Starting off the research session and following on from her memorable Noel-Rice lecture last year, Professor Sushmita Kaushik from Chandigarh not only co-chaired but also presented her experience of using the clinical exome sequencing in managing and diagnosing non-acquired childhood glaucoma. Taking theoretical genetics out of the textbooks and into her clinic room, she showed us multiple examples of how the genetics may help us to take a step back, re-examine the patient from head-to-toe, and remember that the clinical presentation may not always be exactly what it seems! Next, in response to questions raised at UKPGS 2023, Dr Singh (Chandigarh) investigated visual field indices in children with glaucoma, comparing them with adult glaucoma patients with comparable retinal nerve fibre layer thickness. For this he received one of the presentation prizes as well as later presenting his work using UBM as a prognostic indicator in children in glaucoma. 

In the clinical session, both Dr Imamoğlu (Istanbul, Turkey) and Dr Helal (Benha, Egypt) looked at the efficacy of angle surgeries in paediatric glaucoma, with the latter receiving a prize for their work. Dr Imamoğlu compared ab-interno to ab-externo circumferential trabeculotomy and found both procedures to be effective. In the latter, Dr Helal showed that effective IOP reduction could be achieved using only a bent needle technique, allowing for affordable and effective treatment in this cohort. The second prize was also awarded during this session to Dr Hussain Aluzri (Birmingham, UK) for his work looking at paediatric glaucoma transition clinics from childhood to adult care. Whilst not a topic previously analysed in glaucoma, this stage of care is well documented in other medical specialties and therefore we are pleased to see it gain the attention it deserves.

The Glaucoma Tube Symposium began by discussing the long-term outcomes of more traditional tubes, Baerveldt 10-year results and Ahmed Ologen-augmented 1-5 year results then the focus quickly shifted to a case series of Aurolab and PAUL tubes. The session was concluded by Dr Murphy (Dublin, Ireland) who presented the longest case series of paediatric PAUL glaucoma implants to date with her group’s 24-month retrospective cohort study which prompted significant discussion.

Following an optimistic session on successful tube surgeries the topic changed to the ever-challenging issues surrounding tube failure in the next symposium. Talks ranged across multiple devices, from large case series to one unlikely case of intermittent failure due to pharmacological pupil dilation. In this case, Dr Ali (Newcastle, UK) reminded us always to consider the mobile nature of the iris when locating tubes within the eye. Dr Abeysekera (Colombo, Sri Lanka) discussed high rates of Ahmed tube failure; up to 88% by five years, and detailed further procedures to manage this. Amongst multiple excellent talks on tube revision surgery, Ms Martins (London, UK) detailed her expert tips on managing tube exposure. 

A guest lecture from Professor Sus Biswas (Manchester Royal Eye Hospital, UK) entitled “Visual rehabilitation and glaucoma outcomes in severe congenital anterior segment developmental disorders” addressed not only the IOP management of glaucoma patients but also ensuring optimal visual outcomes when managing complex anterior segment pathology. Sharing his experiences, he reminded us that when treating such complex patients, we should offer simple and safe solutions to prevent amblyopia. One example, for patients with central corneal scarring, before discussing more complex surgeries, early scleral-incision, optical iridectomy can be undertaken with good results.

The afternoon rapid-fire sessions covered a wide range of topics from medical education to rare-presentations and finishing with video presentations. In the education session, Dr Persad (Miami, USA) presented results from a simulation-based course in EUA to train a new generation of paediatric ophthalmologists. A number of more rare case presentations were discussed, including but by no means limited to: Dr Ginés-Gallego’s (Manchester, UK) case series of Rubinstein Taybi syndrome, Dr Bayoumi (Alexandria, Egypt) who discussed a complex case of persistent tunica vasculosa in a patient with neurofibromatosis, and Dr Chang (Miami, USA) who presented a single case report of serous retinal detachment in a case of port-wine birthmark and diffuse choroidal haemangioma following commencement of prostaglandin analogue therapy. 

A special mention must be given to two of the delegates presenting this year, Dr Sirisha Senthil (Hyderabad, India) and Dr Deniz Goodman (Miami, USA). Both candidates would win the unofficial modal prize for “most trips to the stage”, with four oral presentations and a poster a piece! Dr Senthil began by telling us about her experiences of using Ologen to augment trabeculectomy-trabeculotomy, characterising the features of both LTBP2 mutations and Phacomatosis Pigmento Vascularis, described a novel technique for slicing the valve of an Ahmed for greater long-term efficacy, as well as a poster on aniridia and anterior segment dysgenesis. Deniz began by exploring the reliability of what our patients/ relatives might learn from ChatGPT. He then moved on to: designing synthetic eyes for training, developing a skills transfer course for budding surgeons, looking at the benefits of head mounted Vs standard automated perimetry machines, and finally, a poster comparison of genetic resource utilisation among ophthalmologists. To top this off, the Bascom Palmer team hosted their own impromptu raffle for three lucky winners who got to take home their own home surgery training kits!

The Noel Rice lecture this year, entitled “Standing on the shoulders of giants” was excellently presented by Professor Christopher Lyons (Vancouver, Canada) whose extensive lecture covered not only the span of his career as a world expert and innovator in the field, but also the recent history of other great ophthalmologists and mentors along his journey. He focussed on the major surgical developments which he learned, implemented, and has passed onto future generations to improve patient outcomes and care; a very inspiring talk for future paediatric ophthalmologists but it also offered the opportunity for us each to personally think about our own mentors and trainers and to reflect upon how they have influenced our learning and practice and helped us improve the care we offer our own patients.

Professor Sir Khaw thanked the delegates in his role as president and closed the meeting for dinner and drinks. The meeting was organised excellently by the UKPGS committee, Lady Peggy Khaw and Louise Richards and generously supported by Thea Pharmaceuticals, Scope, Heine, Nikon, Optos & VISUfarma.

Congratulations to this year’s prize winners (in order right, top to bottom pictures):
•    Ashok Kumar Singh (Chandigarh, India) – Visual field indices in children with glaucoma compared to that in adult glaucoma patients with comparable retinal nerve fibre layer thickness
•    Hussain Aluzri (Birmingham, UK) – Longitudinal analysis of transition clinic follow-up in a tertiary glaucoma centre
•    Hend Helal (Benha, Egypt), presented by Mohamed Awwad – Efficacy of bent angle needle goniectomy as a primary and redo surgery for management of paediatric glaucoma