PurposeTo evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons’ performance.MethodsIn a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9) or not (n = 12). Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room.ResultsComparing each surgeon’s performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room.ConclusionsDespite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.

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Background Diabetic retinopathy (DR) is a leading cause of vision impairment in working-age adults. Patients with DR need extensive follow-ups with timely proper treatment. In Jordan, a complete lockdown was decided during the COVID-19 pandemic including the closure of outpatients’ clinic. In this study, we assess the effect of the lockdown on the progression and visual outcome for patients with DR who had interruption in their plan. Methods Retrospectively, we identified all patients who were scheduled for procedures for the management of diabetic retinopathy (DR) during the COVID-19-related quarantine period in Jordan from March 16th to June 6th, 2020. All demographics and clinical data, procedure information, and visual outcome were collected. Another control group of patients with similar characteristics who were scheduled for procedures related to DR before the COVID-19 pandemic from October 15th to December 31st, 2019 were included. Results One hundred and thirty-seven eyes planned for procedures from 89 patients were included. The case group comprises 56 eyes (40.9%). The mean age of the patients was 61.4 years. The right eye was involved in 69 procedures (50.4%). The mean change in visual acuity for the case group in the procedure eye was 0.176 in LogMAR (drop of almost 9 LogMAR letters) and the mean change in visual acuity for the control group in the procedure eye was −0.103 LogMAR (gain of about 5 LogMAR letters). Also, the central subfield thickness (CST) values were significantly worse in the case group. Furthermore, patients in the case group had significantly more disease progression (new findings and worsening of the already established findings). Conclusion Interrupting the important procedures for DR patients and delaying their follow-up may adversely affect their visual outcome. National decisions should consider conducting these procedures and exempt those patients from any lockdown with proper precautions. Moreover, certain measures would be considered, such as treat-and-extend protocol, home screening and portable OCT examination, and newer long-acting anti-VEGF drugs.

Introduction:In cases of inadequate capsular support for intraocular lens (IOL) implantation, iris-claw IOL is a practical option. Iris-claw IOL can be implanted anteriorly or retropupillary. In this study, we compare the outcome of implantation of iris-claw IOL between anterior and retropupillary locations. Methods: We retrospectively examined the characteristics and outcomes of patients who underwent iris-claw ''Artisan Ò '' intraocular lens implantation (IOL) during the period of January 2014 to July 2020. The study population included all patients who underwent iris-claw IOL implantation, whether as a primary or secondary implantation, regardless of the causative indication. The study population was categorized by location of implantation and indication. The outcome was compared by visual acuity and postoperative complications. Results: In this study, 171 eyes of 151 patients were included. Iris-claw IOL was implanted anteriorly in 110 (64.3%) eyes. The most common indication for iris-claw IOL was complicated cataract surgery, followed by ectopia lentis and by trauma. Patients with retropupillary position achieved better visual outcome whatever the causative indication. Anterior irisclaw IOL patients had more high intraocular pressure readings and macular edema. Conclusions: This study revealed that retropupillary iris-claw IOL may achieve better visual outcome without significant postoperative complications. Further prospective studies and trials on larger sample sizes are needed.