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The incidence of pediatric keratoconus indicates that increased awareness for keratoconus among children is needed, mainly in cases of family history of keratoconus, ocular allergy/pruritus, poor CDVA, corneal hydrops, and/or high astigmatism. [J Refract Surg. 2016;32(8):534-541.].

Purpose: To assess the anatomical and functional outcomes in addition to complications for endoillumination-assisted modified scleral buckling surgery using a noncontact Oculus BIOM wide-angle viewing system in patients with primary rhegmatogenous retinal detachment. Methods: This is an interventional prospective noncomparative case series. Consecutive patients listed for scleral buckle surgery for primary rhegmatogenous retinal detachment were enrolled over an 18-month period and followed up for 1 year. The study cohort consisted of 25 patients (25 eyes) of which 23 patients (23 eyes) completed the 1-year follow-up. Scleral buckling surgery was done with a 23-gauge endoillumination probe, which was inserted through a pars plana sclerotomy. The primary outcome measure was anatomical success rate with one surgery assessed at the 6-month and the 1-year follow-up. Secondary outcome measures included final visual acuity, number of surgeries required, and complication rates such as entry site break, posterior vitreous detachment, endophthalmitis, and cataract. Results: At 1 year, anatomical success with one surgery was achieved in 20 patients (87%). One patient required two additional vitreoretinal surgeries and 2 patients required three additional surgeries. All patients had a flat retina at 1 year with silicone oil present in one eye. Mean best-corrected visual acuity improved by six ETDRS lines, from 1.03 ± 0.83 logarithm of the minimum angle of resolution (20/200) preoperatively to 0.40 ± 0.47 logarithm of the minimum angle of resolution (20/50) at 1 year. No entry site breaks were detected, and posterior vitreous detachment developed in six patients (26%). No cases of endophthalmitis or cataract progression were reported. Conclusion: Endoillumination-assisted modified scleral buckling surgery combined with a noncontact wide-angle viewing system can provide good anatomical and functional outcomes with many advantages and a low complication rate.

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Purpose: To describe a new wet lab model of Descemet membrane endothelial keratoplasty (DMEK) using human corneas mounted on an artificial anterior chamber with an artificial iris and to compare the performance time and scores between beginners and experienced anterior segment surgeons. Methods: Corneas were mounted on an artificial chamber. To simulate an anterior chamber and to avoid loosing the graft into the tubing, a 3D printed iris was added. Each DMEK procedure required only one cornea for graft preparation, insertion, orientation, unfolding and centration. Ten human research corneas were used for training purposes. Intraoperative OCT was only used to validate the different steps of the procedure. Operators were divided into two groups, two beginners and three experienced DMEK surgeons. Results: All DMEK procedures were successfully performed. Descemet's tears were frequent but harvesting was successful in all procedures. All combinations of graft unfolding techniques were possible. Experienced surgeons performed statistically better then beginners with faster harvesting (12.8 versus 28.2 min; p = 0.02) and insertion (13.5 versus 20.8 min; p = 0.05) times and better performance score (94 versus 52; p = 0.03). Conclusion: This DMEK wet lab model offers a close to reality, feasible, resource-sparing and valid teaching technique that permits to perform all DMEK surgical steps. It also offers the possibility of varying the surgical difficulty by changing the anterior chamber depth.