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.

Retinal Sensitivity before and after Silicone Oil Removal Using Microperimetry.

The purpose of the study is to assess the retinal sensitivity, using microperimetry, before and after silicone removal. It included 22 patients admitted for silicone removal after vitrectomy for macula-off retinal detachment. Patients were divided into 2 groups according to the duration of silicone tamponade: Group A: <3 months (included 10 patients), and Group B: 3-6 months (included 12 patients). Retinal sensitivity was tested, using microperimetry, one day before and one month after silicone removal. The best-corrected visual acuity (in LogMAR) significantly improved postoperatively (0.69 versus 1.06 and 0.69 versus 1.07 in Groups A and B, respectively). The mean intraocular pressure (IOP) was 12.89 ± 1.05 mmHg postoperatively versus 14.89 ± 1.76 mmHg preoperatively in Group A (p=0.011) and was 13.33 ± 1.30 mmHg postoperatively versus 15.33 ± 3.11 mmHg preoperatively in Group B (p=0.008). In Group A, the mean postoperative overall retinal sensitivity was 8.70 ± 2.56 dB versus 5.68 ± 2.00 dB preoperatively (p=0.008). In Group B, it was 9.83 ± 3.36 dB versus 7.00 ± 2.55 dB (p=0.002). No statistically significant difference was found between the two groups as regards improvement in overall retinal sensitivity. We concluded that the overall retinal sensitivity significantly increased following silicone removal in both groups. This trial is registered with ISRCTN43187564.