Can virtual reality surgical simulator improve the function of the non-dominant hand in ophthalmic surgeons?

Purpose: Phacoemulsification surgery requires the use of both hands; however, some surgeons may not be comfortable using their non-dominant hand, especially in critical steps such as chopping. This work aims at assessing whether a virtual reality simulator can help cataract surgeons train their non-dominant hand using the capsulorhexis module. Methods: This was a prospective observational study including thirty ophthalmic surgeons; none of them had previous training on the EyeSi surgical simulator. Twenty-three were experienced, and seven were intermediate surgeons. Surgeons were asked to perform capsulorhexis three times using their dominant hand and then using their non-dominant hand. A performance score based on efficiency, target achievement, instrument handling, and tissue treatment was calculated by the simulator. Results: A significant improvement in the score of surgeons using their non-dominant hand from the first trial (69.57 ± 18.9) to the third trial (84.9 ± 9.2) (P < 0.001) was found, whereas such improvement was not noted with the dominant hand (P = 0.12). Twenty-six surgeons managed to reach 90% of the mean score achieved by dominant hand by using their non-dominant hand, 11 (36.7%) from the first trial, seven (23.3%) from the second, and eight (26.7%) from the third. Conclusion: Cataract surgeons showed significant improvement in the scores of their non-dominant hands with simulator training. Thus, it is possible to safely train non-dominant hands for difficult tasks away from the operating room, which would be a fruitful addition to residency training programs.

Optical coherence tomography angiography in juvenile open angle glaucoma: correlation between structure and perfusion.

PURPOSE: Juvenile open angle glaucoma (JOAG) is a type of glaucoma that occurs in patients younger than 40 years. Only a few studies have assessed vascular perfusion in JOAG and correlated it with structural damage. The aim of this study is to investigate vascular perfusion in JOAG by optical coherence tomography angiography (OCTA) and correlate it with structural damage, represented by retinal nerve fiber layer (RNFL) thinning. METHODS: This is a cross-sectional observational study of 25 eyes of patients with JOAG. All patients underwent full ocular examination and scanning by OCTA to measure parameters such as RNFL thickness, peripapillary and disk vascular density. RESULTS: Average superior and inferior RNFL thicknesses were 69.4 (± 22.1) and 70.4 (± 25.6) µm, whereas peripapillary and disk vascular densities were 38.2(± 10), and 39.1(± 12) % and superior and inferior vascular densities were 38.1(± 10.5) and 38.2(± 9.7) %. A strong positive correlation was found between the superior and inferior RNFL thickness and the vascular density of the peripapillary region, the disk and the superior and inferior vascular densities (p < 0.001 for all). CONCLUSION: OCTA parameters are strongly correlated with structural damage in JOAG patients. OCTA can serve as a helpful tool in the diagnosis and assessment of progression in JOAG and be utilized as a prognostic indicator, thus filling the defects and gaps present in other methods of assessment.

Value of Microperimetry in Detecting Early Retinal Toxicity of Hydroxychloroquine in Children with Juvenile Systemic Lupus Erythematosus.

PURPOSE: To evaluate retinal sensitivity in children who are on hydroxychloroquine (HCQ) for systemic lupus erythematosus using microperimetry and compare the results with those of the Humphrey visual field (HVF) 10-2 and spectral-domain optical coherence tomography (SD-OCT). PROCEDURE: A case-control cross-sectional study including 19 patients (less than 18 years old) on HCQ for at least 5 years. Controls were 21 normal children. Participants underwent a complete ophthalmic examination, then were investigated using HVF 10-2, SD-OCT, and microperimetry. RESULTS: Ocular examination revealed no abnormalities. The overall mean microperimetry sensitivity of the patients (15.75 dB) was not significantly different from that of the controls (16.35 dB). The HVF 10-2 showed a significant difference in the mean deviation of the patients. Conclusions and Message: Microperimetry was not more revealing than HVF 10-2 and SD-OCT. Larger studies are required to compare the diagnostic accuracy of screening modalities of retinal toxicity in children on HCQ.

Causes of suboptimal corrected visual acuity following phacoemulsification in a teaching university hospital.

PURPOSE: Cataract is the leading cause of reversible blindness in developing countries, with variable visual outcome following surgery. This work aims at assessing the outcomes of cataract surgery at Kasr Al Ainy Hospital and identifying the reasons for borderline and poor outcome in the studied group. METHODS: A total of 150 eyes of patients with cataract and no other ocular pathology were included in this study. Uncorrected visual acuity (UCVA) and corrected visual acuity (CVA), complete ocular examination using slit-lamp, applanation tonometry, and ophthalmoscopy were performed for all patients. Biometry for intraocular lens power calculation and operative data were recorded. Patients were followed for 6 weeks; UCVA, CVA, and any complications were noted. RESULTS: Mean preoperative CVA was 0.16 ± 0.16 (SD) and mean postoperative CVA was 0.66 ± 0.33 (p<0.001). Forty-two percent of surgeries were performed by junior staff under training. Thirty-five surgeries were complicated by posterior capsular rupture. Mean CVA at 6 weeks in the uncomplicated group was 0.77 ± 0.22; in the complicated group, 0.28 ± 0.34 (p<0.001). Biometry was accurate in 51.6% of cases. Most important causes for suboptimal outcome were aphakia, astigmatism, posterior capsular opacification, and corneal edema. CONCLUSIONS: Kasr Al Ainy Hospital achieved CVA 6/9 or more in 69.3% and CVA 6/18 or more in 81.3% of patients. The capsular complication rate was high at 23.3%. The high complication rate is attributed to the nature of the teaching hospital where most surgeons were in their learning periods.

Orbital epidermoid cysts: a diagnosis to consider.

Background. Orbital epidermoids form a rare pathological entity that is separate from dermoid cysts. They have variable clinical and radiological presentations and they should be considered in the differential diagnosis of orbital cystic lesions. This work describes the various clinical and radiological presentations of 17 cases of epidermoid cysts and the surgical outcome. Method. A prospective interventional study was conducted on 17 patients diagnosed with epidermoid cysts. Patients' symptoms and signs were recorded; CT scan was done for all patients. All lesions were removed through anterior orbitotomy and histopathological diagnosis confirmed. Results. Mean age of patients was 16.3 years ± 10.54. Main complaints were lid swelling, masses, ocular dissimilarity, chronic pain, and ocular protrusion. Clinical signs varied from lid swelling and masses in all cases to proptosis, globe displacement, limitation of ocular motility, and scars. Radiological findings ranged from homogenous hypodense masses (58.8%) to homogenous radiolucent (17.6%) and heterogenous masses (23.5%). No recurrences following surgeries were reported throughout the follow-up (mean 18.8 months ± 0.72). Conclusion. Deep orbital epidemoid cysts are a separate entity that can behave like deep orbital epidermoid; however, they usually present at a relatively older age. They can be associated with increased orbital volume but not necessarily related to bony sutures.

Selective laser trabeculoplasty in Egyptian patients with primary open-angle glaucoma.

PURPOSE: To assess the change in intraocular pressure (IOP) in Egyptian patients after selective laser trabeculoplasty (SLT) as a primary or adjunctive treatment for primary open-angle glaucoma (POAG). MATERIALS AND METHODS: One hundred and six eyes with POAG were enrolled in this prospective study. Patients were divided into two groups: recently diagnosed cases with no preoperative medications (group 1) and; patients with confirmed glaucoma on medical therapy (group 2). All patients underwent 360° SLT. Patients were evaluated to 18 months postoperatively. Data were analyzed on postoperative changes in IOP, number of medications and complications. A P-value less than 0.05 was statistically significant. RESULTS: A statistically significant drop in IOP occurred, from 19.55 ± 4.8 mmHg preoperatively, to 16.03 ± 2.8 mmHg postoperatively (P < 0.001). Each group had a statistically significant drop in IOP (P < 0.001). There was a statistically significant decrease in the number of medications in group 2 from 2.25 ± 0.97 medications preoperatively to 1.0 ± 1.3 medications postoperatively (P = 0.004). No serious complications occurred for the duration of the study. CONCLUSION: SLT can be safely and effectively used as primary or adjunctive therapy for the treatment of POAG.