the diagnosis, establish time of onset and disease subtype. Age and genderstratiﬁed population data from the Australian Bureau of Statistics 2015 were used to calculate incidence and prevalence. Results: The adult population of Greater Melbourne was 3,592,092 people. During the study period, there were 150 new-onset and 19 prior-onset cases of active episcleritis, and 38 new-onset and 23 prioronset cases of active scleritis. For episcleritis, this yielded an overall incidence of 4.2/100,000 personyears and an annual prevalence of 4.7/100,000 persons. Females aged 25-44 years had a higher incidence (p=0.04) and prevalence (p=0.02) of episcleritis. For scleritis, the overall incidence was 1.1/100,000 person-years and the annual prevalence was 1.7/100,000 persons. There were no cases of infectious scleritis. Of those with non-infectious scleritis, diffuse scleritis was the most common (62.3%), followed by nodular (29.5%) and posterior scleritis (8.2%). Most cases of episcleritis were simple (86.4%) with the remaining being nodular. Conclusion: In this ﬁrst Australian study, population rates of episcleritis and scleritis were lower compared to previous U.S. studies and more commonly affected young to middle-aged females. S3109 9. UVEITIS ASSOCIATED WITH MULTIPLE SCLEROSIS (MS) IN A LARGE MS COHORT FROM THE FINGOLIMOD CLINICAL TRIALS Tiffany C Lo1,2, Diego Silva3, Cecily Whitford4, Shannon Ritter3, Helmut Butzkueven5, Lyndell L Lim1,4,6, Anthony J Hall2,4 Email: tiffany.cs.lo@gmail.com 1 Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia, 2Department of Ophthalmology, Alfred Hospital, Melbourne, Australia, 3 Novartis Pharmaceuticals Corporation, East Hanover, New Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 70 Tuesday 31 October Jersey, USA, 4Eye Surgery Associates, East Melbourne, Australia, 5Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia, 6Royal Victorian Eye & Ear Hospital, Melbourne, Australia Purpose: To investigate the prevalence and incidence of uveitis in MS patients, and to determine the effect of uveitis on MS disease outcomes in patients who participated in the ﬁngolimod clinical trials. Methods: Patients who received more than or equal to one dose of ﬁngolimod were included in the analysis. All patients underwent regular ophthalmic examinations as part of their study follow-up. Prevalence and incidence of uveitis per 100 patient-years were determined. The effect of having had uveitis, and other baseline characteristics, on the MS annualised relapse rate (ARR), time-to-ﬁrst MS relapse, and change in Expanded Disability Status Scale (EDSS) from baseline were investigated. Results: A total of 24,785 patients were analysed. Mean age 39.8 years; 70% female; 70% Caucasian. Prevalence of uveitis was 153 of 24,691 patients (0.62%) and incidence was 0.07 per 100 patient-years. Patients without uveitis had a lower number of T2 lesions (21.2 vs. 30.2; p=0.018), a longer time-to-ﬁrst relapse (meanSE, years: 8.00.03 vs. 2.10.07; Logrank p=0.03) and lower mean ARRs (0.2 vs. 0.3; p=0.02) compared with patients with uveitis. At Month 96, change in EDSS from baseline was also lower in patients without uveitis (0.10 vs. 0.18; p=NS). Conclusion: Overall incidence and prevalence of uveitis in this study were low compared with previous reports. Patients with uveitis showed increased MS disease activity and disability compared with patients without uveitis. Uveitis may be a risk factor for poorer disease outcomes in MS. disease, causing great diagnostic challenge due to its protean manifestations. Among ophthalmologists, there is contention over classiﬁcation, diagnosis and treatment of this re-emerging and potentially blinding infection. We sought opinions from uveitis specialists worldwide regarding the management of ocular syphilis, with a view to presenting a guide for ophthalmologists. Methods: In June 2017, a survey was conducted across the membership of the International Ocular Inﬂammation Society (IOIS), regarding presentations, testing, treatment and follow-up of patients with ocular syphilis. Results: A total of 109 responses were received from the IOIS membership of 268 (40.7%). More than 600 cases of ocular syphilis were managed by respondents in 2016, with 40.4% reporting an increase in the number of cases treated over the past 10 years. Most patients presented in the secondary stage of syphilis, and with posterior uveitis. There were different opinions regarding the deﬁnition of neurosyphilis in patients with ocular syphilis, and whether a lumbar puncture should be performed in all cases. A majority of respondents (58%) treated their patients with intravenous aqueous penicillin G, although the length of treatment varied considerably. Most specialists (70%) continue to follow their patients after resolution of uveitis. Conclusion: We present a consensus opinion from a large body of international uveitis experts on the management of ocular syphilis. S3111 11. CAUSES OF VISION LOSS AND CLINICAL OUTCOMES OVER AN 18 YEAR PERIOD IN PATIENTS WITH VOGT–KOYANAGI–HARADA DISEASE S3110 10. MANAGEMENT OF OCULAR SYPHILIS: RESULTS OF THE INTERNATIONAL OCULAR SYPHILIS WORKING GROUP SURVEY Genevieve Oliver1,2, Roy Stathis1, Joao Furtado3, Tiago Arantes4, Peter McCluskey5,6, Justine Smith1 Email: genevieve.oliver@ﬂinders.edu.au 1 Flinders University, Adelaide, Australia, 2Flinders Medical Centre, Adelaide, Australia, 3University of São Paulo, São Paulo, Brazil, 4Fundação Altino Ventura, Recife, Brazil, 5 Sydney Eye Hospital, Sydney, Australia, 6University of Sydney, Sydney, Australia Purpose: Ocular syphilis, caused by infection with Treponema pallidum, is the archetypal masquerade Sophia L. Zagora1,2, Sue Lightman1,3, Oren Tomkins-Netzer1,4 Email: sophia.zagora@gmail.com 1 Moorﬁelds Eye Hospital, London, United Kingdom, 2 Sydney Eye Hospital, Sydney, Australia, 3Institute of Ophthalmo, London, United Kingdom, 4Institute of Ophthalmology, University College London, London, United Kingdom Purpose: To describe the clinical characteristics, factors that predict vision loss and treatment outcomes of Vogt–Koyanagi–Harada (VKH) disease over an 18-year period at Moorﬁelds Eye Hospital. Methods: A cross-sectional study of patients diagnosed with VKH between January 1999 to April 2017 who were seen for at least 6 months were Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 71 Tuesday 31 October identiﬁed and information was gathered from the clinical notes of all subjects. Results: In total, 111 patients (218 eyes) were diagnosed with VKH, of which 21 were male (18.9%). The mean age at diagnosis was 42.2 yrs 13.3 years. Seven patients were diagnosed as complete, 29 as Incomplete and 75 as Probable VKH (as per the diagnostic criteria). Mean baseline best-corrected visual acuity (BCVA) was 20/40; (0.5 0.5 logMAR). Recurrent episodes occurred in 87 (54%) patients. Oral prednisone was administered to 98 patients (88.3%). Fifty -three patients (47.7%) required seondary immunosuppression. At the last visit, the mean BCVA was 20/50 (0.4 0.7 logMAR). The most common complication post treatment was Cataract - 76 eyes (34.8% eyes). On multivariate analysis, visual acuity at referral, glaucoma and CNV were associated with increased risk of MVL; and visual acuity at referral, CNV and glaucoma were associated with increased risk of SVL. This was deﬁned as moderate visual loss (MVL; ≤20/50) and severe visual loss (SVL; ≤20/200). Conclusions: In our study VKH-related uveitis is predominant in young females. Bilateral panuveitis is the most common ocular manifestation. Oral prednisone was the primary treatment and the majority of eyes maintained 20/50 or better vision. S3112 12. TREATMENT OF ACTIVE AND INACTIVE NON-INFECTIOUS UVEITIS WITH ADALIMUMAB: AN AUSTRALIAN EXPERIENCE Jonathan Lee1,2, William Yates3, Sophie Rogers2, Peter McCluskey3, Lyndell Lim2,4 Email: jonlee333@gmail.com 1 The Alfred Hospital, Prahran, VIC, Australia, 2Centre for Eye Research Australia, Melbourne, VIC, Australia, 3 University of Sydney, Camperdown, NSW, Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia 4 Purpose: To compare the efﬁcacy of adalimumab in eyes with active and inactive non-infectious uveitis in a real-world setting. Method: A multicenter retrospective review was conducted at the Royal Victorian Eye and Ear Hospital, St Vincent’s Hospital Sydney and Sydney Eye Hospital. Patients with refractory non-infectious uveitis on adalimumab were included. Outcomes such as prednisolone dose, intraocular inﬂammation, visual acuity, and time to treatment failure were analyzed. Results: 22 patients with 37 affected eyes were studied. Median follow-up was 12.5 months. At enrolment, mean duration of uveitis was 6.8 years, and most patients (68%) had previously trialed at least 3 systemic immunosuppressants. Anatomically, the majority of patients had posterior or panuveitis (55%) and the most common diagnosis was Behcets (36%). Mean prednisolone dose was 18.8mg/day at baseline, which was reduced to <10mg/day from 6 weeks onwards. By 6 months, 90% of the active eyes were able to achieve a 2-step improvement in anterior chamber inﬂammation, whereas only 60% had demonstrated a similar improvement in vitreous haze. Almost all (>90%) of the inactive eyes were able to maintain clinical quiescence at this time point. Median time to treatment failure was 21 weeks in the active eyes, whilst less than half the inactive eyes reached failure criteria. There were no serious adverse effects. Conclusion: Adalimumab appears to reduce the corticosteroid burden in both active and inactive noninfectious uveitis in a real-world setting, mirroring results from recent large randomized controlled trials. Inﬂammatory activity at enrolment may be an important factor in determining long-term treatment success. 1530–1600 AFTERNOON TEA 1600–1730 CONCURRENT SESSIONS 1600–1730 S32 – RANZCO: Stepping up to the Challenges of the Future Venue: Bellevue Ballroom 1 Chair: Dr Brad Horsburgh Synopsis: This jam-packed session will paint a picture of the future of the profession from a nonclinical standpoint. The ﬁndings from the ofﬁcial RANZCO Workforce Survey will be presented and followed by a panel discussion aimed at highlighting changes to work patterns, funding and area of need. The Younger Fellows will then reveal what’s on the horizon; the rise of the digital era everything from e-health records to robots. Finally, ﬁnd out what changes the government is driving regarding CPD and revalidation and how RANZCO can assist you in being prepared and accredited. Speakers and Topics: Dr Bradley Horsburgh - Workforce survey results Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 72 Tuesday 31 October Panel Discussion - Panel Chair: A/Prof Nitin Verma Dr Michael Merriman - NZ & the DHB Dr Deepa Taranath -Area of need Dr Tim Henderson - Rural practice Dr Sam Lerts - Metro practice The future of Ophthalmology: the changing face Chair: Dr Nisha Sachdev Co-Chair: Dr Chameen Samarawickrama Prof Angus Turner - A mobile service for rural Australia: is it the right way? Dr Peter van Wijngaarden - Artiﬁcial Intelligence: the future? Mr Simon Janda - Nucleus program Dr Sukhpal S Sandhu - CPD, Audit & revalidation 1600–1730 S33 – SYMPOSIUM: Thyroid Eye Disease Chair: Dr Thomas Hardy Email: hardy_tg@bigpond.net.au Venue: MR 1 & 2 Synopsis: This symposium will cover important aspects of thyroid eye disease relevant to the general ophthalmologist. A brief review of the current understanding of the aetiology and pathogenesis will be followed by updates on key clinical ﬁndings (especially relating to activity and severity), and established and emerging medical therapies and surgical rehabilitation. Speakers and Topics: Dr Thomas G Hardy - Update on aetiology, pathogenesis, genetics Dr Adam Gajdatsy - Clinical aspects of thyroid eye disease: deﬁnitions, classiﬁcation, and grading. Dr Tim Sullivan - Management of thyroid eye disease: an overview Dr Richard Hart - Update on the medical management of thyroid eye disease Prof Don O Kikkawa - Surgical Management of Thyroid Eye Disease Dr Michael Bynevelt - Advances in radiology for thyroid eye disease 1600–1730 S34 – COURSE: Bugs and Drugs- What’s your Poison? Update on antimicrobials, ocular and systemic microbiomes and related infection and inﬂammation: Current resources for ophthalmologists, the ocular and gut microbiomes, antimicrobial sensitivity and resistance, special topics: rosacea, antivirals Chairs: Dr Jo Richards and A/Prof Mei-Ling Tay Kearney Email: diastella@iinet.net.au Venue: MR 3 Aim: This course will update all ophthalmologists who use antibiotics, antivirals and antiseptics, on current effective agents and how to use them / when not to use them. It will cover current concepts in interactions between our native microbiota and the immune system relevant to our understanding and management of inﬂammation, infection and dry eye. The Moorﬁelds microguide app will be introduced. Speakers and Topics: Dr Matt Ball- ‘Driven by the microbiome - gut matters for the eye surgeon’ The gut microbiome in health and disease Role of probiotics and prebiotics in inﬂuencing the composition of the microbiome The role of certain gut ﬂora in short chain fatty acid and other metabolite production and the result effects on systemic inﬂammation and ocular inﬂammation (including the ocular surface). Dr Jo Richards - "MicrobEYEome in health, infection and inﬂammation" Ocular, periocular and nasopharyngeal microbiomes Prophylactic and therapeutic antibiotics and bacterial ecosystems Deep DNA sequencing and 16S rRNA analysis in health, and in culture negative endophthalmitis and keratitis- Torque Tenovirus and HPV Dr Claire Italiano- "What’s your poison?" To treat or not to treat, when, with what and for how long Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. Tuesday 31 October 73 Antimicrobial sensitivity, spectrum of cover and resistance, common ophthalmology anitmicrobials: chloramphenicol, ﬂuoroquinolones, amoxicillin/ clavulanate, doxycycline, cefuroxime, vancomycin, gentamicin, antivirals, betadine, chlorhexidine. Current concepts in how long to treat, when not to treat, the narrowest spectrum drug for the job, and when to seek advice. Clinical A/Prof Kurt Gebauer-"The Celtic Curse" (Rosacea) Immunology of inﬂammation in Rosacea and dermatologic concepts relevant to ophthalmology Antibiotics (Doxycycline, minocycline, azithromycin, topical metronidazole), and their effect on gut ﬂora, immunology and inﬂammation Role of steroids and immunosuppressives in aggravating disease, treating inﬂammation and managing co-exisiting atopic disease Other factors and treatments: ﬁsh oil, probiotics, sun, vitamin D, heat, insulinogenic diet, cosmetics and sunscreens, ﬂuoride, IPL, brimonidine. A/Prof Tony Hall "Antivirals in 2017" Current antiviral protocols for herpetic eye diseases. Topical, intravitreal, oral, intravenous 1600–1730 S35 – COURSE: Toric IOLs: Planning the Astigmatism Magnitude and Meridian and All Those Other Things Such as Refractive Surprises Chair: Dr Noel Alpins AM Email: alpins@newvisionclinics.com.au Venue: Riverside Theatre Synopsis: The course will address practical and theoretical aspects of the planning and analysis of astigmatism for refractive laser, toric IOLs and LRIs. Participants will be able to plan and analyze astigmatism treatment and understand how to predict and correct for any postoperative refractive surprises following refractive laser, refractive toric IOL and LRI procedures. Speakers and Topics: A/Prof Michael Goggin - Selecting toric cylinder magnitude:- axis ﬂip or no axis ﬂip Dr Noel Alpins AM - Toric IOL and LRI planning-the essential variables to include with the posterior corneal effect Dr Con Moshegov - Even good surgeons get surprises-how to resolve them with a plan Dr Andrew Apel - Slit lamp rotation of Toric IOLs postoperatively and Correcting astigmatism post corneal transplant: lens or cornea? Dr Bonnie An Henderson - Difﬁcult toric case management 1600–1730 S36 – SYMPOSIUM: An Update on the Latest in Macular Degeneration Diagnosis and Treatment from ANZSRS Chair: Dr Xavier Fagan Email: xavierjlf@gmail.com Venue: Bellevue Ballroom 2 Speakers: Dr Xavier Fagan, Prof Mark Gillies, Dr Kenneth Fong, Dr Robyn Troutbeck, Dr Jennifer Arnold Topics: 1. Nomenclature, diagnosis and management of macular vitelliform lesions. A summary of the current types of vitelliform lesions and methods to determine lesions requiring treatment. 2. Polypoidal choroidal vasculopathy. An update on diagnosis, investigation and treatment with a particular focus on treatment in South East Asia. 3. Real world application of anti-VEGF therapy. A review of the data about efﬁcacy, treatment interval and strategies. 4. Where are we with angiography in AMD? Do I still need a ﬂuorescein? Do I need an OCT-A in my practice? 1600-1730 S25 – FREE PAPERS Rapid Fire Presentations - Cornea and External Eye Diseases Chairs: Prof Gerard Sutton and Dr Elsie Chan Venue: Riverview 4 Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 74 Tuesday 31 October S3701 1. THE OUTCOMES OF CORNEAL CROSSLINKING FOR KERATOCONUS FROM ROUTINE CLINICAL PRACTICE ACROSS AUSTRALIA AND NEW ZEALAND: RESULTS FROM THE SAVE SIGHT KERATOCONUS REGISTRY Stephanie Watson1,2, Alex Ferdi1, Mark Daniell3, Elsie Chan4,5, Yves Kerdraon6,2, John Males2, Nigel Morlet7, Peter Beckingsale8, Richard Mills9, Daniel Barthelmes10, Amparo Herrera-Bond6, Vuong Nguyen6, Marco Garcia6, Amanda Dinh6, Mark Gillies6,2 Email: stephanie.watson@sydney.edu.au 1 University of Sydney, Sydney, Australia, 2Sydney Eye Hospital, Sydney, Australia, 3Centre for Eye Research Australia, Melbourne, Australia, 4Centre for Eye Research Australia, Melb, Australia, 5Royal Victorian Eye and Ear Hospital, Melb, Australia, 6Save Sight Institute, Sydney, Australia, 7The University of Western Australia, Perth, Australia, 8University of Queensland, Brisbane, Australia, 9 Flinders University, Adelaide, Australia, 10University of Zurich, Zurich, Switzerland Purpose: To report the 12 month outcomes of 391 eyes undergoing corneal cross-linking for keratoconus performed in routine clinical practice across Australia and New Zealand. Methods: Index visit characteristics, such as visual acuity (VA, in Logarithm of the Minimal Angle of Resolution [logMAR] letters), maximum keratometry (Kmax), pachymetry, as well as treatment parameters (epithelial status, riboﬂavin type, UV duration), outcomes (VA, Kmax, pachymetry) and ocular adverse events were recorded in a prospectively designed electronic database. Index visit characteristics associated with the 12-month VA outcome were identiﬁed using mixed effects linear regression. Results: Mean change in VA in the cohort after 12 months was 2.6 logMAR letters (95% conﬁdence interval [CI], 1.0–4.1); Kmax -0.3 D (95% CI, -0.6, 0.0) and pachymetry -17.6 (95% CI, -21.2, -14.0) microns. There was no signiﬁcant difference in change in Kmax (P = 0.059); a signiﬁcant improvement in VA (P = 0.001) and reduction in pachymetry was found at 12 months (P < 0.001). VA at the index visit was the strongest predictor for the 12-month outcomes. Epithelial off treatment was performed in 367 cases; short duration UV exposure (10 min) in 225 eyes and long duration (30 min) in 152. Adverse events reported were clinically signiﬁcant haze (n=53), microbial keratitis (n=5), persistent epithelial defect (n=3), scarring (n=9), sterile inﬁltrates (n=3) and stromal oedema (n=2) from a total of 36 eyes. Conclusions: These ﬁndings indicate that corneal cross-linking can improve visual acuity and stabilise corneal parameters when used in routine clinical practice. S3702 2. CORNEAL REMODELLING FOLLOWING CATARACT SURGERY: OCT ANALYSIS OF THE EFFECT OF INCISION SIZE ON WOUND ARCHITECTURE IN THE THREE MONTHS FOLLOWING SURGERY Sunny Li1, Stuti Misra1, Charles McGhee1,2, Henry Wallace1, James McKelvie1,2 Email: sixiaosunny.li@gmail.com 1 Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, 2Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand Purpose: To characterise wound healing and corneal incision architecture with different keratome sizes in the three months following cataract surgery. Method: A prospective randomised study of 95 patients undergoing cataract surgery assigned to uniplanar clear-corneal temporal incision sizes of 2.20mm or 2.85mm was completed following formal ethics review. Incision position, length, angle, and leakage were recorded, in combination with total ultrasound energy and corneal thickness. Corneal topography and incision imaging using OCT was completed at one day, one week, one month and three months, postoperatively. Statistical analysis was completed using R statistical software. Results: Endothelial wound gaping was observed in 63% (2.20mm keratome) and 45% (2.85mm keratome), p-value=0.03. Descemet’s membrane detachments were observed in 57% (2.2mm keratome) and 40% (2.85mm keratome), p-value=0.01. Increasing phacoemulsiﬁcation time was associated with Descemet’s membrane detachment (pvalue=0.02), endothelial wound gaping (pvalue=0.03) and increased wound thickness (pvalue=0.02). Endothelial wound gaping improved within the ﬁrst month and wound retraction progressed from one to three months following surgery. Wound leakage was noted only in one case (incision angle=35.00), overall mean incision angle was 25.14.60. Conclusion: Increasing ultrasound energy and smaller incisions are associated with wound gaping and retraction that demonstrate corneal remodelling Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 75 Tuesday 31 October over three months following cataract surgery. Smaller incisions are associated with increased rates of Descemet’s membrane detachment and increased localised corneal thickness in the postoperative period. Uniplanar incisions of 2.2mm and 2.85mm can be consistently constructed, do not leak and typically do not require hydration. Older subjects with keratoconus should be monitored for progression, particularly with respect to possible corneal collagen cross-linking or astigmatic correction in cataract surgery. S3703 4. KERARING INTRASTROMAL CORNEAL RING IMPLANTS WITH/WITHOUT CROSSLINKING IN THE MANAGEMENT OF KERATOCONUS 3. THE NATURAL HISTORY OF CORNEAL TOPOGRAPHIC PROGRESSION OF KERATOCONUS AFTER AGE 30 YEARS IN NON-CONTACT LENS WEARERS Akilesh Gokul, Dipika Patel, Grant Watters, Charles McGhee Email: akilesh.gokul@auckland.ac.nz University of Auckland, Auckland, New Zealand Purpose: To determine if signiﬁcant progression of disease occurs in older, non-contact lens wearing, subjects with keratoconus and to identify potential predictive factors. Method: Clinical and computerised corneal topography records of subjects with keratoconus attending a specialist optometry practice were retrospectively analysed to identify those ≥30 years old, with ≥2 consultations ≥12 months apart, no contact lens wear, and no corneal scarring, surgery or corneal hydrops. Topographic parameters assessed included: maximum keratometry (Kmax), steep keratometry (Ksteep), ﬂat keratometry (Kﬂat), inferiorsuperior (I-S) ratio, and the surface asymmetry and regularity (SAI, SRI) indices. Results: Of the 449 subjects with keratoconus assessed, 43 eyes of 27 patients (6.01%) met inclusion criteria, with median age 38.45 (12.86) years at baseline and median follow-up 4.36 (8.68) years. There was a signiﬁcant increase in Kmax (0.30 (1.21) D), Ksteep (0.27 (0.90) D), Kﬂat (0.34 (1.12) D) and I-S (0.26 (0.82) D) between baseline and ﬁnal review, p<0.05. Notably, 18.6%-25.6% of eyes demonstrated ≥1.00D increase in one or more of four principle topographic parameters (Kmax, Ksteep, Kﬂat, I-S ratio) while 18.5%-37.0% of subjects had ≥1.00D increase in the aforementioned parameters in at least one eye over the study period. However, <10% of eyes exhibited ≥1.00D increase/year in all topographic parameters. The only signiﬁcant predictor of progression was follow-up time. Conclusion: This study conﬁrms that keratoconus may continue to progress beyond the fourth decade. S3704 Rosalind M. K. Stewart1, Tess Huynh2, Alexander C. Poon1 Email: rosalind.stewart@eyeandear.org.au 1 The Royal Victorian Eye and Ear Hospital, Melbourne, Australia, 2South West Vision Institute, Liverpool, Australia Purpose: To evaluate the efﬁcacy of Keraring intrastromal corneal ring implants with/without crosslinking in keratoconus. Methods: A retrospective observational case series of all patients undergoing femtosecond laserassisted Keraring intrastromal ring implantation with/without crosslinking by two surgeons (TH and AP) from November 2014. Uncorrected / best spectacle corrected visual acuity (UCVA / BSCVA) and keratometry was collected pre-operatively and at 1, 3, 6, and 12 months post-operatively. Results: 41 eyes of 36 patients were included; 26 male and 10 female, aged 13-47 (mean 27.7) years. Single rings were inserted in 33 eyes and 2 rings in 8 eyes in accordance to manufacturer recommendations. Combined crosslinking was performed at time of ring implantation in 32 eyes. At 6 months postoperatively UCVA improved by 2.55 +/-2.88 Snellen lines (p<0.03), and BSCVA by 1.63 +/-1.09 Snellen lines (p<0.03). Mean spherical equivalent refraction improved from -5.81 +/-6.07 to -4.34 +/-5.21D (p<0.005). Mean keratometry also reduced signiﬁcantly from 49.26 +/-4.44 (K1) and 53.78 +/-5.78 (K2) to 45.76 +/-2.93 (p<0.001) and 48.93 +/-3.14 (p<0.001) respectively, and KMax from 66.16 +/-8.08 to 58.71 +/-5.04 (p<0.001). One case developed a microbial keratitis and intraocular pressure rise to steroids, both of which were treated successfully medically. No rings required repositioning. Conclusion: Keraring intrastromal ring implantation with/without crosslinking is an effective procedure improving UCVA, BSCVA and keratometry in keratoconic eyes. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 76 Tuesday 31 October S3705 5. VISION-RELATED QUALITY OF LIFE IN KERATOCONUS Jeremy Tan1, Alex Ferdi1, Vuong Nguyen1, Amanda Dinh1, Amparo Herrera-Bond1, Stephanie Watson1,2 Email: tckjeremy@hotmail.com 1 Save Sight Institute, University of Sydney, Sydney, Australia, 2Sydney Eye Hospital, Sydney, Australia Purpose: To examine the relationship between keratoconus disease indicators and vision-related quality of life (V-QOL) in keratoconic patients. Methods: The Save Sight Keratoconus Registry of the Fight Corneal Blindness Project! has collected data from keratoconic patients during routine clinical practice since 2015. Ophthalmologists enter clinical data and patients self-complete the Impact of Vision Impairment Questionnaire (IVI). Registry data from 3 sites—1 tertiary eye hospital and 2 corneal subspecialty practices from June 2015 to March 2017 was included. Data analysed included Kmax, K2 and visual acuity (VA) for each eye; ‘average Kmax’ of the 2 eyes; and IVI score. Results: 107 keratoconic patients’ with median age 31 years (range 13-75) and males: female ratio 7:3, and stage 1 (n=9), stage 2 (n=41), stage 3 (n=12) or stage 4 (n=45) keratoconus completed the IVI. The median ‘average Kmax’ reading was 53.85D (Range 44.55-82.1D), median VA was 79 letters and median IVI score 1.95 (range 0 to 9.81). Higher Kmax and lower VA in the better seeing eye were signiﬁcantly associated with worse IVI scores (p=0.007 and p<0.001 respectively). Pearson’s correlation coefﬁcient for the IVI score was -0.55 for VA and 0.41 for Kmax. Conclusion: Lower V-QOL assessed with the IVI in keratoconus was associated with poorer VA and higher -Kmax reading in the better seeing eye. Of the disease indicators, VA had the greater impact on V-QOL. S3706 6. THE EFFECT OF ACCELERATED CORNEAL COLLAGEN CROSS-LINKING ON CORNEAL BIOMECHANICAL PROPERTIES Hans Vellara, Akilesh Gokul, Jay Meyer, Charles Mcghee, Dipika Patel Email: hans.vellara@auckland.ac.nz Department of Ophthalmology, University of Auckland, Auckland, New Zealand Purpose: To determine if changes in corneal biomechanical properties can be detected with the CorVis ST (CST) in keratoconic corneas following either continuous or pulsed high intensity, high irradiance corneal collagen crosslinking (CXL). Methods: A randomized, prospective, longitudinal, comparative investigation of two accelerated CXL modalities was performed. Eligible participants were randomly allocated to receive high intensity (30 mW/cm2), high irradiance (7.2 J/cm2) CXL with either continuous accelerated CXL (CA-CXL) or pulsed accelerated CXL (PA-CXL) exposure to ultraviolet-A. Each participant was examined preoperatively and 1, 3, 6 and 12-months post-operatively. CST was used to assess corneal biomechanical properties. CST output videos were further analyzed using several previously validated algorithms. Results: The CA-CXL group consisted of 41 eyes of 39 participants (54% male), and the PA-CXL group consisted of 27 eyes of 27 participants (56% male). The mean age of the CA-CXL group was 19.8 5.7 years, while that of the PA-CXL group was 21.6 6.8 years, with no differences in age (P=0.542) and gender distribution (P=0.628) between the groups. ‘Energy absorbed area’ (thought to reﬂect true corneal hysteresis)was the only parameter signiﬁcantly different between pre-operative and all post-operative time points investigated (P<0.01). None of the parameters investigated demonstrated signiﬁcant differences between CA-CXL and PACXL at any follow-up time points. Conclusions: The signiﬁcant difference between the pre and post-operative energy absorbed area may reﬂect alterations in the inter-lamellar sliding resistance and changes in corneal viscoelastic properties that may occur following CXL. Furthermore, the CST was unable to detect differences between CACXL and PA-CXL. S3707 7. CORNEAL BIOPEN – USING 3D PRINTING TO REPAIR TRAUMATIC EYE INJURIES Gerard Sutton1,2,3, Gordon Wallace4,5,6,7, JingJing You8, Hannah Frazer8, Simon Cooper8, Chris Hodge8 Email: lee.wright@visioneyeinstitute.com.au 1 Save Sight Institute, Sydney Medical School, University of Sydney;, Sydney, Australia, 2Vision Group, Sydney, Australia, 3Lions NSW Eye Bank, Sydney, Australia, 4 Australian Research Council Laureate Fellow, wollongong, Australia, 5Australian Research Council Centre of Excellence for Electromaterials Science, Sydney, Australia, 6Intelligent Polymer Research Institute, University of Wollongong., Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 77 Tuesday 31 October wollongong, Australia, 7Australian National Fabrication Facility, Materials Node, Sydney, Australia, 8NA, Sydney, Australia Introduction: Corneal ulceration is a common debilitating condition that accounts for 55,000 presentations to Accident and Emergency in Australia each year. Furthermore it can be complicated by infection and in extreme cases cornel melting leading to severe visual loss. Current treatments include contact lenses, antibiotics and commercial glue for severe cases. The Corneal BioPen is a unique delivery system that allows in situ printing of multiple corneal layers that can be modiﬁed depending on the clinical situation and can seal wounds, promote healing and reduce scarring. Methods: In collaboration with University of Wollongong Intelligent Polymer Research Institute (IPRI) we have modiﬁed their orthopaedic BioPen for use on the cornea. Meanwhile, we have developed a customised BioInk that can promote corneal epithelialisation. A collagen crosslinking device has been added to the Biopen delivery system. Results: The Biopen is capable of delivering the BioInk. The BioInk can be modiﬁed to adjust its constituency and mechanical properties including strength. It is a transparent liquid at room temperature but solidiﬁes at body temperature. in vitro testing conﬁrms the promotion of cell migration and stratiﬁcation. The bioink bio-degradable. Conclusions: The Corneal BioPen is a novel treatment for precision, customised treatment of corneal ulceration. It has the potential to improve accelerate healing, reduce risk of infection, reduce hospital admissions, improve health outcomes and reduce corneal/ donor pressure. S3708 8. DMEK VS DSAEK - SINGLE SURGEON EXPERIENCE Alexander Poon, Sam Fielding Email: alexpoon@ozemail.com.au Lansdowne Eye Clinic, Melbourne, Australia Purpose: T compare results of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) performed by a single surgeon. Method: respective study of patients undergoing endothelial keratoplasty as treatment of endothelial failure will be presented. Patients with at least 3 months follow-up were included. Results of patients having DMEK (n=31) and DSAEK (n=47) were compared. There were 4 DMEK and 6 DSAEK patients with pre-existing pathology limiting visual potential excluded from visual analysis. Best spectacle corrected visual acuity (BSCVA) and complications will be presented for 1 and 6 months. Results:31 eyes of 29 DMEK patients and 47 eyes of 39 DSAEK patients were included. At 1 month post-op BSCVA was equal or better than 6/9 for 19 out of 27 (70%) DMEK patients and 8 out of 41 (20%) DSAEK patients. At 6 months post-op BSCVA was equal of better than 6/9 for 15/17 (88%) DMEK patients and 21/32 (66%) DSAEK patients. Complications for DMEK patients include 1 intraoperative bleeding causing failure, 1 primary failure, 1 rejection, 1 cystoid macular oedema (CMO) and 2 cases of rebubbling. DSAEK complications include 1 intraoperative bleeding causing failure, 5 primary graft failures, 2 rejections, 1 CMO and 3 rebubbling. Conclusion: DMEK patients tend to achieve superior vision earlier and at all post-operative time points up to 6 months compared to DSAEK patients. The complication rates of DMEK patients at 6 months are no higher than that of DSAEK patients. S3709 9. THE NATURE AND INCIDENCE OF CICATRISING CONJUNCTIVITIS: AN AUSTRALIAN AND NEW ZEALAND OPHTHALMIC SURVEILLANCE UNIT STUDY Samantha Bobba1, Connor Devlin2, Nick Di Girolamo3, Dennis Wakeﬁeld3,1, Peter McCluskey2, Stephanie Watson1,2 Email: samantha.bobba@gmail.com 1 Prince of Wales Hospital Clinical School, Sydney, Australia, 2 Save Sight Institute, Sydney Eye Hospital, Sydney, Australia, 3School of Medical Sciences, University of New South Wales, Sydney, Australia Purpose: To determine the incidence and nature of cicatrising conjunctivitis in Australia and New Zealand. Method: A prospective surveillance study was conducted over 17 months via the Australian and New Zealand Ophthalmic Surveillance Unit (ANZOSU) with a one-year follow-up period. Practicing ophthalmologists were contacted monthly by the ANZOSU and asked to report newly diagnosed cases of cicatrising conjunctivitis. Questionnaires were sent to reporting ophthalmologists to obtain demographic and medical data. Population data was extrapolated to estimate the incidence of cicatrising conjunctivitis in Australia and New Zealand. Results: During the 17-month study period (December 2011-April 2013), 56 cases of cicatrising Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 78 Tuesday 31 October conjunctivitis were reported. Data was obtained for 35 cases (62%) with a mean age of 74 years and a predominance of males (57%). Of those recorded, the aetiologies included ocular mucus membrane pemphigoid (OcMMP) (n = 18 cases, 51.4%), Steven-Johnson Syndrome (n = 3), medication-induced (n = 2), linear IgA disease (n = 1) and ocular lichen planus (n = 1). Seventy-eight percent (n = 14/18) of the patients with OcMMP underwent a conjunctival biopsy to conﬁrm diagnosis and 55% (10/18 cases) experienced extra-ocular manifestations. The incidence of cicatrising conjunctivitis in Australia and New Zealand was extrapolated to 1.5 per million; this was comparable to that reported in the United Kingdom. Conclusion: This study is the ﬁrst to document the incidence of cicatrising conjunctivitis in Australia and New Zealand and the second worldwide. It provides novel data on the demographics and management of cicatrising conjunctivitis, which may aid in developing a collaborative network of specialist clinics. Acknowledgement: Professor Stephanie Watson was supported by an NHMRC Career Development Fellowship (APP1050524). covered dosing of oral and topical antivirals as well as topical steroids; for adults, children, immunocompromised, renal impairment and pregnant women. Of 181/305 (59%) eyes treated according to our guidelines; 99 (55%) eyes improved, 16 (9%) worsened, 13 (7%) continued prophylaxis and 53 (29%) were lost to follow-up. In comparison, of 124/305 (41%) eyes outside of the guidelines; 70 (56%) eyes improved, 12 (10%) worsened, 2 (2%) continued prophylaxis and 40 (32%) were lost to follow-up The Drug & Therapeutics Committee approved the guidelines. They are available on lanyard cards, email, mobile application, the SELAHS intranet and in out-patients, wards, and emergency. Conclusions: Guidelines for initial treatment of HSK were developed for use in Australia and improved patient outcomes. The guidelines will standardise the initial antiviral therapy of HSK to improve patient care and rationalise health resources. S3711 11. STEROIDS IN MICROBIAL KERATITIS: PATTERNS OF USE AND EFFECT OF TIMING ON DISEASE DURATION S3710 10. DEVELOPMENT AND IMPLEMENTATION OF GUIDELINES FOR THE MANAGEMENT OF HERPES SIMPLEX KERATITIS. Maria Cabrera-Aguas1,2, Dana Robaei1,2, Yves Kerdraon1,2, Richard Symes1,2, Peter McCluskey1,2, Stephanie Watson1,2 Email: mcab3563@uni.sydney.edu.au 1 Save Sight Institute, University of Sydney, Sydney, Australia, 2Sydney Eye Hospital, Sydney, Australia Purpose: To develop and implement local guidelines for the management of herpes simplex keratitis (HSK). Methods: A retrospective case review of all HSK cases aged 18 years and above, at Sydney Eye Hospital, from January 2012 to December 2013 was conducted. A literature review, case review, consensus meetings with corneal and uveitis specialists, and pharmacy consultation were undertaken. The guidelines were then assessed using outcomes data from the case series. Results: Review of 305 eyes from 300 HSK patients found diverse prescribing patterns and HSK trials included medications not routinely used/available in Australia. Developed ‘Australian’ guidelines included recommendations for initial treatment of epithelial, stromal, endothelial keratitis and keratouveitis and Shivesh Varma, Georgia Cleary, Mark Daniell Email: shivesh.varma@gmail.com Royal Victorian Eye and Ear Hospital, East Melbourne, Australia Purpose: The use of topical steroids in bacterial keratitis is contentious. While steroids improve visual outcome in eyes with central ulcers or poor initial vision, their effect on disease duration is unknown. We investigated the pattern of steroid use at our outpatient clinics, with a focus on determining how steroid timing relates to disease duration. Methods: A 12-month review of patients with microbial keratitis managed at RVEEH outpatient clinics from March 2016 to April 2017 is in progress. Data on clinical presentation, microbiology, treatment utilised, and follow-up was recorded. Results: 6 months’ preliminary data identiﬁed 102 patients: 52 received topical steroids, and 50 did not. Steroid recipients had poorer initial bestcorrected visual acuity (BCVA) (0.35 logMAR vs. 0.14 logMAR, p=0.02), larger inﬁltrates (1.0mm2 vs. 0.5mm2, p=0.03), and larger epithelial defects (1.3mm2 vs. 0.4mm2, p=0.01). At resolution, steroid receivers had a longer duration of follow-up (23.5 days vs. 12.7 days, p<0.01) and required more outpatient attendances (3.7 vs. 2.4, p<0.01). Sub-analysis of the steroid group found that steroids were started at day two or three in 23 patients Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors. 79 Tuesday 31 October (‘early’), and were started day four or later in 29 patients (‘late’). ‘Early’ steroid therapy was associated with shorter follow-up (19.3 days vs. 26.8 days, p=0.05) and fewer outpatient attendances (3.1 vs. 4.1, p<0.01) compared with ‘late’ steroid treatment. Conclusion: Steroid treatment appears to be reserved for eyes with more severe bacterial keratitis, possibly accounting for their longer follow-up compared with non-steroid patients. Earlier initiation of steroids may result in a shorter duration of disease and less followup when compared with late steroid therapy. Clinical and Experimental Ophthalmology 2017; 45 (Suppl 1): 54–79 Editorial material and organization © 2017 Royal Australian and New Zealand College of Opthalmologists. Copyright of individual abstracts remains with the authors.

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