COVID-19 reduced scleral buckling training in fellows and shifted young ophthalmologists' preference toward vitrectomy: An Asia-Pacific survey.

BACKGROUND: To assess rhegmatogenous retinal detachment (RRD) surgery trends and training among young ophthalmologists (YOs, vitreoretinal fellows or attendings/consultants with ≤10 years of independent practice) and the impact of the COVID-19 pandemic. METHODS: An anonymous online survey was completed by 117 YOs in the Asia-Pacific regarding their RRD surgery experiences in 2021-2022. RESULTS: To achieve a 90% probability of surgical competency, 91 vitrectomy and 34 scleral buckling (SB) completions during fellowship were needed. In total, 49 (41.9%) YOs had fellowship affected by COVID-19. In the COVID versus pre-COVID era, however, the volume of SB completions per fellowship year decreased significantly (median [IQR] 3.3 [1.5, 9] vs. 13 [6.5, 23]; p < 0.001) and was lower than the required volume to achieve competency. YOs were less confident in conducting SB versus vitrectomy (3.5 ± 1.1 vs. 4.2 ± 0.8, p < 0.001), and they reported a decrease in the proportion of SB (-3.1%, p = 0.047) and an increase in the proportion of vitrectomy (+4.8%, p < 0.001) after the pandemic outbreak. Apart from RRD clinical characteristics, surgical confidence is among the main factors that affect surgical method decisions. During the pandemic, more YOs may have avoided SB due to the need for general anaesthesia, leading to longer surgical time and risk of viral transmission during intubation/extubation. CONCLUSIONS: SB surgical exposure is suboptimal in most fellowship programs in the 11 Asia-Pacific countries/regions we surveyed and further declined during the COVID-19 pandemic. YOs are less confident in performing SB, leading to a trend toward primary vitrectomy since the COVID-19 outbreak.

FULL-THICKNESS MACULAR HOLE SECONDARY TO LIVE INTRAOCULAR FILARIAL WORM: A NOVEL CLINICAL ASSOCIATION.

PURPOSE: To report a unique case of live intraocular filarial worm leading to development of a full-thickness macular hole (FTMH). METHODS: An 18-year-old woman presented with decreased vision in the right eye of 1 week duration. Her best-corrected visual acuity in the right eye was 6/24, whereas it was 6/6 in the left eye. Clinically, there was presence of a live intravitreal worm with FTMH and inferior retinal track marks in the right eye, whereas the left eye was normal. Spectral-domain optical coherence tomography of the right eye established the FTMH with hyperreflective debris at its base. The patient underwent right eye vitrectomy with worm retrieval in-toto followed by an internal limiting membrane peel and 15% sulfur hexafluoride gas injection. The worm sample was sent for histopathological analysis. RESULTS: At 1 month, the patient had successive closure of FTMH with improvement in the visual acuity upto 6/6 in the right eye. Histopathology confirmed the worm as Wuchereria bancrofti . CONCLUSION: Presence of a live worm in posterior segment can precipitate formation of a FTMH. Possible reasons for development of MH could be secondary to subclinical trauma induced by excessive whipping movements of the worm in the subretinal space or by triggering an acute posterior vitreous detachment.