Abstract: Four challenging and unusual retinal cases: (I) 11-year follow-up for retinal hemangioblastoma with von Hippel-Lindau (VHL) disease; (II) treatment for central serous chorioretinopathy (CSC)—observation, half does photodynamic therapy (PDT) or micropulse laser photocoagulation; (III) diagnosis and treatment for a child with optic nerve defect; (IV) the optional treatment for retinal detachment (RD) with iridolenticular choroidal coloboma, were presented and discussed by three international retinal specialists at a retinal clinical round in Fundus Diseases Center of Zhongshan Ophthalmic Center (ZOC). The discussion helps us a better understanding of the pathogenesis and managements of these four retinal diseases and their association with systemic conditions.
Abstract: This perspective describes and justifies the need for looking for alternatives for the traditional lecture classroom such as the “flipped classroom”. We describe a 4-step process for building the class. Suggestions are made on how to create or curate material for lectures and software for generating interactivity in the active part of the classroom.
Abstract: Cataract surgery is arguably the most commonly performed operation in ophthalmology. Surgical skills transfer from experienced surgeons to resident surgeons is complicated by the fact that the teaching surgeon primarily acts as an observer rather than directly performing the procedure. Therefore, wet lab and simulator training are utilized to reduce the learning curve of the novice surgeons, which establishes tissue awareness, dexterity and muscle memory required to perform each step of the procedure, safely. Access to a wet lab and simulator environment is accomplished by establishing a surgical training curriculum in residency programs. In the operating room, topical anesthesia is a safe alternative for teaching cataract surgery. There are three well-described approaches to teaching individual steps of cataract surgery: forward, “backwards”, and deconstructed step-by-step instruction. Simulator training can be incorporated prior to live patient experience or integrated concurrently with learner presence in the operating room. The trend towards a competency-based instruction model has necessitated appropriate evaluation tools that include Objective Assessment of Skills in Intraocular Surgery (OASIS), Global Rating Assessment of Skills in Intraocular Surgery (GRASIS), and the International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR). We review the literature on trends in surgical teaching in ophthalmology, with the focus on cataract surgery instruction to the novice surgeon.
Abstract: Training qualified ophthalmic professional is crucial for any eye care system worldwide. Education of modern western Ophthalmology in China started late but develops rapidly. This review focused on ophthalmic education in China and US, describing details of the programs and analyzing the differences. This summary may provide useful information for practitioners of medical education from both countries and help improve the present training designs.
Abstract: Primary vitreoretinal lymphoma (PVRL), as a subset of primary central nervous system lymphoma (PCNSL), is a rare and fatal ocular malignancy. Most PVRL masquerades as chronic posterior uveitis, which makes the clinical diagnosis challenging. Vitreous cells, subretinal lesions and imaging techniques are essential for clinical diagnosis. Importantly, cytopathology/histopathology identification of malignant cells is the gold standard for the diagnosis of PVRL. In addition, molecular detection of immunoglobulin heavy chain (IgH) or T cell receptor (TCR) gene rearrangements, immunophenotyping for cell markers, and cytokine analysis of interleukine-10 elevation are often used as adjunct procedures. Current management of PVRL involves local radiation, intravitreal chemotherapy (methotrexate and rituximab), with or without systemic chemotherapy depending on the involvement of non-ocular tissues. In cases with concomitant PCNSL, systemic high-dose methotrexate/rituximab based therapy in conjunction with local therapy, whole brain radiotherapy and/or autologous stem cell transplantation is considered. Although PVRL normally responds well to initial treatment, high rates of relapse and CNS involvement usually lead to poor prognosis and limited survival. A professional team of medical experts in ophthalmologists, ocular pathologists, neuro-oncologists and hemato-oncologists is essential for optimizing patient management.
Background: To explore the safety and effectiveness of Sclera patch grafts in the management of scleral defects.
Methods: This is a retrospective uncontrolled study. Medical records were retrospectively reviewed for 8 eyes of 8 patients with sclera patch grafts. Two patients had necrotizing scleritis, 2 patients had scleral melting/perforation secondary to thermal burns, 4 patients had scleral staphyloma secondary to surgery. Sclera was reconstructed with allogenic sclera patch grafts, 6 in 8 patients combined autologous conjunctival pedicle flap, 1 patient combined partial medial rectus translocation, 1 patient combined autologous pedicle tenon graft, simultaneously. Treatment outcomes were evaluated using structural integrity, best corrected visual acuity (BCVA), scleritis remission, sclera rejection and melt, and ocular symptoms.
Results: Eight patients were reviewed. In all of these cases, satisfactory anatomic and functional outcomes were achieved. In the at least half a year follow-up, the BCVA of all the eight patients were no worse than that of preoperative. No eye pain, foreign body sensation and other discomforts showed in all the patients, except one woman, who showed sclera rejection and melt 1 month postoperative. In addition, one patient showed high intraocular pressure (28 mmHg), which can be controlled by a kind of medicine.
Conclusions: In this series, sclera patch grafts is an effective method for management scleral defects in the at least half a year following-up. Attention should be paid to the sclera patch rejection and melt post operatively.
Background: To report a new simplified surgical technique to manage small iris coloboma or traumatic iris defect.
Methods: A new surgical technique in which simplified pupilloplasty technique through only a clear corneal paracentesis to manage the iris coloboma or traumatic iris defect within the 120° range was designed. A retrospective revision of the medical records of patients treated with this technique between the years 2013 and 2016 was made. Six eyes of six patients with iris coloboma or traumatic iris defect treated with this new technique were included.
Results: All the operated eyes quickly recovered with central round pupil, negligible complications, inessential symptoms of photophobia and glare, and mild inflammation after a median follow-up time of 22 months (range: 6–34 months).
Conclusions: The simplified pupilloplasty technique presented here could be a good alternative for the management of small iris coloboma or traumatic iris defect.
