Ophthalmology practice in the era of COVID-19 : a personal reflection from a Sarawakian Ophthalmologist

When COVID-19 first gained international mentioned back in December 2019 (at that time it was first referred to as the ‘Wuhan virus’), never would I imagine that this problem will become such a menacing international pandemic affecting almost the entire world population and claiming hundreds of thousands of lives thus far

Minimally Invasive Sutureless Day Case Vitrectomy Surgery for Retinal Detachments, Floaters, Macular Holes and Epiretinal Membranes – An Experience from London, Windsor and Reading

This chapter takes an ophthalmologist through vitreo-retinal (VR) surgery from the beginning to the end, using a case-based approach to highlight the skills required, lessons learnt from and pit-falls to avoid in VR surgery. This is especially useful to those who are new and intermediate VR surgeons

Update on surgical management of complex macular holes: a review

Abstract Modern surgical interventions efectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotam‑ ponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM fap as the frst-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM fap manipulations in combination with surgical adjuncts increase surgical success, especially in difcult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM fap that can assist in MH closure even though the functional outcome may be afected by the MH chronicity. Despite relative success anatomi‑ cally and visually after each technique, most techniques require a long-term study to analyze their safety profle and to establish any morphological changes of the MH plug in the closed MHs. Keywords: Macular hole, Vitrectomy, Vitreoretinal disease, Internal limiting membrane peelin

Human coronaviruses: ophthalmic manifestations

The 2019 novel coronavirus which causes severe acute respiratory syndrome (SARS) known as SARS-CoV-2 still remains as a global pandemic since its discovery and continues to spread across the world, given how highly contagious the virus is. We reviewed various articles that explore eye involvement in COVID-19 and other human coronaviruses, its human manifestations in comparison to animal studies and potential mechanism of viral entry into the eye surface. Evidence of animal studies depicted various complications of coronaviruses infection into the eyes, in both anterior and posterior segments of the eye. Conjunctival inflammation remains uncommon in association with COVID-19, with other ophthalmic findings. The risk of transmission via the ocular surface remains likely low, though it is inarguably present based on preliminary finding of viral load in ocular samples and expression of ACE2 on the ocular surface. Testing the tears sample for diagnosing SARS-CoV-2 was unreliable due to limitations of the testing kits and conflicting evidence of the viral titre in the ocular samples. Further larger, more precise and specific studies are required to allow us to better understand the pattern of virulence underlying the associations of SARS-CoV-2 in the eye despite its rare occurrence. This review article aims to enhance better awareness among clinicians regarding ocular manifestations associated with COVID-19 and necessary precautions should be implemented to minimise the risk of person-to-person especially in the nosocomial setting

Enriching traditional didactic teaching in undergraduate ophthalmology with lateral thinking method: a prospective study

Purpose:To evaluate undergraduate medical students’ perspective on lateral thinking pedagogy in teaching clinical ocular anatomy in correlation to developing differential diagnoses and recognising red flags in managing common eye conditions.Methods:The prospective study compared the lateral thinking method (LTM) versus the traditional didactic method in teaching clinical ocular anatomy. Two hundred seventy‑two medical students who underwent ophthalmology clerkships were recruited over 3 years. They were randomised into two groups, the LTM and regular didactic groups. Students participated in pre and post‑tests to assess their theoretical clinical ophthalmic knowledge, and their responses to respective teaching methods were measured via the self‑assessment questionnaire (SAQ), which incor‑porated a five‑point Likert‑type scale.Results:Overall, the LTM group scored significantly higher than the control group, and they found the innovative teaching method improved their confidence and awareness in theoretical knowledge in generating differential diag‑noses, managing common eye conditions and recognising potential signs that could be sight and/or life‑threatening compared to the regular teaching group (P < 0.05). However, all students were neutral towards both lectures regard‑ing changing their negative perception of the current ophthalmic curriculum.Conclusion:From the student’s perspective, LTM is an effective tool in enriching regular teaching. The method encouraged versatile thinking patterns while enhancing the effectiveness of learning experience in time and resource‑limited undergraduate ophthalmic teaching

Therapeutic deep lamellar keratoplasty for corneal perforations

Objectives/aims Corneal perforation can be potentially blinding unless the integrity of the globe is restored quickly. Although penetrating keratoplasty (PK) may achieve this, it carries a high risk of endothelial rejection in inflamed eyes. Deep lamellar keratoplasty (DLK) may be an alternative option to PK in such eyes owing to its potential for a lower incidence of rejection. We report the efficacy of DLK in patients with corneal perforations. Patients and methods Four patients underwent layer-by-layer DLK for noninfective corneal perforation, after measures such as the use of a bandage contact lens, tissue adhesive, and conjunctival pedicle flap had failed. The preoperative visual acuity was hand movements in one patient, 1/60 in two, and 6/60 in one. All four had iris incarcerated within the corneal perforations. SF6 gas (three patients) and air (one patient) were injected into the anterior chamber at the end of surgery