Infusion-related iatrogenic retinal breaks (IRBs) are a significant complication in vitrectomies, particularly when smaller-gauge cannulas are used during fluid infusion. Using two-dimensional finite element analysis (FEA), we analyzed forces exerted on the retina from different cannulas: traditional 25-gauge, 20-gauge, 23-gauge, and 27-gauge, then investigated four alternative new cannula designs: (A) oblique orifices, (B) external obstruction, (C) side ports, and (D) perpendicular orifices. The analysis revealed that the standard 25-gauge cannula had a force of 0.546 milli-Newtons (mN). Optimized cannulas demonstrated decreased forces: 0.072 mN (A), 0.266 mN (B), 0.417 mN (C), and 0.117 mN (D). While all the designs decrease fluid jet force, each has unique challenges: Design A may complicate manufacturing, B requires unique attachment techniques, C could misdirect fluid toward the lens and peripheral retina, and D requires a sealed trocar/cannula design to prevent unwanted fluid ejection. These four innovative cannula designs, identified with detailed engineering simulations, provide promising strategies to reduce the risk of IRBs during vitrectomy, bridging the gap between engineering insights and clinical application.

MAF encodes a transcription factor involved in T-helper-2 (Th2) cell differentiation. Heterozygous pathogenic variants in MAF have been observed in both isolated and syndromic congenital cataract cases; genotype–phenotype correlations are based on the location of the variant within the gene. Variants in the N-terminus domain of MAF are associated with cataracts as part of Aymé-Gripp syndrome. The purpose of this report is to expand the ocular phenotypic spectrum of Aymé-Gripp syndrome by describing a patient with MAF variant c.185C>G, p.Thr62Arg, and the traditional systemic findings and congenital cataracts as well as an unusual feature of pigmentary retinopathy, which has not been previously reported in Aymé-Gripp syndrome. Additionally, a comprehensive review of the literature was completed to report ocular genotype–phenotype data on previously reported patients with MAF-associated Aymé-Gripp syndrome.

Background: The COVID-19 pandemic necessitated the transition of in-person examinations into virtual formats. As cases decreased, some examinations returned to in-person, while others remained virtual or instituted hybrid models. Virtual examinations offer benefits including decreased travel costs, and the opportunity to share examiners globally. We assessed a virtual trainee practice examination strategy and investigated perceptions and preferences regarding the virtual formats. Method: Ten ophthalmology residents from the Tennent Institute of Ophthalmology, Glasgow, Scotland, and the University of Arkansas for Medical Sciences, Little Rock, United States, participated in virtual mock oral exams conducted by two examiners. Examiners and examinees answered questions graded on a Likert scale to determine perceptions of the format. Results: Most examinees and examiners were satisfied or very satisfied with the overall examination, as well as the internet connectivity, video quality, and audio quality. The majority of examinees (70%) had either no preference or a preference for in-person examination. One examiner preferred the virtual format, and the other had no preference. Conclusion: Virtual oral examinations can be a feasible and effective alternative to in-person examinations. They have the added benefit of decreased travel costs and the ability to share examiners amongst institutions to replicate a more realistic examination experience for trainees.

To evaluate the cumulative incidence of strabismus in childhood glaucoma and compare its risk to that in healthy controls. A retrospective clinical cohort study. Childhood glaucoma patients aged ≤18 years from the TriNetX US Collaborative Network. Patients were identified using the International Classification of Diseases Ninth and 10th Revision codes. The primary study group included childhood glaucoma patients aged ≤18 years, while the control group consisted of healthy children with no history of ocular disorders. We analyzed the cumulative incidence of strabismus in both primary and secondary glaucoma. Propensity score matching (PSM) was used to compare the risk of strabismus between glaucoma and control groups. A Cox proportional hazards model was employed to identify predictors of strabismus among children with glaucoma. The primary outcome was the cumulative incidence of strabismus at 1 and 5 years after glaucoma diagnosis. The secondary outcomes included (1) comparative risk of strabismus between glaucoma and control groups, (2) evaluating the rates of strabismus surgery in the glaucoma cohort, and (3) identifying the risk factors associated with strabismus development in the glaucoma group. The study group included 12 637 patients, with a mean age at glaucoma diagnosis of 3.81 ± 4.44 years in the primary glaucoma group and 5.18 ± 4.40 years for the secondary glaucoma group. The cumulative incidence of strabismus in primary glaucoma was 9.19% at 1 year and 18.89% at 5 years. In secondary glaucoma, the cumulative incidence was 20.40% at 1 year and 31.39% at 5 years. After PSM, the 5-year risk of strabismus was significantly higher in the glaucoma group compared with controls (adjusted hazard ratio [aHR]: 7.95; 95% confidence interval [CI]: 5.67-11.14; P <0.01 for primary glaucoma and aHR: 14.51; 95% CI: 12.59-16.72; P <0.01 for secondary childhood glaucoma). Risk factors for strabismus development in the glaucoma group included younger age at secondary glaucoma diagnosis, nystagmus, and amblyopia. Childhood glaucoma is associated with a significantly increased risk of developing strabismus compared with healthy controls. Within the glaucoma group, younger age (in secondary glaucoma), nystagmus, amblyopia, and glaucoma surgery were all associated with an increased risk of strabismus. The authors have no proprietary or commercial interest in any materials discussed in this article.