Can the Three-Dimensional Heads-Up Display Improve Ergonomics, Surgical Performance, and Ophthalmology Training Compared to Conventional Microscopy?

PURPOSE: To explore ophthalmic surgeons' opinions regarding three-dimensional heads-up display (3D HUD) use and investigate musculoskeletal (MSK) complaints among ophthalmologists. METHODS: Physicians were invited to complete an online questionnaire. Musculoskeletal complaints and data of the HUD system use were correlated with demographic information. We explored surgeons' feedback on image quality, depth perception, and the educational value of 3D microscopy. RESULTS: In this study, the prevalence of self-reported MSK pain was 82.6% (n=132). The pain started after joining ophthalmology practice and significantly improves on weekends and vacations. We found that the pain intensity in non-HUD users is higher than in HUD users, but this correlation was not statistically significant. Sixty-one (84.7%) of HUD system users were satisfied with depth perception, and 27 (37.5%) reported improvement in peripheral acuity. Thirty-seven (51.4%) of the participants believed they perform surgeries better through HUD; this was why most participants (83.3%) recommended its use in surgical training. CONCLUSION: Heads-up display use provides more comfortable sitting positions for surgeons, superior depth perception, and serves as a better educational tool. We believe that adopting this technology may help improve career longevity and productivity.

Intermediate uveitis: Etiologies and outcomes in a tertiary referral hospital in KSA.

PURPOSE: The purpose of the study is to evaluate the common causes of intermediate uveitis (IU) and outcomes of this disease in patients presenting to King Khaled Eye Specialist Hospital (KKESH) in Riyadh, KSA. METHODS: This retrospective cohort study evaluated medical files of patients with IU was reviewed. A total of 109 patients were included in the study. The diagnosis followed the Standardization of Uveitis Nomenclature criteria. Data analysis included personal data, etiology of IU, treatment, and complications. RESULTS: We identified 109 patients with IU. The mean age at diagnosis was 26.45 ± 15.31 years. Most were female (64.9%), and 86% were bilateral at presentation. The etiology of IU was idiopathic in 63.3%. Multiple sclerosis (MS) (19.3%) and tuberculosis (14.7%) were frequent systemic causes of IU. The pattern of complications included macular edema (42.1%), cataract (48.2%), and secondary glaucoma (30.7%); 28.9% of the patients had none of the complications. Treatment comprised topical, local, and systemic steroids, immunosuppressive agents, and biologics. The best-corrected visual acuity was better than 20/40 in 57.5% of the eyes after more than 10 years of follow-up. CONCLUSION: This study demonstrated that at KKESH, most of the IU cases were idiopathic or associated with MS and tuberculosis. Visual prognosis is favorable even with the long duration of IU and numerous complications.

Heads up Sutureless Chandelier assisted scleral buckle.

PURPOSE: This study aims to describe chandelier assisted scleral buckle (CSB) using 3D visualizing system in phakic uncomplicated Rhegmatogenous Retinal Detachment (RRD). METHODS: This technique was performed in 6 eyes of 6 patients with primary rhegmatogenous RD who underwent encircling circumferential scleral buckling with scleral tunnels. Heads up display 3D system was used for visualization and localization of the breaks, and Chandelier Endoillumination was used as a light source was inserted through a 27 G needle sclerotomy 3.5mm from the limbus. A partial-thickness scleral "belt-loop" tunnels in the four quadrants were created using crescent knife angle beveled (2.3 mm in width) to facilitate the smooth passage of the band a 240-silicone band as encircling circumferential buckle. Cryopexy was performed and the incision was closed with cautery or absorbable sutures. RESULTS: Primary attachment success of 5 out of 6 and overall success was 100%. No intraoperative or postoperative complications observed although fellows in training performed half the procedures. CONCLUSIONS: Heads up Sutureless Chandelier assisted Scleral Buckle can achieve excellent anatomical success while improving ergonomics and training. Furthermore, it is a safe procedure with less risk of complications and retinal phototoxicity.

Management of iatrogenic globe perforation during peribulbar anesthesia with submacular hemorrhage.

A patient with an amblyopia and poor vision in the fellow eye experienced iatrogenic globe perforation during peribulbar anesthesia for cataract surgery. The injection and surgery were immediately aborted. Visual acuity was hand motion, and retinal examination revealed retinal detachment, hemorrhagic choroidal detachment, and submacular hemorrhage. These were initially managed medically until the hemorrhagic choroidal detachment resolved and afterward by combined phacoemulsification with pars plana vitrectomy, subretinal recombinant tissue plasminogen activator, and gas tamponade. Two weeks post operative, the patient achieved the best-corrected visual acuity of around 20/200, which after 1 year of follow-up improved to 20/70.

Macular Hole-Related Retinal Detachment in Children with Knobloch Syndrome.

PURPOSE: To describe the findings and the management of macular hole (MH)-related retinal detachment (RD) in children with Knobloch syndrome. DESIGN: Retrospective interventional case series. PARTICIPANTS: Patients with Knobloch syndrome who presented with MH-related RD. METHODS: Retrospective chart review of patients with Knobloch syndrome who presented with MH-related RD from January 2012 to December 2018. Interventions included pars plana vitrectomy and silicone oil tamponade with or without scleral buckle, drainage retinotomy, or relaxing retinectomy. MAIN OUTCOME MEASURES: MH characteristics and surgical anatomical outcome. RESULTS: The study included 9 eyes of 5 patients (age range 2 months to 5 years; median age 5.5 months). Presenting symptoms were poor fixation and nystagmus. The fellow eye of 1 patient had RD due to peripheral breaks. The MH was clinically visible in 8 eyes and detected only by OCT in 1 eye. The RD was shallow and extended to the anterior equator in 7 eyes and localized to a punched-out atrophic lesion in 1 eye. Seven eyes underwent surgical repair. At the last follow-up examination (follow-up range 11 to 42 months; mean 24 months, standard deviation 11.8 months), retinal reattachment with MH closure was achieved in 5 eyes along with marked improvement in fixation. CONCLUSION: Patients with Knobloch syndrome may develop MH-related RD as early as infancy. The condition may be easily overlooked in children but should be suspected in the setting of high myopia, vitreoretinal degeneration, and encephalocele.

Benign reactive lymphoid hyperplasia of the conjunctiva in childhood.

BACKGROUND/AIM: Our aim is to the report the clinical and histopathological features of benign reactive lymphoid hyperplasia (BRLH) of the conjunctiva in children and the outcomes of treatment. METHODS: A retrospective chart review was performed for children aged 0-18 years, diagnosed with conjunctival BRLH from January 2000 to December 2013 at two large ophthalmology hospitals in the Middle East. Data were collected on patient demographics, features of the lesions, the site of the lesion, location, adnexal involvement, lymph nodes involvement, local spread, histopathology and molecular genetic studies of the cases (if available), outcomes of treatment and recurrence. RESULTS: There were 24 patients with lymphoid lesions classified as conjunctival BRLH during the 12-year period evaluated in this study. The mean age at diagnosis was 11.6 years. Twenty-three patients were males (96%). Systemic medical history included three patients with bronchial asthma, one patient with Down's syndrome, one patient with generalised skeletal malformation and one patient with gastritis. The initial uncorrected visual acuity was 20/30 or better in 93.5% of the eyes. At presentation, the tumour was unilateral in 12 cases (50%). The conjunctival mass was located on the bulbar conjunctiva in all cases. The mass was present nasally in 96% of lesions. No cases (that were tested) had an infectious aetiology. PCR demonstrated monoclonality suggestive of lymphoma in two cases; however, this did not alter the final diagnosis as BRLH per histopathological criteria and clinical course, CONCLUSIONS: All investigated cases of paediatric conjunctival BRLH had a benign clinical course with no local or systemic dissemination and a male predominance. Recurrence was rare, and in our cohort, it was not associated with malignant transformation.

Serous Retinal Detachment in Dome-shaped Macula with 7 Years Follow-up.

Dome-shaped macula (DSM) was first described by Gaucher et al. as a convex protrusion of macula within a staphyloma in highly myopic eyes that cause visual impairment associated with serous foveal detachment (SFD). We describe a patient with persistent SFD in DSM documented by serial spectral domain optical coherence tomography for 7 years with stable vision.