Effect of fine-motor-skill activities on surgical simulator performance.

PURPOSE: To determine the effect of fine motor activity and nondominant-hand training on cataract surgical simulator (Eyesi) performance. SETTING: Departments of Ophthalmology, University of Iowa, and Veterans Affairs Health Care Systems, Iowa City, Iowa, USA. DESIGN: Prospective controlled trial. METHODS: Medical students completed a questionnaire and baseline microsurgical dexterity evaluation using the following 3 surgical simulator tasks: navigation, forceps, and bimanual. Participants were randomized to control (16) or intervention (17) consisting of writing, completing a labyrinth, eating, and brushing teeth once per day with their nondominant hand. Participants returned 4 weeks after baseline evaluation for follow-up simulator testing. RESULTS: Of the 33 students, regular video game players had greater baseline scores than nonplayers on navigation (P = .021) and bimanual tasks (P = .089). All participants showed statistically significant improvements in all 3 tasks at follow-up after a single baseline evaluation on the surgical simulator (navigation: P = .004; forceps: P < .001; bimanual: P = .004). Nondominant-hand training with daily activities did not show statistically significant differences for dominant hands or nondominant hands. The intervention group (n = 17) trended toward greater improvement than the control group (n = 16) in navigation (14.78 versus 7.06; P = .445) and bimanual tasks (15.2 versus 6.0; P = .324) at follow-up. CONCLUSIONS: Regular video game play enhanced baseline microsurgical performance measured on the surgical simulator. Simulation performance improved significantly in the intervention group and control group after 1 session on the simulator. Although not statistically significant, training the nondominant hand with daily activities showed a trend toward improved navigation and bimanual performance.

Dermoid cysts: clinical predictors of complex lesions and surgical complications.

PURPOSE: To evaluate the clinical characteristics and role of imaging in the evaluation of dermoid cysts and to determine predictors of cyst rupture during surgical excision of dermoid cysts. METHODS: In this single-center, consecutive, nonrandomized comparative case series, the records of consecutive patients with suspected dermoid cysts who underwent surgery between January 1, 2000, and December 31, 2014, were reviewed retrospectively for demographic information, clinical findings, preoperative imaging, surgical details, and pathology reports. RESULTS: A total of 100 patients were included. Cyst volume was similar between superomedial and superotemporal lesions (P = 0.61) but greater in patients >10 years of age (P < 0.001). Immobility of the cyst was present in all complex dermoids (4/4), but there was no difference in the mobility of superotemporal or superomedial cysts (P = 0.69). Forty-two patients underwent imaging; superomedial lesions were more likely to be imaged than superotemporal lesions (P = 0.073). All 4 patients with complex dermoids presented with orbital signs and underwent preoperative imaging. None of the remaining 38 patients who underwent imaging had orbital signs, and the results of imaging had no effect on surgical planning. Intraoperative cyst rupture occurred in 18 patients. There was no significant difference in cyst rupture between superotemporal and superomedial cysts (P = 0.452). Smaller cyst volume was associated more often with intraoperative cyst rupture (P < 0.001). CONCLUSIONS: Preoperative imaging of superomedial and superolateral dermoid cysts is likely unnecessary unless associated with orbital signs. Intraoperative cyst rupture is not influenced by cyst location but does appear to be more likely in smaller cysts.

CENTRAL RETINAL ARTERY OCCLUSION IN A YOUNG HIV-INFECTED PATIENT ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY.

PURPOSE: To report a case of central retinal artery occlusion (CRAO) in a young human immunodeficiency virus (HIV)-infected patient recently started on highly active antiretroviral therapy. METHODS: Case report observation of a 33-year-old HIV-infected patient who developed a CRAO after starting highly active antiretroviral therapy. RESULTS: Elevated triglycerides caused by starting highly active antiretroviral therapy preceded the development of CRAO in an HIV-infected patient. CONCLUSION: Atherosclerotic vascular disease is an important complication of HIV therapy, which can ultimately lead to cardiovascular disease. An unusual case of a young patient developing a CRAO after the initiation of highly active antiretroviral therapy is reported. In the patient, the authors expound that elevated lipids from efavirenz/emtricitabine/tenofovir resulted in carotid atherosclerosis, ultimately leading to CRAO. Eye care providers, as well as the internal medicine colleagues, should be aware of the possibility of this devastating condition in HIV-infected patients on antiretroviral therapy.

Postoperative hemorrhagic occlusive retinal vasculitis associated with intracameral vancomycin prophylaxis during cataract surgery.

We present the case of a 75-year-old man who had uneventful cataract surgery and administration of intracameral vancomycin for endophthalmitis prophylaxis, followed by the same procedure in the fellow eye 1 week later. The patient subsequently developed bilateral hemorrhagic occlusive retinal vasculitis, resulting in profound vision loss in both eyes. A second case of hemorrhagic occlusive retinal vasculitis previously reported from our institution is summarized. That case was characterized by a far milder course, with rapid resolution of vision loss. The 2 cases illustrate the broad range of toxicity potentially associated with intracameral vancomycin, suggest that bilateral administration results in a worse prognosis, and indicate that this disorder may be underrecognized due to the potential for a mild course. We recommend that intracameral vancomycin not be used for endophthalmitis prophylaxis. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Ischemic Retinal Vasculitis Associated with Cataract Surgery and Intracameral Vancomycin.

Recently, there have been reports suggesting that intracameral vancomycin has been associated with retinal vasculitis; some have described this phenomenon as postoperative hemorrhagic occlusive retinal vasculitis. We present a case of a 65-year-old woman who underwent uncomplicated phacoemulsification and posterior chamber intraocular lens implantation followed by intracameral antibiotic prophylaxis. Unlike prior reports, this report demonstrates a case of mild visual reduction and minimal inflammation with subtle but complete unilateral peripheral retinal ischemia associated with cataract surgery and intracameral vancomycin, suggesting a spectrum of toxicity that may be underrecognized.

Peritoneal dialysis in elderly patients.

People over the age of 80 years are the fastest-growing segment of the population with stage 5 chronic kidney disease, which is dialysis initiation. We set out to describe the experiences of those elderly patients in initiating and being maintained on peritoneal dialysis. We interviewed 4 patients (1 woman, 3 men; time on dialysis: 2-5 years) 75-88 years of age. A predetermined set of questions evaluating 7 domain topics were asked. The topics were initiating dialysis, dialysis knowledge, physical condition, social support, experience of dialysis, psychological support, and coordination of care. These in-depth interviews were analyzed in each category to determine common themes. Within each domain, several themes were identified. The themes most important for physicians to understand to be able to deliver a high level of care to elderly patients on dialysis were the importance of peer and family influence on decision-making, the patient's support system, the patient's integration into the community, and the patient's increased perception of autonomy. Patients in this age group on peritoneal dialysis have strong support systems and an increased perception of autonomy that allows them to be integrated into their community through hobbies and other social engagements.