Oculoplastic surgical simulation using goat sockets.

PURPOSE: To describe a reproducible and easily available goat socket model for training of various oculoplastic operations, and to evaluate trainees' perception of this training model in terms of their learning progress and satisfaction. METHODS: Goat sockets including orbital rim and eye with eyelids were harvested in form of a split-head model. Ophthalmology residents underwent individual surgical training using the goat socket model, supervised by an oculoplastic attending. Participants completed a questionnaire in form of a 5-point Likert Scale to evaluate their learning progress and satisfaction. OUTCOME MEASURES: Types of oculoplastic operations performed using the goat socket models, and participants' rating of their learning progress and satisfaction were reported. RESULTS: A wide range of oculoplastic operations including both eyelid and orbital operations could be simulated because of similarities of the goat eye model to the human eye anatomy. Fifteen ophthalmic trainees participated in surgical training using the goat eye model. All (100%) participants agreed that surgical simulation using the goat socket model increased their skills in surgical instrumentation and carrying out surgical steps, and their confidence in operating on patients. Most (87%) agreed the model resembled reasonably well compared to surgeries in human, and 93% would recommend training with the model to fellow resident ophthalmologists before operating on human patients. CONCLUSIONS: Oculoplastic surgical training using goat sockets is simple, readily available, and inexpensive. Trainee users showed promising feedback and positive learning progress using the goat socket model.

Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong.

At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.

Self-retaining magnetic implant: A novel design of orbital prosthesis for the exenterated orbit.

Orbital exenteration can lead to significant disfigurement causing considerable functional, cosmetic and psychological disturbances to the patient. Orbital prosthesis is important for the patient's cosmetic and psychological rehabilitation. A 49-year-old man received orbital exenteration and postoperative radiotherapy for malignant orbital carcinoma. In view of uncertain suitability and survival of osseointegrated implant in his case, a novel design of ocular implant consisting of a self-retaining magnetic spring retainer and a coupling silicone prosthesis was used. This novel design was shown to provide the patient with ease of use, good cosmetic outcome and better quality of life.

Sentinel events in ophthalmology: experience from Hong Kong.

Purpose. To arouse ophthalmologists' awareness in patient safety by reviewing sentinel events in Ophthalmology submitted to a web-based incident reporting system involving all public hospitals in Hong Kong. Methods. Sentinel events in Ophthalmology reported from November 2007 to October 2014 were identified and classified into different categories for further presentation and analysis. Key contributing factors attributing to the occurrence of the incidents were described. Suggestions aiming to prevent future occurrence of similar events were made. Relevant literature and case law were discussed. Results. Twelve sentinel events were included in this observational case series. They were classified into 4 main categories, namely "wrong eye" (5 cases, 41%), "wrong prescription" (3 cases, 25%), "wrong patient and surgery" (2 cases, 17%), and "retained surgical items" (2 cases, 17%). The key contributing factor leading to the occurrence of the incidents was largely human error. Increased staff awareness and proper time-out procedures were recommended to help prevent occurrence of these errors. Conclusion. Sentinel events in Ophthalmology do occur. Many of these incidents were attributed to human error. Surgeon's awareness and willingness to prevent occurrence of sentinel events are warranted.

Eccrine Porocarcinoma of the Eyelid in a Non-Caucasian Patient.

A 60-year-old lady of Chinese origin presented with a right medial canthal mass. The lesion had been present for many years but progressively increased in size a few months prior to the consultation. Clinical examination revealed a medial canthal mass measuring 1.8 cm in diameter. It was firm with an irregular crusting surface. It was not attached to underlying deep lamella, and there were overlying telangiectatic vessels with contact bleeding. Excisional biopsy of the lesion confirmed a diagnosis of eccrine porocarcinoma. Eccrine porocarcinoma rarely occurs in the eyelid, and this is the first reported case of its occurrence in non-Caucasian patient. Given the significant risk of recurrence and metastasis, long-term surveillance is warranted. Although being rare, ophthalmologists should be vigilant of this potentially life-threatening lesion in the management of eyelid tumors.

Prognostic factors for outcome of endoscopic dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction.

PURPOSE: To evaluate the prognostic factors for outcome of endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction. MATERIALS AND METHODS: Eighty-three consecutive cases of endoscopic DCR performed for primary acquired nasolacrimal duct obstruction by a single surgeon were included in a retrospective, noncomparative case series. The outcome was assessed at a minimum of 5 months after surgery, being at least 3 months after removal of stents. Surgical success was defined both subjectively and objectively. Subjective success was defined as absence of epiphora. Objective anatomical success was defined as patency on syringing, and presence of a functioning rhinostomy evaluated using the functional endoscopic dye test. Variables assessed included age at surgery, gender, side, duration of intraoperative mitomycin C application, and duration of stent left in-situ. The prognostic factors for outcome were analyzed by the logistic regression test. RESULTS: Of the 79 analyzed cases, 74 (93.7%) had successful surgical outcomes. The mean age at time of surgery was 55.5 ± 13.3 years, and the majority of patients were female (85%). The mean follow-up period was 23.3 ± 16.8 months. Age at surgery is a significant factor influencing the surgical outcome (P < 0.05). Gender, side, duration of intraoperative mitomycin C application, and duration of stent left in-situ had no significant association with the outcome (P > 0.05). CONCLUSION: In endoscopic DCR for primary acquired nasolacrimal duct obstruction, younger patient age at time of surgery was associated with a higher rate of failure.

Preseptal cellulitis in a child caused by Megacopta centrosignatum.

Preseptal cellulitis in children can be caused by a reaction to embedded insects, their body parts, or secretions. We report the case of a 2-year-old girl who presented with preseptal cellulitis caused by an insect identified as Megacopta centrosignatum in her superior fornix.

Malignant eyelid tumors in Hong Kong 1997-2009.

PURPOSE: To determine the epidemiologic and clinical characteristics of patients with malignant eyelid tumors in Hong Kong. METHODS: A computerized retrieval system was used to identify all patients with histologically confirmed malignant eyelid tumors residing in Western Kowloon and the Southern New Territories, Hong Kong, during the 13-year period from 1997 to 2009. The patients' medical records were reviewed for clinical and demographic data. RESULTS: A total of 36 patients were identified; all were Chinese. The mean age at diagnosis was 73.4 ± 11.5 years. Women were more commonly affected. Each patient had 1 tumor. Tumors developed more commonly on the lower eyelid (n = 19; 52.8%) than on the upper eyelid (n = 11; 30.6%). The right eye was more often involved (n = 20; 55.6%). With regard to the type of tumor, 27 were basal cell carcinoma (BCC) (75%), 4 sebaceous gland carcinoma (11.1%), 2 squamous cell carcinoma (5.6%), 1 mucinous eccrine carcinoma (2.8%), 1 verrucous carcinoma (2.8%), and 1 metastatic carcinoma (2.8%). Most were treated by frozen section-guided excision and eyelid reconstruction. Recurrence occurred in 1 case only. Incidence was low until approximately 45 years of age, after which it rose sharply. The incidence continued to increase until above the age of 85 years. There was an overall increase in incidence from 0.6 per million in 1997 to 2.3 per million in 2009. CONCLUSION: Increasing incidence of malignant eyelid tumors was noticed in Hong Kong from 1997 to 2009, with BCC dominating the incidence trend. Recurrence after complete surgical excision was uncommon.

Finasteride-associated cataract and intraoperative floppy-iris syndrome.

UNLABELLED: A 47-year-old man who had been using finasteride for male pattern alopecia for 4 years complained of progressive bilateral blurring of vision. His general health had been good, and he was not on any other long-term medication. Examination showed bilateral anterior subcapsular cataracts. Phacoemulsification and insertion of intraocular lenses were performed, and both eyes showed features of intraoperative floppy-iris syndrome (IFIS), including undulation and billowing of the iris, iris prolapse, and pupil constriction. We believe the use of finasteride can be associated with cataract formation and IFIS. Ophthalmologists and physicians prescribing finasteride should be aware of this possible association. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Verrucous carcinoma: a rare tumor of the eyelid.

A 72-year-old gentleman presented with a left upper eyelid mass existing for several years but progressively increased in size over 2 weeks. Clinically the 1.5 × 1-cm firm, pigmented and sessile mass resembles a large wart. Excisional biopsy of the mass reveals a diagnosis of verrucous carcinoma. Verrucous carcinoma rarely occurs in the eyelid, and this is the first reported case of its occurrence in an Asian patient. As its appearance simulates that of a wart, it may be mistaken as the latter. Deep excisional biopsy is required in differentiating the two. Although being rare, ophthalmologists have to be aware of the diagnosis to avoid missing this potentially curable malignant lesion in patients presenting with eyelid tumors.

Successful treatment of Pseudallescheria boydii keratitis with topical natamycin as monotherapy.

PURPOSE: To report a case of Pseudallescheria boydii keratitis successfully treated with topical natamycin as monotherapy. METHODS: Interventional case report describing the clinical presentation, histopathologic findings, course, and treatment of a patient with P. boydii keratitis. RESULTS: A 50-year-old male electrician with a 4-day history of right eye pain and blurring of vision was referred. There was history of right eye injury while hammering and examining a hole in the ceiling. Examination showed a corneal abscess with overlying epithelial defect measuring 2 mm in diameter. Histopathologic investigation revealed septate hyaline cylindrical hyphae with acute angle branching and formation of oval to pyriform conidia truncated at the base, compatible with P. boydii. The patient was treated with topical natamycin 5%, which eradicated the infection, resulting in a final best-corrected visual acuity of 6/7.5. CONCLUSION: The fungus P. boydii can cause keratitis. The success rate for treatment was generally thought to be poor. Early detection and treatment is important in improving the outcome. This is believed to be the first reported case of P. boydii keratitis successfully treated with topical natamycin as monotherapy.

Clinical evaluation of the intraoperative refraction technique for intraocular lens power calculation.

OBJECTIVE: To evaluate clinically the intraoperative refraction technique for intraocular lens (IOL) power calculation using 2 existing formulas proposed by Ianchulev and Leccisotti and to derive alternative formulas for this technique. DESIGN: Comparative case series. PARTICIPANTS: One hundred eighty-two eyes from 182 patients with cataract. METHODS: Recruited patients were separated into a normal cornea group and a special group that included eyes with surgically altered corneas. Phacoemulsification was carried out for all cases. Intraoperative aphakic autorefraction using a portable autorefractor was performed. An IOL with power calculated before surgery then was implanted. In each eye, postoperative refraction was obtained. The IOL power that would have achieved emmetropia was calculated retrospectively. Aphakic autorefraction readings obtained during surgery were used to calculate the aphakic spherical equivalent (SE). The 2 formulas incorporating aphakic SE were applied to calculate the target IOL power. Comparison then was made to determine the accuracy of the formulas. MAIN OUTCOME MEASURES: A difference (referred to as IOL difference) was calculated by subtracting the adjusted emmetropic IOL power determined by postoperative refraction from the emmetropic IOL power calculated by the 2 formulas using intraoperative aphakic SE. RESULTS: One hundred forty-four patients were in the normal cornea group and 18 were in the special group. In the normal group, the Ianchulev formula showed a relatively accurate prediction for IOL power to achieve emmetropia over almost the full range of axial length except in extremely long eyes. The Leccisotti formula tended to overestimate IOL power and worked particularly poorly in short eyes. It worked best in long eyes. In the special group, neither of the 2 formulas was able to show superiority universally. Using data from the normal group, alternative formulas for IOL power calculation were derived. These new formulas then were validated on the special group that showed good estimation. CONCLUSIONS: The Ianchulev formula could be applied to most eyes, with the exception of those in highly myopic subjects. The Leccisotti formula showed good performance in myopic patients. For eyes falling into the special group, an alternative formula, correction factor, or both, may be required. The new formulas reported herein may be an option. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Calcification of a hydrophilic acrylic intraocular lens: clinicopathological report.

A 72-year-old man who had phacoemulsification with implantation of an Akreos Adapt Advanced Optics (AO) IOL in the left eye complained of blurring vision 4 months postoperatively. Multiple fine white granules were found within the IOL. Intraocular lens exchange was performed at 7 months, and the explanted IOL was sent for histopathological analysis. Diffuse fine white granules were seen within the explanted IOL material just beneath the surface; they were stained positive by alizarin red and the von Kossa method. Scanning electron microscopy confirmed the presence of calcium deposits in the IOL material. Blood and aqueous were drawn from the patient for biochemical analysis, and the results were normal. We believe this is the first clinicopathological report of calcification of the Akreos Adapt AO IOL.