Validation of a novel strabismus surgery 3D-printed silicone eye model for simulation training.

PURPOSE: To demonstrate the validity of a new 3D-printed silicone model for practicing strabismus surgery, compared with the rabbit head, in terms of simulator fidelity. METHODS: In this multicenter study, a validated questionnaire was developed to assess fidelity of the model and rabbit head. Participants were asked to rate overall globe, conjunctiva, muscle, and scleral fidelity using a 5-point scale. The survey instrument was disseminated at three strabismus instruction courses: at two meetings, participants practiced on the model and rabbit head prior to completing the questionnaire; at the third, instructors demonstrated advanced surgical skills using only the model and then completed the questionnaire. Repeated measures analysis of variance compared ratings. Pearson's or Spearman's correlation evaluated correlation between years of experience to participants' responses. Qualitative data were coded into themes. RESULTS: A total of 47 participants completed the questionnaire. The model rated 18% higher than rabbit head for anatomical accuracy (mean difference, 0.667; P = 0.001) and 25% higher for position of eyes within the head (mean difference, 0.867; P = 0.006). More experienced participants were more likely to strongly agree that the silicone conjunctiva effectively mimics real conjunctiva (ρ = 0.337; P = 0.036) and that scleral tissue effectively mimics real sclera (ρ = 0.298, P = 0.042). Qualitative data supported the model. CONCLUSIONS: This study demonstrated the validity of the surgical model in terms of fidelity compared to the rabbit head.

Sebaceous adenomas of the eyelid and Muir-Torre Syndrome.

BACKGROUND/AIMS: Sebaceous adenomas (SAs) are rare, benign sebaceous gland tumours of the eyelid. SAs may be associated with primary internal malignancies. This association is known as Muir-Torre Syndrome (MTS). The purpose of this study was to approximate the prevalence of SAs, to determine the reliability of the clinical diagnosis of SAs and to demonstrate immunohistochemical staining of DNA mismatch repair proteins mutL homologue 1 (MLH1) and mutS homologue 2 (MSH2) for a case of MTS. METHODS: We reviewed the histopathology reports from all eyelid specimens collected between 1993 and 2013 at the Henry C Witelson Ocular Pathology Laboratory to determine the proportion of SAs. For the SAs identified on histopathology, we looked at patient charts to see what diagnosis was originally suspected on clinical examination. Immunohistochemical staining for MLH1 and MSH2 was performed on all SAs to screen for MTS. RESULTS: Of the 5884 eyelid specimens collected, 9 were SAs (6 women, 3 men; 42-72 years old). The diagnosis of SA was suspected clinically in only one of the nine cases based on the gross appearance of the eyelid lesion. Immunohistochemistry revealed one SA case with positive MLH1 expression and negative MSH2 expression. These findings prompted systemic work-up and this patient was diagnosed with MTS after discovery of a colon adenocarcinoma T2M0N0. CONCLUSIONS: The diagnosis of eyelid SA is rare. The importance of this benign eyelid tumour stems from its association with internal malignancies in MTS. Immunohistochemical staining of mismatch repair proteins MLH1 and MSH2 is a valid and accessible strategy for investigating MTS in patients with SAs.

Relative importance of the components of the Canadian Residency Matching Service application.

OBJECTIVE: The primary goal of this project was to investigate Canadian ophthalmology residency program directors' and department heads' perceptions about the relative importance of the various components of the Canadian Residency Matching Service (CaRMS) application package. Secondary goals were: (i) to investigate the perceptions of all program directors and department heads at Queen's University's residency programs; and (ii) to compare faculty's perceptions with the perceptions of medical students at Queen's University. DESIGN: Survey. PARTICIPANTS: Queen's University medical students, Queen's University faculty, and Canadian Ophthalmology faculty participated in this survey. METHODS: A validated survey was administered to faculty and students. The study targeted program directors and department heads of 15 Canadian ophthalmology residency programs, 18 residency programs at Queen's University, as well as 404 medical students at Queen's University. Qualitative questions were included in the faculty survey. Quantitative data were analyzed with nonparametric tests. Qualitative data were organized according to primary themes. RESULTS: Response rates ranged from 64% to 87%. On a scale of 1 to 4 in order of increasing importance, faculty and students respectively assigned the highest scores to the following components: interview performance (3.73, 3.89), electives (3.64, 3.83), reference letters (3.53, 3.74), and personal letter (3.27, 3.58). For all 4 components, student scores were significantly higher than faculty scores. First- and fourth-year medical students' scores differed significantly in eight areas including research experience and volunteer experience. In both of these components, there were statistical differences between fourth-year student scores and faculty scores, whereas the first-year class had scores that were comparable with faculty scores. Queen's University faculty and Ophthalmology faculty did not differ significantly. Faculty scores also did not differ significantly based on age or sex. CONCLUSIONS: Faculty and students agreed on the most important components of the application, but significant differences were found in their perceptions of the relative importance of other components.

Expression of focal adhesion kinase in uveal melanoma and the effects of Hsp90 inhibition by 17-AAG.

INTRODUCTION: Focal adhesion kinase (FAK) is implicated in tumor progression and metastatic cascade, and has been shown to be overexpressed in a variety of human cancers. However, the role of FAK in human uveal melanoma (UM) is not well defined. The purpose of this study was to evaluate the expression of FAK in UM tumors and normal eyes, and to determine the effect of Hsp90 inhibition on FAK expression in UM cells. METHODS: FAK expression was assessed in 39 UM specimens, FAK[pY397] expression was assessed in 51 UM specimens, and both FAK and FAK[pY397] expression were assessed in 20 normal eyes. The expression of FAK and FAK[pY397] was detected by Western blot in five UM cell lines after treatment with 10 µmol/L of 17-AAG. RESULTS: FAK was positive in 87.2% and FAK[pY397] in 90% of UM specimens. Low FAK expression was detected in non-tumor structures and in normal eyes. The cell lines with the most proliferative, invasive phenotype (92.1, SP6.5 and MKT-BR) displayed high expression of FAK[pY397], and the levels of FAK and FAK[pY397] were decreased in the presence of 17-AAG starting with 24 h of exposure. CONCLUSION: FAK and FAK[pY397] were overexpressed in human UM tumors compared to normal ocular tissue and high levels of FAK[pY397] were seen in the most aggressive UM cell lines. Hsp90 inhibition led to downregulation of FAK expression. We propose a role for FAK in the pathogenesis of UM. Future studies are needed to explore the use of Hsp90 inhibitors as a feasible approach for modulating FAK in UM.