Beyond the Surface: A Systematic Review of Perforating and Penetrating Globe Injuries From Blepharoplasty.

PURPOSE: This study aims to address the infrequent but serious complication of globe injuries in blepharoplasty. METHODS: A case series of 3 patients with globe injuries postblepharoplasty is presented, along with a systematic literature review that revealed 13 previously reported cases. Quantitative and comparative analysis is described. RESULTS: Injuries ranged from deep thermal burns to full-thickness corneal or scleral lacerations, with one instance of traumatic cataract. The median time from surgery to symptom onset was 1 day, with a concerning median delay of 7 days to presentation to an ophthalmologist. Visual outcomes were generally poor, with nearly all patients experiencing permanent visual morbidity. The systematic review revealed 3 cases of endophthalmitis following perforating scleral injuries. Comparative analysis showed no significant differences in visual outcomes between penetrating and perforating injuries. CONCLUSIONS: The findings of this study emphasize the need for increased vigilance for globe injuries that require prompt ophthalmological evaluation following blepharoplasty, especially considering the observed delay in presentation and the extent of visual morbidity. The study advocates for improved practitioner training in recognizing and managing these complications and underscores the importance of patient education regarding the potential risks and the necessity of timely postoperative care.

Quintuple Procedure for Ocular Surface Reconstruction and Visual Rehabilitation.

PURPOSE: The aim of this study was to describe a combined surgical approach for ocular surface and visual rehabilitation in patients with limbal stem cell deficiency, corneal scarring, and cataract. We aimed to introduce this combined approach as an alternative to a staged approach and to describe the intraoperative use of a diamond ophthalmic burr (DOB) and optical coherence tomography (OCT) to achieve and confirm a smooth graft-host interface during the anterior lamellar keratoplasty (ALK) portion of the procedure. METHODS: The quintuple procedure described herein consists of a modified ALK, cataract extraction, intraocular lens implantation, simple limbal epithelial transplantation, and temporal tarsorrhaphy. Intraoperative OCT and DOB were used to guide the creation of the stromal bed during the ALK. The procedure was performed in a patient with limbal stem cell deficiency and corneal scarring after a chemical ocular burn. RESULTS: The tarsorrhaphy was removed at 3 months postoperatively once complete corneal epithelialization was observed. The best-corrected visual acuity improved from light perception preoperatively to 20/30 at 16 months postoperatively with the use of scleral contact lenses. At this postoperative time point, the cornea was clear and compact, and the ocular surface was stable. CONCLUSIONS: The quintuple procedure allowed for visual and ocular surface rehabilitation in cases in which follow-up for a staged approach was not possible. Intraoperative OCT allowed for real-time visualization and dissection of the stromal bed, whereas the use of the DOB helped achieve a smooth stromal surface for an optimal graft-host interface.

Trends in keratoplasty from central and Northern India. Part I: Indications for keratoplasty.

PURPOSE: To report the indications for keratoplasty and analyze trends in two decades in India. METHODS: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and northern India from 2005 to 2021. The patterns of corneal pathology and changes in trends were analyzed. RESULTS: Between 2005 and 2021, 13223 corneal grafts were performed in the six collaborating tertiary eye care centers. The most common indication for keratoplasty in both decades was corneal ulcer (41.1%), followed by corneal scar (25.5%), failed graft (12.0%), post-cataract surgery corneal edema (11.7%), corneal dystrophies (3.1%), corneal ectasia (1.8%), corneal trauma (0.3%), congenital corneal opacity (0.3%), and others (4.1%). An increasing trend was seen in corneal ulcers, failed grafts, and keratoconus. A reducing trend was seen in corneal scar and aphakic bullous keratopathy. There was no change in pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy. CONCLUSION: Corneal ulcers, corneal scars, failed grafts, and post-cataract surgery corneal edema remained the foremost indications for keratoplasty in two decades in India. An increasing trend was seen in corneal ulcers and failed grafts which are of concern as these indications carry a poorer outcome. Capacity building in lamellar keratoplasty techniques is the need of the hour as pseudophakic bullous keratopathy was an important indication, and an increasing trend was noticed in keratoconus.

Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India.

Purpose: To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods: A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted. Results: Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion: Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.

Corneal regeneration strategies: From stem cell therapy to tissue engineered stem cell scaffolds.

Corneal epithelial defects and excessive wound healing might lead to severe complications. As stem cells can self-renew infinitely, they are a promising solution for regenerating the corneal epithelium and treating severe corneal epithelial injury. The chemical and biophysical properties of biological scaffolds, such as the amniotic membrane, fibrin, and hydrogels, can provide the necessary signals for stem cell proliferation and differentiation. Multiple researchers have conducted investigations on these scaffolds and evaluated them as potential therapeutic interventions for corneal disorders. These studies have identified various inherent benefits and drawbacks associated with these scaffolds. In this study, we provided a comprehensive overview of the history and use of various stem cells in corneal repair. We mainly discussed biological scaffolds that are used in stem cell transplantation and innovative materials that are under investigation.

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in Keratoconic Eyes With Previous Hydrops-Related Corneal Scar.

PURPOSE: This study aimed to compare the outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) procedures in keratoconic eyes with a previous hydrops-related corneal scar. METHODS: In this retrospective study, the medical records of patients who had hydrops-related corneal scarring and underwent keratoplasty surgery were reviewed. Patients treated with DALK were classified as group 1, and patients treated with PK as group 2. Preoperative and postoperative best-corrected visual acuity, central corneal thickness, keratometry (K), and refractive error values of each group were recorded and compared. RESULTS: Seventy-eight eyes (41 in group 1 and 37 in group 2) were included in this study. The mean follow-up period of the patients was 37.7 ± 30.0 months in group 1 and 51.2 ± 29.4 months in group 2 ( P = 0.06). The preoperative and postoperative best-corrected visual acuity and central corneal thickness values were statistically similar in both groups (each P value >0.05). Keratometry values (K1 and mean keratometry) were significantly steeper in group 1 ( P1 = 0.02 and P2 = 0.03, respectively). Descemet membrane perforation was experienced in 7 (4 macroperforation and 3 microperforation; 15.6%) of 45 eyes that planned to perform DALK. These 4 eyes with macroperforation underwent PK and were excluded from the study. When all postoperative complications were assessed, although the total complication rate was 21% after DALK, it was 43% after PK ( P = 0.04). CONCLUSIONS: DALK with a big-bubble technique is a feasible surgery in eyes with corneal scarring due to previous hydrops and is comparable with PK in terms of visual and refractive outcomes. This study suggests that DALK, which is safer than PK with less postoperative complication rates, should be the primary surgical option to avoid serious complications in keratoconic eyes with hydrops-related corneal scarring.

Scleral Lens Applications Focused on Korean Patients with Various Corneal Disorders.

PURPOSE: We aimed to report on the clinical outcomes of scleral lens applications in Korean patients with various corneal disorders. METHODS: This retrospective review was conducted for 62 eyes of 47 patients who had been fitted with scleral lenses for various corneal disorders. The patients were referred for inadequate spectacle-corrected visual acuity and rigid gas permeable (RGP) or soft contact lens intolerance. Uncorrected visual acuity, habitually corrected visual acuity, best lens-corrected visual acuity, topographic indices, keratometry indices, and lens parameters were evaluated. RESULTS: Twenty-six eyes of 19 patients with keratoconus were enrolled. Other conditions included corneal scar (13 eyes of 12 patients), phlyctenules (three eyes), laceration (four eyes), chemical burn (one eye), keratitis (one eye), Peters' anomaly (one eye), fibrous dysplasia (one eye), ocular graft-versus-host disease (two eyes of one patient), irregular astigmatism (18 eyes of 12 patients), and corneal transplant status (five eyes of four patients). The mean topographic values of the eyes include flat keratometric value (43.0 ± 6.1 diopters [D]), steep keratometric value (48.0 ± 7.4 D), and astigmatism (4.9 ± 3.6 D). Of the eyes fitted with scleral lenses, best lens-corrected visual acuity (0.10 ± 0.22 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the habitually corrected visual acuity (0.59 ± 0.62 logMAR, p < 0.001). CONCLUSIONS: Scleral contact lenses are a good alternative for patients with corneal abnormalities and those who are intolerable to RGP contact lenses, resulting in both successful visual outcomes and patient satisfaction, especially concerning keratoconus, corneal scar, and corneal transplant status.

Presenting clinical characteristics of open globe injuries in ocular trauma: baseline analysis of cases in the ASCOT national clinical trial.

BACKGROUND/OBJECTIVES: The Adjunctive Steroid Combination in Ocular Trauma (ASCOT) trial is a unique pragmatic, multi-centre, patient and assessor masked, randomised controlled trial. We evaluate the clinical characteristics and pathology of this large trial cohort of patients with open globe injuries undergoing vitreoretinal surgery, including the associations between patient characteristics and their baseline vision. SUBJECTS/METHODS: We (i) summarise demographics, injury history and ocular history of the 280 participants recruited into the ASCOT trial using descriptive statistics; (ii) analyse the national and seasonal variation across England and Scotland in these participant characteristics; and (iii) explore the associations between participant demographic, trauma history, ocular history and presenting baseline visual acuity (measured using the Early Treatment Diabetic Retinopathy Study, ETDRS) using multivariable regression analyses. RESULTS: The majority of participants with open globe penetrating injuries were of white ethnicity (233, 84%), male (246, 88%), with a median age of 43 years (IQR 30-55 years). There was considerable variability in presenting visual acuity with 75% unable to read any letters on the ETDRS chart, whilst the median ETDRS letter score was 58 (IQR 24-80) for those who could read ≥1 letter. The most common causes of injury were workplace related (31%) or interpersonal violence (24%). Previous eye surgery, visual axis corneal scar, lens status, hyphaemia and vitreous haemorrhaging were found to be associated with presenting vision as measured by the ETDRS chart. CONCLUSION: The ASCOT trial provides valuable insights into the spectrum of pathology of patients with open globe eye injuries undergoing vitreoretinal surgery. The identified causes of injury and clinical presentation of the cases will help in training and resource planning to deal with these often challenging surgical cases. TRIAL REGISTRATION: EudraCT No. 014-002193-37. HTA Project 12/35/64.

Modified Continuous Suturing Technique for Amniotic Membrane Fixation after Chemical Corneal Injury: An Octagonal Graft.

This case report aims to describe a modified continuous suturing technique for firm fixation of a human amniotic membrane graft in a patient with persistent epithelial defect (PED) after a chemical eye injury. As a result of this technique, the amniotic membrane (AM) was firmly fixed to the corneal surface with eight continuous and locked episcleral sutures that resembled an octagon graft. This technique was performed in a 14-year-old patient with PED after a chemical corneal burn. Three weeks after the surgery, the PED was completely healed. This simple continuous suturing technique can allow firm and stable fixation of AM grafts on the ocular surface in cases of PED after chemical burn. It may prevent early loss of the graft and facilitate corneal epithelial wound healing.

Resveratrol increases tear production and ocular pain after corneal abrasion in male, but not female, rats using a photorefractive keratectomy model.

Photorefractive keratectomy (PRK) is an alternative to LASIK and can cause intense acute pain that is often not relieved by standard treatments. To assess potential therapeutics for this type of acute pain, appropriate preclinical models are needed. We describe a preclinical corneal abrasion rat model that simulates the initial stages of PRK surgery and demonstrates similar pain and tear dysfunction as seen clinically. We used both behavioral and homeostatic assays to determine the therapeutic potential of resveratrol on pain and tear production. Studies were conducted in male and female Sprague-Dawley rats. Heptanol was applied to one eye and the superficial corneal epithelium was removed, mimicking the abrasion used in PRK. Spontaneous pain was assessed with orbital tightening (OT) scores for 7 days. Topical resveratrol increased OT scores sex-specifically in abraded males, but not females, at 72 h and 1 week after abrasion. Resveratrol increased tear production in abraded males, with no effect in abraded females. There was no correlation between OT score at 1 week and tear production measurements, demonstrating no relationship between spontaneous ocular pain and tear dysfunction in this model. These findings demonstrate the usefulness of our corneal abrasion preclinical PRK model for the assessment of ocular pain therapeutics and indicate that topical resveratrol may not be useful for managing PRK-induced pain.

Influences of SMILE and FS-LASIK on Corneal Sub-basal Nerves: A Systematic Review and Network Meta-analysis.

PURPOSE: To compare postoperative corneal sub-basal nerve density and number between small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: A search was made in PubMed, EMBASE, and the Cochrane library for prospective comparative studies. The analysis was divided into two parts: network meta-analysis and traditional meta-analysis of the studies directly comparing two surgical groups. Stata 16 (Stata Corporation) and Rev-Man 5.4 (Cochrane) software were used to analyze the data. RESULTS: Twelve studies (n = 775) were included. In the network meta-analysis, the SMILE group showed a significant increase compared with the FS-LASIK group in corneal nerve density at 1 month postoperatively (mean: 4.23; 95% CI: 0.06 to 8.39, P < .05), and in the number of corneal nerve trunks at 6 months postoperatively (mean: 13.25; 95% CI: 10.20 to 16.30, P < .05). In the traditional meta-analysis, the SMILE group showed significant improvement compared with the FS-LASIK group in corneal nerve density at 1 (weighted mean difference [WMD]: -2.05, 95% CI: -3.11 to -1.00, P < .05) and 3 (WMD: -0.90, 95% CI: -1.30 to -0.50, P < .05) months postoperatively, and in the number of corneal nerve trunks (WMD: -2.52, 95% CI: -4.91 to -0.14, P < .05) and corneal nerve branches (WMD: -2.80, 95% CI: -3.41 to -2.19, P < .05) at 1 month postoperatively. CONCLUSIONS: The corneal nerve injury in the FS-LASIK group was worse than that in the SMILE group. The corneal nerve recovery in the SMILE group was better at 3 months postoperatively. However, there was no significant difference in corneal nerve density and number between the two groups at 6 months postoperatively. [J Refract Surg. 2022;38(4):277-284.].

Autologous tenon plug and patch in phacoburn.

This 75-year-old woman had phacomorphic angle closure, dense nuclear sclerosis, deep set eye, miotic pupil and tight corneal wound during phacoemulsification. Phacoemulsification wound burn was noted at the end of surgery. Tenon was harvested from the inferior conjunctiva, placed over the gape and anchored by two radial corneoscleral 10-0 nylon. Ten days later, anterior optical coherence tomography showed good wound apposition and sutures were removed with visual recovery to 20/25 (6/7.5) without astigmatism.

Y-27632 Promotes the Repair Effect of Umbilical Cord Blood-Derived Endothelial Progenitor Cells on Corneal Endothelial Wound Healing.

PURPOSE: To investigate the proliferation of umbilical cord blood-derived endothelial progenitor cells (UCB EPCs) and the differentiation efficiency toward corneal endothelial cell (CEC)-like cells induced by rho-associated protein kinase (ROCK) inhibitor Y-27632 and to determine the most effective strategy for repairing corneal endothelium injuries in rabbits. METHODS: UCB EPCs were cultured in Endothelial Cell Growth Medium-2 (EGM-2) media or conditioned media (CM) from human CECs, with and without the addition of Y-27632. Bromo-deoxyuridine (BrdU) immunocytochemistry and cell counting kit-8 assays were used to examine the proliferation of the cells. Real-time polymerase chain reaction, western blot, and immunocytochemistry were used to detect the CEC markers. Nd:YAG laser was used to establish an appropriate endothelium injury model based on rabbit corneas. The following intracameral injections were then performed to repair the model: 100 µL Opti-MEM I reduced serum medium (model group), 2 × 105 UCB EPCs diluted in 100 µL Opti-MEM I reduced serum medium (EPC group), 100 µM Y-27632 diluted in 100 µL Opti-MEM I reduced serum medium (Y-27632 group), and 2 × 105 UCB EPCs supplemented with 100 µM Y-27632 (final volume 100 µL, EPC/Y-27632 group). The follow-up tests focused on corneal transparency, central corneal thickness, intraocular pressure, and in vivo confocal microscopy, which were performed to evaluate the healing of the wounds. RESULTS: Culturing UCB EPCs in CM supplemented with 10 µM Y-27632 resulted in higher proliferation rates compared with EGM-2 media and CM. There were significantly improved protein levels of Zona Occludens 1, N-cadherin, Na+-K+-ATPase α1, Na+-K+-ATPase ß1, and Pax6 and improved mRNA levels of collagen type IV and VIII and AQP1. The combined intracameral injection of Y-27632 and UCB EPCs accelerated the recovery of corneal transparency, regression of corneal edema, and healing of the corneal endothelium compared with the injections of Y-27632 and UCB EPCs on their own. CONCLUSIONS: Y-27632 not only promotes the proliferation of UCB EPCs but also contributes to differentiation of UCB EPCs toward CECs in the presence of CM. The intracameral injection of Y-27632 itself promotes the healing of corneal endothelium wounds. On this basis, supplementing UCB EPCs with Y-27632 accelerates the healing of corneal endothelium wounds.

Lamellar Dissection Technique for Traumatic Cataract With Corneal Incarceration.

PURPOSE: To describe a technique for traumatic cataract management for cases in which part of the anterior capsule has been incarcerated into a healed corneal laceration. METHODS: This is a single-center retrospective chart review of 3 patients with capsular/corneal incarceration after penetrating injury. Each patient underwent primary globe repair, followed by subsequent cataract surgery with intraocular lens (IOL) and iris prosthesis placement. The main outcome measure was corrected distance visual acuity. RESULTS: At a mean of 19-month postoperative follow-up (range 12-26 mo), corrected distance visual acuity ranged from 20/25 to 20/80 and all patients had improved vision compared with before cataract surgery. At the final follow-up, all IOLs and iris prostheses were in stable position and no eyes required corneal transplantation. CONCLUSIONS: Traumatic cataracts may be complicated by incarceration of the anterior capsule into the cornea. Incorporating the posterior aspect of the cornea into the anterior capsulotomy enables cataract removal and IOL placement in a stable capsular bag complex.

Combined Penetrating Keratoplasty Followed by Pars Plana Vitrectomy for Firecracker Induced Bilateral Corneal and Intraocular Foreign Body: A Case Report.

Firecracker induced open globe injury is a big challenge for ophthalmic surgeons. Its association with the intraocular foreign body makes the diagnosis and treatment even more difficult resulting in poor anatomical and visual outcomes. We report a case of a 35-year-old male who presented with bilateral, multiple corneal and intraocular foreign body due to firecracker explosion. His vision was limited to hand movement in both eyes. Combined penetrating keratoplasty and cataract surgery were done in both eyes followed by pars plana vitrectomy for intraocular foreign body removal. The final best-corrected visual acuity of the patient stood to be 6/6 and 6/9 in the right and left eye respectively. The encouraging result in our case prompts ophthalmologists for a timely stepwise multidisciplinary approach in all open globe injuries with intraocular foreign body cases having poor initial acuity.

Effects of Cisatracurium, Rocuronium, and Mivacurium on Intraocular Pressure During Induction of General Anesthesia in Ophthalmic Surgery.

OBJECTIVE: Maintaining intraocular pressure (IOP) is important in preventing ocular complications in patients undergoing ophthalmic surgery for general anesthesia. The effects of non-depolarizing neuromuscular blockers on IOP remain unclear. The present study compared the effects of cisatracurium, rocuronium, and mivacurium on IOP during induction of general anesthesia in vitreous retinal surgery. MATERIALS AND METHODS: In this prospective randomized double-blinded study, 133 patients undergoing vitreous retinal surgery were randomized into one of the three groups: Group cisatracurium (n=45), Group rocuronium (n=44), or Group mivacurium (n=44). Each drug (cisatracurium 0.1 mg kg-1 in Group cisatracurium, rocuronium 0.6 mg kg-1 in Group rocuronium, and mivacurium 0.2 mg kg-1 in Group mivacurium) was administered during induction of anesthesia. IOP and hemodynamic parameters were measured at 1 min before anesthesia induction (T0). Bispectral index (BIS) was maintained between 45 and 55 after propofol administration (T1). Train-of-four stimulation (TOF) was below 0 after muscle relaxant administration (T2) and after laryngeal mask implantation (T3). RESULTS: Both ipsi-operative and control-operative IOP at T1, T2, and T3 significantly decreased from the baseline values (T0) in all three groups (P<0.05). The IOP changes between T1 and T2 among three groups were similar (P>0.05). The values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T1 and T2 significantly decreased in all three groups compared to T0 (P<0.05). CONCLUSION: Bilateral IOP significantly decreased from the baseline values in all three groups during the induction phase. Cisatracurium, rocuronium, and mivacurium did not induce significant changes in bilateral IOP.

A low cost surrogate eye model for corneal foreign body removal.

BACKGROUND: Patients commonly present to the Emergency Department with a corneal foreign body (FB). There is currently a lack of adequate training for junior doctors in the management of this condition. Our self-made surrogate eye model aims to address this void in our junior doctors' knowledge. METHODS: Participants were guided through a hands-on session with a slit-lamp using our eye model, which is made of a hemispherical agar embedded with pencil lead fragments simulating as FBs. Using a 7-point Likert scale, all participants completed a questionnaire both before and after training, for: (1) knowledge in corneal FB removal, (2) confidence in corneal FB removal, and (3) effectiveness of the model. RESULTS: Out of 73 participants, 82.2% (60/73) had no prior experience in corneal FBs removal. After the training session, their knowledge improved from a median score of 2 (interquartile range [IQR] 1 to 3) to 5 (IQR 5 to 6), with improvement in confidence levels from 2 (IQR 1 to 2) to 5 (IQR 4 to 6). The effectiveness of our eye model scored a median of 6 (IQR 5 to 7). CONCLUSIONS: Our surrogate eye model is low-cost, quick and easy to reproduce. After use, our learners expressed greater confidence in managing the removal of corneal FBs and use of slit lamp. With a recent focus in patient safety and quality, teaching this procedure via simulation is a safe way of bridging the gap between traditional didactic teaching and the clinical environment.

Cultivated oral mucosal epithelial transplantation (COMET) and penetrating keratoplasty in long-standing severe ocular surface injury.

Ocular chemical injury is a true ophthalmic emergency requiring immediate medical intervention. Damages can be devastating and potentially resulting in blindness, corneal perforation and phthisis bulbi. We describe here a successful treatment outcome in a patient who sustained Roper-Hall Grade 4 injury to both eyes. Patient received medical therapy followed by serial ocular surgeries with eventual visual recovery in one eye from counting finger to 6/15 after a decade. In conclusion, after maximum medical therapy, a carefully planned serial surgeries of cultivated oral mucosal epithelial transplantation (COMET) and PK has proven beneficial for this patient with advanced limbal stem cell deficiency (LSCD).