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ePoster Mania at APACRS 2024: A Round-up of the Prize-Winning Vanguard of APAC Cataract and Refractive Research 

Posters have evolved from their days on the fringes of ophthalmic research to become the focal point of major conferences like the 36th Annual Meeting of the Asia-Pacific Society of Cataract and Refractive Surgeons (APACRS 2024). 

This year’s iteration of poster mania did away completely with the traditional rows of pasteboard at other conferences in favor of an all-electronic competition. On this, the final (and traditionally more sparsely attended) Day 3 of APACRS 2024, your correspondent still found himself waiting for a free computer to view this year’s awardees. Such is the power and popularity that posters now command. 

Awards were given out in this year’s five categories, all duly deserving of the large crowds flocking to the poster station here in Chengdu. 

GENERAL
Factors Influencing Myopia Stabilization in Young Myopic Adult Singaporeans; 

Li-Lian Foo, Chuen Seng Tan, Brennan Noel, Hla Myint Htoon, Raymond P Najjar, Biten Kathrani, Charumathi Sabayanagam, Seang-Mei Saw

Dr. Foo’s team out of the Singapore National Eye Centre (SNEC) set out to answer one question: What happens when the children of the myopia epidemic grow up? They found that the vast majority (5 in 6) of Singaporean adolescents and young adults achieved myopia stabilization (<1.00 D) over a 10-year period. 

The question now becomes when—or if—it becomes prudent to stop myopia control treatment early in patients at low risk of progression.

Cyclic Cell-Penetrating Peptide-Engineered Cerium Oxide Nanoparticles for Non-invasive Intervention of Ultraviolet Radiation-Induced Cataract; Luyang Jiang, Yibo Yu, Haijie Han

In this poster, a novel, water-soluble drug delivery vehicles cCP-CeNP were surface modified with cell-penetrating peptides and the effects were studied in vivo on mouse models to discover their ability to resist oxidative damage from ultraviolet-B radiation. 

The authors believe that this could be a massive new—and critically, non-invasive—method for the conservative treatment of a variety of lens disease. They also mentioned its potential in other stress-related chronic conditions, like glaucoma and diabetic fundus diseases.

Artificial Intelligence to Predict Refractive Error using Biometry: A New Paradigm;
Samaresh Srivastava, Ashok Puri, Vaishali Vasavada, Shail Vasavada, Abhay Vasavada

This poster out of Raghudeep Eye Hospital (India) contributed to the ever-growing intermeshing of artificial intelligence and eye care. They began by attempting to use AI to model refractive error from optical biometry data.  

The investigators took undilated biometry measurements from 1,000 eyes in 1,000 patients and entered the data into the XG Boost AI algorithm. Though the research is still ongoing, the team discovered that the algorithm spat out data closer to cycloplegic refraction than subjective refraction. Further research is needed, according to the authors, to tap into this potentially powerful source of objective refractive assessment. 

CATARACT
Correlation of the Angle Kappa and Alpha on Visual Outcomes in Eyes Implanted With Three Types of Diffractive Trifocal Intraocular Lenses;
Zoe Alethinos M. Doroy, Justin Alan A. Yao, Robert Edward T. Ang

Angle kappa is somewhat in vogue for its supposed utility in cataract surgery, and Dr. Ang’s group looked at the effect of angle kappa and alpha, and especially of eyes that have relatively large values for these variables, on visual outcomes in trifocal IOL implantation. 

The findings have big implications for the future of these values—not only did he find that very few eyes had angle kappa and alpha values of greater than 0.5 mm, but he also found that good visual outcomes could be achieved in these eyes. All in all, the poster argues that angle kappa and alpha do not have as high of predictive power in multifocal IOL implantation as hoped. 

Mild temperature photothermal assisted nanosystem for synergistic treatment of post-cataract surgery endophthalmitis;
Yang Ye, Jian He, Min Zhou, Ke Yao

In this poster, nanoparticles took the spotlight once more in an attempt to battle one of cataract surgery’s great villains—endophthalmitis. Prof. Ke’s team selected AuAgCu2O-bromfenac sodium nanoparticles for their integrated anti-bacterial and anti-inflammatory properties, assisted by photodynamic and photothermal effects. 

They verified these nanoparticles in vitro and in vivo on methicillin-resistant staphylococcus aureus, and found that this combo holds great promise in endophthalmitis, warranting further investigation in preparation for its use in human subjects. 

INTRAOCULAR LENS IMPLANTS (IOLs)
Association between Preoperative Ocular Parameters and Myopic Shift in Children Undergoing Primary Intraocular Lens Implantation;
Yunqian Li, Zhenzhen Liu

Refining the predictive power of preoperative measurements will always be a hot topic for pushing cataract surgeries to the next level, and this poster took various variables to see if improving prognostication of myopic shift in children was possible.

Drs. Li and Liu found that age at surgery and axial length were associated with myopic shift in these pediatric patients, and suggested that adjusting target refraction based on preoperative axial length holds promise in cracking the complex code behind this troublesome phenomenon.

The Accuracy of IOL Power Calculation Formulas Based on AI in Highly Myopic Eyes: A Systematic Review and Network Meta-Analysis;
Yi Zhou, Minhui Dai, Lingyu Sun, Xiangyi Tang, Ling Zhou, Zhiyao Tang, Jian Jiang, Xiaobo Xia

The battle of IOL power calculation formulae rages on, and AI has added a new dimension to the battlefield. This research on which formula reigns supreme in highly myopic eyes took top billing with this systematic review and meta-analysis.

Based on twelve studies from PubMed, Web of Science, Embase and the Cochrane Library, the researchers found that three formulae were significantly better than the others in this patient subset: XGBoost, Hill-RBF and Kane.  

REFRACTIVE SURGERY
Lenticular Profiling and Corneal Nerve Regeneration: A Thorough Investigative Analysis;
Panaah Shetty, Rohit Shetty, Pooja Khamar, Durgalakshmi Modak

This star-studded poster out of India took a look at various lenticular profiles and their effect on corneal nerve regeneration. Noting that the cornea is a densely innervated tissue, the study divided procedures into 3 groups: KLEx 1 (Visumax SMILE; Carl Zeiss AG), KLEx 2 (Elita SILK; Johnson & Johnson Vision), and KLEx 3 (ATOS Smartsight; SCHWIND Eye Tech Solutions GmbH). 

The study authors found less nerve damage and faster regeneration of nerves in KLEx 2 and 3 when compared to KLEx 1, as evidenced by the minimal change in CNFD and CNFL in these patients. They also found lesser incidence of dry eye disease in the KLEx 2 and 3 groups compared to KLEx 1.

Epithelial Remodeling Following Epithelium-off Continuous Accelerated Corneal Collagen Cross-linking in Progressive Keratoconus;
Junjie Piao, Shen Wang, Ye Tao, Yue Hua Zhou, Ying Li

Epi-off continuous accelerated corneal cross-linking (CXL) has attracted its fair share of controversy in cornea-land, and this paper dove deeper to see what lies beneath. To tackle this, the authors analyzed regional corneal epithelial and stromal remodeling following the procedure. 

Using the Avedro KXL (Glaukos), the authors found that corneal epithelial remodeling was more significant in the inner areas than the outer. The conclusion? That epi-off continuous accelerated CXL is still very much a viable option for keratoconus according to 12-month data. 

CORNEAL SURGERY
Incidence and Factors Associated With Secondary Glaucoma after Endothelial Keratoplasty: A Pilot Study;
Nucharee Parivisuit, Jidapa Sarikit

Endothelial keratoplasty (EK) is a major operation that can come with some serious surgeon-independent consequences. Secondary glaucoma is one of them, and this paper dug deeper into this phenomenon. 

Their primary objective was to find incidence of secondary glaucoma after these procedures, and in this retrospective cohort study, they found it to be 35.71%. Even more significantly, however, was that they found the male gender to be a significant risk factor for post-EK secondary glaucoma. 

The authors concluded that more work must now be done to further identify such risk factors in order to reduce incidence of the condition through better patient selection and preoperative handling of those that are modifiable. 

Comparison between Automated and Manual Segmentation of Corneal Haze on Sclerotic Scatter and Densitometry Maps in Fuchs Endothelial Corneal Dystrophy;
Kai Yuan Tey, Ten Cheer Quek, Tyler Hyungtaek Rim, Jodhbir S. Mehta

You can’t talk about Fuchs endothelial corneal dystrophy (FECD) without corneal haze, and researchers from the Singapore National Eye Centre (SNEC) and Singapore Eye Research Institute (SERI) couldn’t agree more. Their poster sought to make corneal haze judgments more subjected with automated segmentation in order to take some of the guesswork out of relating it to disease severity. 

The group found excellent early returns on automated segmentation of densitometry, with high performance compared to manual segmentation. They also found that intergrader segmentation in the manual group found little agreement, and that automated segmentation of corneal densitometry performed better than sclerotic scatter photos, potentially opening new doors in the severity assessment of FECD.

Editor’s Note: Reporting for this event took place during the 36th Annual Meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2024), held from May 30 to June 1, 2024 in Chengdu, China. The 36th APACRS annual meeting is jointly organized with the 24th CSCRS (Chinese Society of Cataract & Refractive Surgery) annual meeting.

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