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In this paper we present the analysis of two physics teaching activities that were developed for and applied in a group of visually impaired students. The content of the activities was focused on the concept of gravitational acceleration. In the first activity the concept was explored by means of the movement of an object in an inclined plane; in the second, it was explored through the movement of a metallic disk inside a tube. Both experimental setting emitted audible signals. In this sense, all the “observational” practice were based in the audible perception of the gravitational phenomena, which permitted discussion among the students, in small groups, and a debate aiming at a general conclusion. The analysis of the data was based in a category labeled “comprehension”, which illuminated some attitudes of the students throughout the experiments such as: the sharing of ideas, the defense and arguing of meanings, and the reconstruction of meanings. As conclusions we can say that the activities were valuable for motivating the students and for giving to them some background for: (1) performing experiments; (2) observing a phenomena through an audible via; (3) collecting and analyzing data related to the variation of speed; (4) sharing, arguing and reformulating hypothesis during the discussions.

Purpose of Review: This review aims to provide an updated summary of the combined approach of cataract surgery with endothelial keratoplasty (EK), addressing key considerations, including intraocular lens (IOL) choice and calculation, decision between sequential and triple EK, and modifications in surgical techniques and postoperative management., Recent Findings: Advances in imaging techniques (Scheimpflug tomography and anterior segment optical coherence tomography) have improved the ability to detect subclinical corneal edema, aiding in surgical decision-making for EK. Recent studies comparing sequential and triple-EK indicate that both methods yield similar visual outcomes. Though triple-EK offers quicker recovery, it may have higher complication rates. The use of gases like SF6 and C3F8 for anterior chamber tamponade is evolving, with conflicting findings on their efficacy in preventing graft detachment. Furthermore, IOL selection remains crucial, as hyperopic refractive surprises are common, and hydrophilic lenses should be avoided owing to the risk of opacification after EK., Summary: The combination of cataract surgery with EK has emerged as an effective treatment for patients with corneal endothelial diseases and cataract. Careful preoperative evaluation, appropriate IOL selection, and advances in surgical techniques contribute to better outcomes, although patient-specific factors must guide the choice between sequential and triple-EK procedures., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

BACKGROUND We report a case of late-onset chronic fistula in a decompensated cornea after multiple ocular surgeries and a recent phototherapeutic keratectomy (PTK). CASE REPORT A 73-year-old woman presented to our service with a past ocular history of bilateral chronic angle closure glaucoma and pseudophakic bullous keratopathy in the left eye. Given a history of long-term uncontrolled glaucoma with advanced disc cupping and poor visual potential, the patient underwent multiple palliative procedures, including, most recently, a PTK. Few years later she presented with a spontaneous late onset of slowly appearing corneal leak on fluorescein staining upon routine clinical examination. Corrected distance visual acuity was hand motion and intraocular pressure (IOP) was 40 mmHg in the affected eye. Serial anterior segment optical coherence tomography (AS-OCT) sections were obtained, which aided in understanding the current presentation and revealed distinctive multilayer corneal changes during the healing process. The patient was successfully managed with cyanoacrylate corneal gluing and ocular hypotensive medications, which halted the corneal leak. CONCLUSIONS We report a case of a rare finding of corneal fistula in an eye with multiple previous ocular surgeries, and provide an explanation of the possible etiopathogenesis. We also highlight the pivotal role of AS-OCT for evaluating such cases and stress the importance of early detection of similar subtle leaks in the setting of a formed anterior chamber, which can often be missed, carrying a risk of infection.

Purpose: The purpose of the study was to evaluate the visual outcomes and recurrence rate of patients with macular corneal dystrophy (MCD) who have undergone phototherapeutic keratectomy (PTK)., Methods: This retrospective, single-centered study enrolled patients from King Khaled Eye Specialist Hospital who had undergone PTK for MCD between 2000 and 2020. Pre-, intra-, and post-operative data were collected, and the primary outcome measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalent, central keratometry, keratometric astigmatism, recurrence rate, and necessity of subsequent surgery., Results: This study evaluated 42 eyes of 29 patients. BCVA improved from 0.41 (±0.17) preoperatively to 0.30 (±0.16) postoperatively. Sixteen out of 42 eyes (38%) had the recurrence of macular dystrophy deposits within the stroma; the average time from PTK to recurrence was 37 months (range: 5.5-115.4 months). The overall success rate of PTK at 2 years was 44.8%. Eleven eyes (26%) required subsequent surgery following PTK at an average of 43 months postoperatively. Deeper ablation and longer application of mitomycin C (MMC) were both found to be statistically significant factors associated with visual improvement and lower recurrence rate following PTK., Conclusion: PTK can be considered a treatment modality for younger patients to defer keratoplasty to a later stage. Deeper ablation is associated with improved postoperative visual acuity, and longer application of MMC is associated with lower recurrence rates of MCD., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Saudi Journal of Ophthalmology.)

Purpose: To identify the risk factors for glaucoma drainage device (GDD) exposure in children., Design: Retrospective case-control study., Methods: The study population comprised children (one eye each) who presented with a history of GDD exposure to a tertiary care eye hospital over the period January 2014 to January 2020. Consecutive children (age <18 years) were included. A control group from the same time period (children without GDD exposure) were included in the ratio of 5 controls to every 1 case of exposure. The main outcome measures included risk factors for exposure (univariate and multivariate analysis)., Results: A total of 21 eyes (of 21 children with implant exposure) and 115 eyes (of 115 children without exposure) were included in this study. During the same study period, a total of 494 eyes had undergone GDD implantation, giving an estimated incidence of exposure of 4.25%). In the bivariate analysis, GDD exposure was associated with multiple previous ocular surgeries (P = .001), longer follow-up duration (P < .001), combined procedure at the time of primary implantation (P = .002), and a younger age at the time of primary implantation (P = .006). The former 3 risk factors continued to prove a statistically significant association on multivariable regression analysis. Postoperative use of eye lubricants was more common among children in the control group (P = .007)., Conclusion: In pediatric glaucoma patients, younger age and combined procedure at the time of primary GDD implantation, in addition to multiple previous ocular surgeries, were associated with greater risk of implant exposure. Postoperative use of eye lubricants may be protective., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: To report a case of uncontrolled juvenile open angle glaucoma (JOAG), with secondary high axial myopia who presented with scleral melting and uveal prolapse post pars plana-vitrectomy., Observations: A 17-year-old male juvenile glaucoma patient, not known to have any systemic disease underwent a right eye 23-gauge-pars plana vitrectomy for retinal detachment repair. Three weeks following his surgery he presented complaining of tearing and photophobia in the operated eye in the absence of any ocular pain. Clinical exam revealed enlarged sclerotomy sites with localized conjunctival and episcleral injection, scleral thinning and uveal prolapse. Infectious and serologic work up were obtained to rule out an infectious etiology or underlying autoimmune disease. Patient was successfully managed with topical steroids and a donor scleral patch graft., Conclusion and Importance: This report addresses multiple risk factors for a devastating complication that may occur in predisposed patients, with primary or secondary axial myopia and a compromised sclera. This group of patients can be at risk of post-operative scleral melting and thinning and should be identified pre-operatively and monitored closely during their post-operative course., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Purpose: To report novel life-threatening coronary and systemic arterial disease associated with Retinal Arterial Macroaneurysms with Supravalvular Pulmonic Stenosis (RAMSVPS) syndrome, previously known as Familial Retinal Arterial Macroaneurysms (FRAM)., Observations: A 29-years old woman with longstanding poor vision in her right eye presented with acute myocardial infarction and subclavian bruit. Her polyangiogram showed peculiar ostial coronary aneurysms, left anterior descending coronary artery stenosis, occlusion of the left subclavian artery, stenosis of both renal arteries, irregularities in the mesenteric artery and tapering of the aorta. Takayasu arteritis was initially presumed, however fundus examination revealed beading and macroaneurysms along major retinal arteries, intraretinal exudation and hemorrhages, retinal arterial sheathing and stenosis, Coats'-like features and submacular gliosis in the right eye, vitreous hemorrhage in the left eye, and persistent hyaloid artery remnant in both eyes. These features evoked RAMSVPS syndrome. Genetic testing identified the same homozygous IGFBP7 c.830-1G > A mutation reported with RAMSVPS syndrome, rectifying the systemic diagnosis., Conclusion and Importance: RAMSVPS syndrome can be associated with more life-threatening coronary and widespread major arterial disease than previously recognized. It is crucial for ophthalmologists to recognize RAMSVPS syndrome and refer patients for a thorough cardiovascular evaluation. Likewise, a careful retinal examination and the possibility of an IGFBP7 mutation should be considered in the setting of systemic arterial or cardiac disease., Competing Interests: No conflict of interest exists., (© 2022 The Authors.)

Purpose To assess ophthalmologists' preparedness in such a critical period in the history of pandemics, a logical socio-psychological framework assessment using the health belief model (HBM) is essential to evaluate their risk perception, their willingness to actively participate in engaging in protective health behavior and acknowledge its benefits, and their capability to perform adequate successful methods for limiting the spread of coronavirus disease 2019 (COVID-19) and overcome the barriers they might encounter while implementing such precautions. Methods A cross-sectional study conducted at King Khaled Eye Specialist Hospital using a questionnaire-based (HBM) was distributed to 135 ophthalmologists in the institute to evaluate their risk perception of COVID-19 and determine which components of the HBM contribute to preventive health behavior related to the COVID-19 infection. Results The questionnaire had a reasonable response rate (79.3%, 107 ophthalmologists, including 48 consultants, 51 fellows, and 36 residents). The study demonstrated that this model is useful and mapped how several components were significantly correlated to actions. Most significantly, perceived susceptibility was the most important predictor of action. The second most important determinant of action was the perceived benefit. Conclusion Pandemics such as COVID-19 are likely to happen again in the future. Explicit attention to factors influencing motivation such as threat perception to adopt appropriate health-related behavior to limit the spread of communicable diseases is necessary. This study has successfully represented preparedness and risk behavior perception of ophthalmologists of the novel COVID-19 pandemic in one of the largest tertiary eye hospitals in the Middle East using the Health Belief Model., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Almazyad et al.)