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Omar Solyman,1,2 Hashem Abu Serhan,3 Hesham F Kamel,1 Amgad Eldib,1,4– 6 Ahmed S Abo Obaia,1 Amr Aref,1 Ibrahim Osama Sayed-Ahmed,7,8 Mohamed Khashaba,9 Mohamed M Khodeiry,1,8 Mokhtar M Abushanab1 1Department of Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt; 2Department of ophthalmology, Qassim University Medical City, Al-Qassim, Saudi Arabia; 3Department of Ophthalmology, Islamic Hospital, Amman, Jordan; 4Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA; 5UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 6University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 7Department of Ophthalmology, Baylor College of Medicine, Houston, TX, 77030, USA; 8Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; 9Department of Anesthesiology, Research Institute of Ophthalmology, Giza, EgyptCorrespondence: Omar Solyman, Department of Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt, Email o.solyman@rio.edu.egIntroduction: We describe and validate a low-cost simulation model for practicing anterior lens capsule continuous curvilinear capsulorhexis (CCC).Methods: A simulation model for CCC was developed from widely available low-cost materials. Ophthalmologists attending the annual scientific meeting of the Research Institute of Ophthalmology, Giza, Egypt, were asked to perform a five CCC model task and then anonymously answer a questionnaire that assessed the realism and training utility of the model using a five-point Likert scale (1 = unacceptable, 2 = poor, 3 = acceptable, 4 = favorable and 5 = excellent).Results: Twenty-seven ophthalmologists completed the task and the anonymous questionnaire. Overall, participants felt that the model simulated CCC step in cataract surgery well (mean: 3.5) and was comparable to other kinds of CCC simulation models (mean: 3.3). The model scored highly for its overall educational value (mean: 4.00) and for enlarging a small CCC (mean:3.7), while the feasibility of this model in practicing the management of a runaway leading edge of CCC scored 2.9.Conclusion: This model may provide an alternative method for training for CCC and other anterior lens capsule-related maneuvers. This option may be particularly helpful for residency training programs with limited access to virtual reality simulators or commercially available synthetic eye models.Keywords: cataract simulation, capsulorhexis, capsulotomy, microsurgical model

Mohamed M Khodeiry,1,2 Xiangxiang Liu,1,3 Mohamed S Sayed,1 Raquel Goldhardt,1 Giovanni Gregori,1 Thomas A Albini,1 Richard K Lee1 1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; 2Research Institute of Ophthalmology, Department of Ophthalmology, Giza, 12557, Egypt; 3Beijing Eye Institute, Beijing Tongren Eye Center, Beijing Tongren Eye Hospital, Capital Medical University, Beijing, 100730, People’s Republic of ChinaCorrespondence: Richard K LeeBascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, 900 NW 17 th Street, Miami, FL 33136, USATel +1 305 326-6400Fax +1 305 547-3658Email rlee@med.miami.eduPurpose: Peripapillary halos (PPH) are peripapillary changes observed surrounding the optic nerve head in normal eyes and eyes with different disorders. Recognizing the microstructure and mechanism of development of these halos will help clinicians understand the different associated retinal and optic nerve head pathologies. We describe the in vivo histological characteristics of PPH in birdshot chorioretinopathy (BSCR).Patients and Methods: This was a prospective observational case-series in a single tertiary referral center. Six eyes of three patients with PPH associated with BSCR were determined through clinical examination, fundus photography, and fundus autofluorescence (FAF). Patients underwent swept-source optical coherence tomography (SS-OCT) imaging of the optic nerve head and peripapillary region.Results: In SS-OCT B-scans across the area of PPH, we observed thinning and interruption of retinal pigment epithelium (RPE)-Bruch’s membrane complex. These halos are a circumferential form of alpha zone RPE-associated crescentic peripapillary atrophy (PPA), unlike the PPH observed with myopia and normal aging.Conclusion: PPH in BSCR patients may be a sign of prior inflammatory optic neuropathy.Keywords: birdshot chorioretinitis, optical coherence tomography, optic nerve head, peripapillary halo, peripapillary atrophy