Low-tech intraocular ophthalmic microsurgery simulation: A low-cost model for home use.

In order to maintain manual dexterity and surgical skills, trainees are encouraged to partake in regular simulation. Current options for intraocular surgical simulation require specialist microscopic equipment which is expensive and requires access to simulation facilities. A set of core simulation exercises and basic surgical skills of performing the corneal incisions, capsulorhexis, improving the manual dexterity, and suturing were identified, discussed, and agreed among authors before designing this simulation exercise. In this paper, we propose a smartphone-based, low-cost, low-tech model with corresponding exercises for intraocular simulation that can be used at home for the above-mentioned surgical skill set. This model provides an easy, portable, and reproducible method of simulation and can serve as an adjunct to patient-facing surgical training, especially in the current pandemic, where the excess to the simulation facilities or setup of these facilities may be difficult.

Teleophthalmology and COVID-19: the patient perspective.

Oculoplastic services at a UK district general hospital underwent reconfiguration to incorporate teleconsultations during the COVID-19 pandemic, and patient satisfaction was assessed. Methods All oculoplastic patients at Maidstone Hospital underwent telephone or video consultations in place of face-to-face reviews. Patient feedback surveys were conducted. Results 80 telephone and 40 video consultation responses were analysed. The majority of teleconsultations lasted 6-10 minutes. 55% of telephone and 82.5% of video consultation patients felt face-to-face reviews would not have changed the appointment outcome. Satisfaction scores of 10/10 were given by 71.3% of telephone and 72.5% of video consultation patients. Correlation between age and preference of consultation type was observed, with 62.5% of patients aged >65 years requesting regular face-to-face reviews compared to only 18.8% of 25-64-year-olds. Conclusion Patients highly support teleconsultation adaptations. This is an opportunity to incorporate and enhance teleconsultation facilities to meet current and future demand, especially with ongoing social distancing guidelines.

Management of congenital nasolacrimal duct obstruction: results of a national survey of paediatric and oculoplastic ophthalmologists.

BACKGROUND: To survey variation in management of congenital nasolacrimal duct obstruction (CNLDO) by oculoplastic and paediatric ophthalmologists in the UK. METHODS: A 14-question online survey was sent to all members of the British Oculoplastic Surgery Society (BOPSS) and the British and Irish Paediatric Ophthalmology and Strabismus Association (BIPOSA) in February 2020. The aim was to establish preferred primary, secondary and tertiary interventions for CNLDO treatment, with emphasis on the use of nasoendoscopy and ductal intubation. Results were compared with a national survey from 2007 to observe trends in management. RESULTS: One hundred and three responses from single-speciality consultants were analysed. In total, 71.8% of CNLDO patients were assessed by paediatric ophthalmologists. Fluorescein dye disappearance test was the commonest investigation, and paediatric consultants were five times more likely to perform Jones test. No clinicians performed outpatient probing. Age of first intervention was most commonly 12 months, although more interventions are being conducted at younger ages than in 2007. Preferred primary procedure for both subspecialties was syringe and probe under general anaesthetic, with 43.9% of oculoplastic consultants using nasoendoscopy vs 12.9% of paediatric consultants. Most common re-do procedure for both subspecialties was nasoendoscopy-guided syringe and probe ± intubation. In contrast to 2007, dacryocystorhinostomy is now the commonest tertiary procedure, with endonasal approach twice as common as external. CONCLUSION: Despite changes in approach since 2007, there is still considerable variation between oculoplastic and paediatric ophthalmologists regarding treatment preferences for CNLDO, particularly the use of nasoendoscopy. We propose a national audit of CNLDO treatment outcomes to potentially standardise treatment protocols.

Pembrolizumab-related Bilateral Ocular Hypotony, Uveitis, Cataracts, Exudative Retinal, and Choroidal Detachments: An Unusual Success Story.

Here, we report the presentation and management of a rare case of sight-threatening bilateral panuveitis with secondary chronic hypotony, subcapsular cataracts, exudative retinal detachments, and choroidal detachments, following initiation of pembrolizumab immunotherapy for metastatic melanoma. An 82-year-old white woman presented with painful, blurry vision 3 days after initiation of pembrolizumab immunotherapy. She had developed a marked panuveitis causing secondary hypotony. The fundal view was entirely limited by acutely dense cataracts and small, uveitic pupils unresponsive to topical dilation. Urgent cataract surgery with intravitreal dexamethasone implant (Ozurdex) was completed successfully and allowed a fundal examination. This revealed bilateral, symmetrical, inferior exudative retinal detachments, and choroidal detachments secondary to chronic hypotony. After 3 months of observation and cessation of oral steroids, the panuveitis remains quiescent, hypotony persists, and the choroidal and retinal detachments are showing progressive self-resolution. The current best-corrected visual acuity is 6/24 OU. She remains under close monitoring. The immune checkpoint inhibitor, pembrolizumab, has been reported to cause sight-threatening adverse effects. We report a rare case of profound bilateral complications treated successfully with oral and intravitreal steroids. To the authors' knowledge, this has not previously been reported in the literature. Ophthalmologists and oncologists should be aware of the ocular effects of pembrolizumab and be able to identify various complications early. Here, cataract surgery with a steroid implant has been an effective sight-saving intervention. The promising visual outcome makes this an unusual success story.

Alzheimer-related decrease in CYFIP2 links amyloid production to tau hyperphosphorylation and memory loss.

Characteristic features of Alzheimer's disease are memory loss, plaques resulting from abnormal processing of amyloid precursor protein (APP), and presence of neurofibrillary tangles and dystrophic neurites containing hyperphosphorylated tau. Currently, it is not known what links these abnormalities together. Cytoplasmic FMR1 interacting protein 2 (CYFIP2) has been suggested to regulate mRNA translation at synapses and this may include local synthesis of APP and alpha-calcium/calmodulin-dependent kinase II, a kinase that can phosphorylate tau. Further, CYFIP2 is part of the Wiskott-Aldrich syndrome protein-family verprolin-homologous protein complex, which has been implicated in actin polymerization at synapses, a process thought to be required for memory formation. Our previous studies on p25 dysregulation put forward the hypothesis that CYFIP2 expression is reduced in Alzheimer's disease and that this contributes to memory impairment, abnormal APP processing and tau hyperphosphorylation. Here, we tested this hypothesis. First, in post-mortem tissue CYFIP2 expression was reduced by ∼50% in severe Alzheimer's hippocampus and superior temporal gyrus when normalized to expression of a neuronal or synaptic marker protein. Interestingly, there was also a trend for decreased expression in mild Alzheimer's disease hippocampus. Second, CYFIP2 expression was reduced in old but not in young Tg2576 mice, a model of familial Alzheimer's disease. Finally, we tested the direct impact of reduced CYFIP2 expression in heterozygous null mutant mice. We found that in hippocampus this reduced expression causes an increase in APP and ß-site amyloid precursor protein cleaving enzyme 1 (BACE1) protein, but not mRNA expression, and elevates production of amyloid-ß42 Reduced CYFIP2 expression also increases alpha-calcium/calmodulin-dependent kinase II protein expression, and this is associated with hyperphosphorylation of tau at serine-214. The reduced expression also impairs spine maturity without affecting spine density in apical dendrites of CA1 pyramidal neurons. Furthermore, the reduced expression prevents retention of spatial memory in the water maze. Taken together, our findings indicate that reduced CYFIP2 expression triggers a cascade of change towards Alzheimer's disease, including amyloid production, tau hyperphosphorylation and memory loss. We therefore suggest that CYFIP2 could be a potential hub for targeting treatment of the disease.