Diabetic glomerulosclerosis can be the pathogenesis of refractory diabetic macular edema

Eman Saeed Al Kahtani King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia Background: Kidney failure provoked by glomerulosclerosis leads to fluid filtration deficits and other disorders of kidney function. Refractory diabetic macular edema (DME) can be another warning sign of glomerulosclerosis in diabetic patients. Case: A 40-year-old Saudi male presented with macular edema that was refractory to all possible medical and surgical ophthalmic interventions in both eyes. The macular edema significantly improved once the patient began systemic treatment for newly diagnosed diabetic glomerulosclerosis. This case report is presented with optical coherence tomography (OCT) documentation of before and after each medical and surgical intervention. Observations: Considerable improvement occurred after treatment with a systemic angiotensin-converting enzyme inhibitor and diuretic treatment due to newly diagnosed diabetic glomerulosclerosis. Conclusion: Refractory DME can be secondary to diabetic glomerulosclerosis. This case indicates the possibility that systemic intervention may be warranted in cases of refractory DME, and the importance of collaboration between ophthalmologists, endocrinologists, and internists in these cases. Keywords: angiotensin-converting enzyme inhibitor, diuretic, proteinuri

The use of a virtual reality surgical simulator for cataract surgical skill assessment with 6 months of intervening operating room experience

Shameema Sikder,1 Jia Luo,2 P Pat Banerjee,2 Cristian Luciano,2 Patrick Kania,2 Jonathan C Song,1 Eman S Kahtani,3 Deepak P Edward,1,3 Abdul-Elah Al Towerki3 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; 2College of Engineering, University of Illinois at Chicago, Chicago, IL, USA; 3King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia Purpose: To evaluate a haptic-based simulator, MicroVisTouch™, as an assessment tool for capsulorhexis performance in cataract surgery. The study is a prospective, unmasked, nonrandomized dual academic institution study conducted at the Wilmer Eye Institute at Johns Hopkins Medical Center (Baltimore, MD, USA) and King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia).Methods: This prospective study evaluated capsulorhexis simulator performance in 78 ophthalmology residents in the US and Saudi Arabia in the first round of testing and 40 residents in a second round for follow-up.Results: Four variables (circularity, accuracy, fluency, and overall) were tested by the simulator and graded on a 0–100 scale. Circularity (42%), accuracy (55%), and fluency (3%) were compiled to give an overall score. Capsulorhexis performance was retested in the original cohort 6 months after baseline assessment. Average scores in all measured metrics demonstrated statistically significant improvement (except for circularity, which trended toward improvement) after baseline assessment. A reduction in standard deviation and improvement in process capability indices over the 6-month period was also observed.Conclusion: An interval objective improvement in capsulorhexis skill on a haptic-enabled cataract surgery simulator was associated with intervening operating room experience. Further work investigating the role of formalized simulator training programs requiring independent simulator use must be studied to determine its usefulness as an evaluation tool. Keywords: medical education, computer simulation, educational assessment, technology assessment, cataract surger