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OBJECTIVE: To assess participant attendance and engagement for an in-person Canadian Ophthalmological Society (COS) annual meeting (2019) compared with a virtual COS annual meeting (2020). DESIGN: Retrospective case-control study of key event metrics of the 2019 and 2020 COS meetings as well as Twitter activity. METHODS: Key annual meeting metrics were collected retrospectively for 2020 virtual meeting and compared with the most recent in-person annual meeting cohort from 2019. Metrics collected included attendance by ophthalmology specialist, geographic distribution of attendees, postevent survey rate, and social media engagement (Twitter). RESULTS: Overall, there was a 7% (n = 60) increase in the number of registrants between 2019 and 2020. The largest change noted was the increase in registrants from British Columbia (n = 78). More ophthalmologists registered for the 2020 meeting than for 2019 meeting (627 versus 592). Of those who registered for the meeting, meeting participation (defined as checking in for the 2019 and logging in for the 2020 meetings) increased from 70% in 2019 to 79% in 2020. There was a 158% (n = 15 000) increase in tweet impressions in 2020 compared with 2019. CONCLUSION: The first COS virtual meeting attracted more participants and was available to a geographically wider audience. Indeed, more professionals from provinces that are geographically further from the traditional COS meeting locations were able to participate in the event. Meeting engagement on a social media platform increased in the virtual meeting in 2020 relative to the in-person meeting in 2019, and possible enablers for increased engagement should be sought and incorporated into future meetings.

Objective Pterygium surgery requires the removal of pterygium tissue and repair of the conjunctiva with either sutures or fibrin glue. The literature suggests that the cost of fibrin glue could be compensated by reducing procedure time and be more cost-effective. However, to our knowledge, no formal studies have examined this hypothesis. Method Retrospective chart review of patients who received pterygium surgery with only sutures between January 2008 and January 2010, and those whose surgeons used fibrin glue with or without sutures, between April 2017 and November 2018. Equipment cost, operating room (OR) maintenance, and surgeon's remuneration were compared between the groups. Results A total of 164 eyes were included. Three different procedure methods were noted: use of sutures only, combination of sutures and fibrin glue, or application of fibrin glue alone. The equipment cost was $97, $169.50, and $152.10 for the suture group, dual method, and fibrin-only method. Average procedure time was 35.8 minutes for the sutures-only group, 21.1 minutes for the dual method, and 25.6 minutes for the method using only glue. OR maintenance cost was $51.20 CAD per minute. The total cost for the method using only sutures was $2528.90, whereas the average cost for the protocol using only fibrin glue was $2063. Conclusion Although using fibrin glue for conjunctival graft adhesion increases the equipment cost, it significantly decreases procedure time, which allows a reduction of the total surgery cost. Therefore, fibrin glue is a more cost-effective approach than sutures alone.

Objective To compare the outcomes of Boston keratoprosthesis (KPro) type I implantation between patients who are legally blind versus sighted in the contralateral eye. Design Single centre retrospective comparative case series. Participants Patients who underwent Boston KPro type I implantation between 2008 and 2017. Methods Single-center retrospective comparative case series. Patients were divided into 2 groups based on the preoperative best-corrected visual acuity (BCVA) in the contralateral eye: group I (>20/200) and group II (20/200). Main outcome measures Postoperative BCVA, device retention, and complications. Results Group I (56 eyes) and group II (53 eyes) had similar demographics, median preoperative BCVA (hand movements) in the operated eye, and median duration of postoperative follow-up (76.92 vs 85.6 months, respectively). Final postoperative BCVA of the operated eye was statistically better in group I compared with group II (20/400 and hand movements, respectively, p = 0.03). There was no statistical significance in device retention mean survival time. The most common complication in both groups was retroprosthetic membrane. Cystoid macular edema occurred more frequently in group I (p = 0.004), whereas retinal detachment was more common in group II (p = 0.052). Conclusions Most patients who underwent Boston KPro type I implantation experienced an improvement in their vision, with final BCVA being superior in the unilateral blind group. Despite similar complication rates and device retention, there are additional socioeconomic factors that need to be considered in sighted individuals. Because the prognosis is tied to the underlying etiology, it is important to recognize that some diagnoses may influence a better outcome.

Objective To measure the difference in intraocular pressure (IOP) before and after pharmacologic mydriasis in normal subjects using Goldmann applanation tonometer (GAT) and the Diaton transpalpebral tonometer (DT). Design Prospective case series study. Participants Sixty-seven adult patients attending a tertiary general ophthalmology eye care center. Methods Patients were recruited based on a lack of glaucoma history and normal anterior segment on slit lamp examination. IOP measurements predilation and postdilation were collected. Predilation, both eyes were measured using GAT followed immediately by DT. Forty-five minutes post pharmacologic mydriasis, the measurements were repeated sequentially in the same order. Central corneal thickness (CCT) and additional parameters were also collected to corroborate the absence of glaucoma. Results Using GAT, the mean IOP predilation was 16.7 ± 3.1 mm Hg OD and 16.12 ± 3.0 mm Hg OS. The mean difference between predilation and postdilation time-points was −1.1 ± 2.5 mm Hg in the right eye and −0.7 ± 2.3 mm Hg in the left eye. Using DT, the mean IOP predilation was 12.8 ± 3.8 mm Hg OD and 13.2 ± 3.5 mm Hg OS. The mean difference between predilation and postdilation time points was −0.8 ± 4.0 mm Hg in the right eye and −0.7 ± 3.6 mm Hg in the left eye. There was a larger fluctuation of postdilation measurements using DT. The difference in IOP measured by the 2 instruments was statistically significant both predilation and postdilation (paired sample analysis pre-correlation 0.38 p = 0.002; post correlation 0.40 p = 0.001). Conclusions The use of pharmacologic mydriasis affected the reliability of IOP measurements which was decreased when taken postdilation by both GAT and DT. The poor agreement between GAT and DT values indicates an intrinsic difference between the two types of instrumentation.

Objective To evaluate the risks and benefits of sequential bilateral Boston type 1 keratoprosthesis (KPro) implantation for bilateral corneal blindness. Design Comparative retrospective study. Participants Patients who underwent a sequential bilateral KPro surgery. Methods All 11 patients who underwent sequential bilateral KPro surgery at the Centre Hospitalier de l'Universite de Montreal between October 2008 and October 2011 were recruited. Data from the 22 patient eyes in our study were separated in 2 groups based on the first (group 1) or second eye (group 2) implanted with the Kpro. Both groups were then compared for the best corrected visual acuity (BCVA) and complications. Bilateral BCVA following both surgeries and the overall number of complications that affected each patient after both interventions were also analyzed. Results At 24 months, BCVA was 20/150 in group 1 and 20/200 in group 2 ( p = 0.67). Throughout the study, there was no significant difference in BCVA between the 2 groups ( p > 0.05), and bilateral BCVA was similar. The complication rate was comparable in the 2 groups. Patients had a mean of 2.45 complications following the first surgery and a mean of 5.27 in both eyes combined after the second intervention ( p = 0.03). Conclusions Because visual gain observed following the second surgery was the same as that with the first and multiple surgeries increased the number of complications for each patient, we recommend saving bilateral KPro implantation for cases in which the first eye with KPro develops a disease limiting its visual potential.

Congenital fibrosis syndromes constitute a rare group of related disorders characterized by restric­ tive, nonprogressive ophthalmoplegia and blepharopto­ sis. They usually occur in isolation and are rarely asso­ ciated with systemic abnormalities. The etiology of congenital fibrosis syndromes is con­ troversial. It has been thought that these clinical abnor­ malities result from fibrosis of the extraocular muscles. In a few reports, histopathological studies of biopsied extraocular muscle showed a decreased number of muscle fibres and increased fibrosis tissue. 1 • 2 There­ fore, myopathy was thought to play a causative role. However, these same "myopathic changes" have also been demonstrated on histopathological examination following denervation of extraocular muscles in the dog. 2 Hence, the currently established histologic crite­ ria are considered inadequate in differentiating between myopathy and denervational atrophy. More recently, a neuropathic etiology has been pro­ posed.3-11 Although there is insufficient evidence to attribute the syndrome to purely innervational factors, associated disturbances of innervation have been clearly documented. 3 11 We describe three children with congenital fibrosis syndrome and radiologically

Objective: To describe the characteristics, indications, complications, and outcomes of the patients who underwent Boston type 1 keratoprosthesis (KPro) surgery at the Universite de Montreal affiliated Notre-Dame Hospital. Design: Retrospective case series. Participants: Forty-seven eyes of 43 patients who underwent KPro surgery. Methods: The charts of all patients who underwent KPro surgery at Notre-Dame Hospital between October 2008 and February 2010 were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were collected and analyzed. Results: The indication for Boston type 1 KPro was corneal graft failure in 27 eyes; 20 eyes had KPro as a primary procedure. Preoperative diagnoses included aniridia (34%), mechanical trauma (11%), infections (9%), surgery-related bullous keratopathy (9%), chemical burns (9%), corneal dystrophies (9%), and Stevens-Johnson syndrome (2%). A known history of glaucoma was present in 36 eyes (77%). Median preoperative best-corrected visual acuity (BCVA) was hand motion (range, 20/100 to light perception). The assembly of the KPro and surgery were uneventful in all cases. Mean follow-up was 10 ± 5 months. Median BCVA at last follow-up was 20/150 (range, 20/30 to no light perception). The device retention rate was 100% at the end of the follow-up period. Postoperative complications included retroprosthetic membrane in 12 eyes (26%) and glaucoma progression in 11 eyes (23%). Conclusions: Our study demonstrates an excellent retention rate of the Boston type 1 KPro and an improvement of BCVA in the majority of patients. Many patients undergoing KPro surgery have ocular comorbidities that require ongoing care to prevent further vision loss following KPro surgery.

Case report: In India and Southeast Asia, rhinosporidiosis is a common infectious disease, but it has rarely been reported in western countries. Infrequently, isolated ocular rhinosporidial infections have been reported, but to our knowledge, there are no reported cases in Canada. Two cases of rhinosporidiosis have been recently diagnosed and managed at our university-based hospital. Comments: Rhinosporidiosis presents with certain characteristic clinical features; however, the diagnosis is confirmed histopathologically. The presence of typical sporangia and spores in a fibrovascular stroma infiltrated by acute and chronic inflammatory cells including granulomas is diagnostic. Surgical excision is the treatment of choice, and recurrence is possible but rare.

Recently, photodynamic therapy (PDT) has proven beneficial in the treatment of chronic central serous chorioretinopathy (CSCR). As with CSCR, chronic serous retinal pigment epithelial detachment (RPED) can also lead to a significant decrease in visual acuity. We describe a case of chronic serous RPED in a young patient that progressively worsened over several years but regressed markedly, with improvement in visual acuity, after PDT with verteporfin.