Late onset sclerotomy dehiscence in a patient with Marfan syndrome presenting as recurrent episodes of raised intraocular pressure.

A man in his 50s presented to the eye emergency department on three separate occasions complaining of blurred vision and discomfort in the left eye. He had a history of Marfan syndrome and had undergone bilateral 20-gauge (G) pars plana vitrectomy and lensectomy 20 years prior for ectopia lentis. On examination he had epithelial corneal oedema, raised intraocular pressure >40 mm Hg and conjunctival chemosis, which later appeared as a bleb-like conjunctival elevation. Acute treatment with oral acetazolamide and topical ocular hypotensive agents produced a marked reduction in intraocular pressure to 2-4 mm Hg. A presumed diagnosis of a leaking scleral wound was made. He underwent scleral exploration under general anaesthesia and a leaking sclerotomy was uncovered. The defect was repaired successfully using a scleral patch graft. Late dehiscence of a sclerotomy has been reported rarely in patients with Marfan syndrome. This is the first reported case to present atypically with intermittent episodes of raised intraocular pressure rather than with hypotony.

Case series of scleral patch grafts during COVID-19 pandemic.

Scleral graft is done for clinical conditions as scleral melt post pterygium surgery, immune or infection related scleral melt, for covering the tubes of Ahmed glaucoma valve implant, for covering the orbital implants post enucleation, etc. A review of literature revealed the use of sclera for corneal perforations in the past, but became obsolete after the cornea being used for patch grafts. Now in this COVID-19 time, due to scarcity of corneal tissue, this technique of scleral patch grafts can be considered as an alternative to corneal patch grafts, which serves well the tectonic/therapeutic purpose and helps salvage the eye.

Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial.

This study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery. Surgical videos of the first 20 attempts at tunnel construction were reviewed by masked video raters. The primary outcome was the total number of any of 9 pre-specified errors. On average, the total number of errors was 9.25 (95% CI 0-18.95) in the EG and 17.56 (95% CI 6.63-28.49) in the CG (P = 0.05); the number of major errors was 4.86 (95% CI 0.13-9.59) in the EG and 10.09 (95% CI 4.76-15.41) in the CG (P = 0.02); and the number of minor errors was 4.39 (95% CI 0-9.75) in the EG and 7.47 (95% CI 1.43-13.51) in the CG (P = 0.16). These results support that novice surgeons trained using the novel simulation-based curriculum performed fewer errors in their first 20 attempts at tunnel construction compared to those trained with a conventional curriculum.