William R. Raymond

Virtual reality simulation in acquiring and differentiating basic ophthalmic microsurgical skills.

Objective: A virtual reality (VR) surgical simulator (EyeSi ophthalmosurgical simulator: VRMagic, Mannheim, Germany) was evaluated as a part-task training platform for differentiating and developing basic ophthalmic microsurgical skills. Methods: Surgical novice performance (residents, interns, and nonmicrosurgical ophthalmic staff) was compared with surgical expert performance (practicing ophthalmic microsurgeons) on a basic navigational microdexterity module provided with the EyeSi simulator. Results: Expert surgeons showed a greater initial facility with all microsurgical tasks. With repeated practice, novice surgeons showed sequential improvement in all performance scores, approaching but not equaling expert performance. Conclusion: VR simulator performance can be used as a gated, quantifiable performance goal to expert-level benchmarks. The EyeSi is a valid part-task training platform that may help develop novice surgeon dexterity to expert surgeon levels.

Chorioretinitis Sclopetaria from BB Ex Memoria

Chorioretinitis sclopetaria presents a characteristic pattern of choroidal and retinal changes caused by a high velocity projectile passing into the orbit, in close proximity to the globe. While it is unlikely that a patient should completely forget the trauma causing such damage, preserved or compensated visual function may blur the patients memory of these events over time. Characteristic physical findings help to clarify the antecedent history. Despite the lack of an acknowledged history of ocular trauma or surgery, in our case, the characteristic ocular findings discovered at presentation allowed for recognition of the underlying etiology. Because of good visual function, the patient had completely forgotten about the trauma that occurred 12 years earlier. Strabismus surgery was performed for treatment of the presenting symptomatic diplopia. The pathognomonic findings in chorioretinitis sclopetaria are invaluable in correctly diagnosing this condition, especially when a history of ocular trauma is unavailable.

A Review of Pediatric Uveitis: Part I. Infectious Causes and the Masquerade Syndromes

Uveitis is a manifestation of complex processes that can represent an infectious or a purely immune system modulated condition and may have grave effects on the eye. Much of the morbidity in these conditions is the result of the immune response to these stimuli. These infectious diseases may be successfully treated by addressing the inciting organism with recognized interventions. Treatment of the immune response to the organism often must be pursued simultaneously to minimize long-term complications caused by structural changes within the eye. Assisting the individuals immune response to eliminate the organism while minimizing the immune responses damaging effects remains a unique challenge drawing on both the science and the art of medicine. Several non-infectious conditions that are not autoimmune diseases may commonly masquerade as uveitis, leading to delays in appropriate treatment.

Characteristics of Okihiro syndrome.

PURPOSE To describe Okihiro syndrome, a syndrome consisting of Duanes syndrome, radial ray anomaly, and sensorineural deafness. METHODS The incidence of anomalies in 41 individuals from 9 affected families was assessed by literature review and patient examination, and the frequency of the characteristics occurring together was determined. RESULTS Of all the individuals with at least one of the above characteristics, only 12% had all three characteristics. However, 44% had both Duanes syndrome and radial ray anomaly, whereas sensorineural deafness alone occurred in only 17% of patients. CONCLUSION Okihiro syndrome is consistent with autosomal dominance with variable penetrance, manifesting primarily with Duanes syndrome and radial ray anomaly, and less frequently, sensorineural deafness.

A review of pediatric uveitis: part II. Autoimmune diseases and treatment modalities.

Uveitis is a manifestation of complex processes that can represent an infectious process or a dysfunction of the immune system that may have grave effects on the eye. Although infectious causes, once properly identified, may be successfully treated by addressing the inciting organism with recognized interventions, the immune-modulated chronic forms of uveitis often provide more complex challenges in management. Recent strides in understanding the inflammatory pathway and better bioengineering capabilities have resulted in some new modalities of treatment.

Analysis of anterior and posterior corneal curvature changes using Orbscan technology in radial keratotomy eyes exposed to hypoxia

Purpose: To study the changes in anterior and posterior corneal curvatures in radial keratotomy (RK) and normal eyes exposed to hypoxia using Orbscan (Bausch & Lomb) technology. Setting: Department of Ophthalmology, Madigan Army Medical Center, Tacoma, Washington, USA. Methods: At sea level, 11 RK subjects and 10 control subjects were exposed to ocular surface hypoxia in 1 eye by filtering humidified, compressed 100% nitrogen (0% oxygen) through an airtight goggle system for 2 hours. The contralateral eye was exposed to humidified, compressed air (21% oxygen) simultaneously through the airtight goggle system. Orbscan analysis was performed in each subject before and immediately after gas exposure. This analysis included measurement of the anterior axial and posterior axial corneal curvatures as well as corneal pachymetry. Results: In the RK eyes exposed to 100% nitrogen gas, there was a statistically significant flattening in the anterior axial corneal curvature (P = .0012) and in the posterior axial corneal curvature (P = .0067). Radial keratotomy and control eyes exposed to air and control eyes exposed to 100% nitrogen gas demonstrated no statistically significant change in the anterior axial or posterior axial corneal curvature. Conclusions: Corneal hypoxia induced a statistically significant flattening in the anterior axial and posterior axial corneal curvatures in eyes that had had RK. There was no significant change in these curvatures in RK eyes exposed to air and in control eyes exposed to air or 100% nitrogen gas.

Eye Injuries From Merchandise Display Hooks

PURPOSE/METHODS Four patients had ocular or ocular adnexal injuries, which resulted from store merchandise display hooks. RESULTS/CONCLUSIONS Ocular and periocular injuries from display hooks include conjunctival, eyelid, and canalicular lacerations, as well as penetrating brain injury. Display hooks are commonly used in retail establishments and pose a high risk when placed below eye level.

Simplified Method for Rapid Field Assessment of Visual Acuity by First Responders After Ocular Injury

Objective Initial visual acuity after ocular injury is an important measure, as it is an accurate predictor of final visual outcome and gives a rapid estimation of the overall severity of the injury, thereby aiding evacuation prioritization. We devised a simple method for rapidly assessing visual acuity in the field without having to rely on formal screening cards. Methods Using common objects, icons, and text found in the injury zone - for example, common military name tapes, rank insignias, patches, emblems, and helmet camouflage bands, which will be known collectively as the Army Combat Optotypes (ACOs) - a Snellen-equivalent method of assessing visual acuity was devised and correlated to the ocular trauma score (OTS). Results Ability to read the ACOs at 2, 3, and 5 ft correlates with acuities in the range from 20/20 to 20/400. Identification of ACOs with visual acuity of 20/50 and 20/200 approximates important inflection points of severity for the OTS. Conclusion Accurately assessing visual acuity in the field after ocular injury provides essential information but does not require sophisticated screening equipment. Pertinent and accurate acuities can be rapidly estimated using commonly available text or graphical icons such as standard name tapes, patches, and rank insignias.

Herpes zoster ophthalmicus and strabismus: a unique cause of secondary Brown syndrome

Herpes zoster ophthalmicus can be associated with a variety of ocular and visual sequelae, including isolated or even multiple cranial neuropathies, potentially affecting the oculomotor, trochlear, or abducens nerves. We report a case of a secondary Brown syndrome following resolution of a unilateral isolated trochlear nerve palsy associated with herpes zoster ophthalmicus in an immunocompetent 57-year-old man.