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Shafeena P, Venkataramanan P, Murugesan S, Gosalia H, Chandrakanth P, Venkatapathy N. EYESPIRATOR- A novel do-it-yourself suction device. Indian J Ophthalmol 2023; 71:3715-3717. [PMID: 37991310 PMCID: PMC10788750 DOI: 10.4103/ijo.ijo_720_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 11/23/2023] Open
Abstract
Surgery, by nature, involves blood loss. Thus, suction plays an important role in ensuring a clean operating view and ease of access. In ophthalmology, there is a void for an efficient and flexible suction apparatus that is yet to be filled. Our innovation, the Eyespirator, is made using recycled or inexpensive parts, is easy to assemble, and can serve as a cost-effective alternative to the current apparatus under use. It helps to overcome the difficulties caused by large instruments and non-pliable suction tips, unregulated generation of vacuum, and high pressures generated causing trauma to the delicate structures, and can prove to be of immense use in fields such as ophthalmology where the small surgical field is a big challenge. It creates a vacuum by using a simple water pump and is regulated by a foot pedal. This can be deployed even in rural settings, and small modifications can allow its usage in a wide variety of surgical fields.
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Affiliation(s)
- P Shafeena
- DNB Resident, Department of General Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | | | - Sindhuja Murugesan
- Department of Orbit and Oculoplasty Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Hirika Gosalia
- DNB Resident, Department of General Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Gupta N, Bhogal M, Vaddavalli PK, Boldini A, Semeraro F, Varshney A, Romano V. A goat eye, wet lab model for training in Descemet membrane endothelial keratoplasty. Indian J Ophthalmol 2023; 71:2230-2233. [PMID: 37202956 PMCID: PMC10391481 DOI: 10.4103/ijo.ijo_1834_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Here we describe a new, non-human, ex-vivo model (goat eye model) for training surgeons in DMEK surgeons. In a wet lab setting, goat eyes were used to obtain a pseudo-DMEK graft of 8 mm from the goat lens capsule that was injected into another goat eye with the same maneuvers described for human DMEK. The DMEK pseudo-graft can be easily prepared, stained, loaded, injected, and unfolded into the goat eye model reproducing the similar maneuvers used for DMEK in a human eye, except for the descemetorhexis, which cannot be performed. The pseudo-DMEK graft behaves similar to human DMEK graft and useful for surgeons to experience and understand steps of DMEK early in learning curve. The concept of a non-human ex-vivo eye model is simple and reproducible and obviates the need for human tissue and the issues of poor visibility in stored corneal tissue.
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Affiliation(s)
- Nidhi Gupta
- Department of Cornea and Refractive Services, and Stem Cell Lab, Dr. Shroff's Charity Eye Hospital, Delhi, India
| | | | | | - Alessandro Boldini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Italy
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Italy
| | - Akhil Varshney
- Department of Cornea and Refractive Services, and Stem Cell Lab, Dr. Shroff's Charity Eye Hospital, Delhi, India
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Italy; Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Gurnani B, Kaur K, Kumar M. Innovative inexpensive wet-lab training model for practicing keratoplasty during COVID-19 pandemic. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Paul A, Nagarajan S. Making the most of limited resources in wet-lab training during COVID-19. Indian J Ophthalmol 2021; 70:351-352. [PMID: 34937295 PMCID: PMC8917605 DOI: 10.4103/ijo.ijo_1996_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Anujeet Paul
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Sri Balaji Vidyapeeth, Pondicherry, India
| | - Swathi Nagarajan
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Sri Balaji Vidyapeeth, Pondicherry, India
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Akkara JD, Kuriakose A. Commentary: Intravitreal injection of formalin as a life hack for ophthalmic wet lab training. Indian J Ophthalmol 2021; 69:3755-3756. [PMID: 34827039 PMCID: PMC8837281 DOI: 10.4103/ijo.ijo_1682_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- John D Akkara
- Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu; Department of Glaucoma, Westend Eye Hospital, Cochin, Kerala, India
| | - Anju Kuriakose
- Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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Odayappan A, Sulaiman SM, Nachiappan S, Venkatesh R. Formalin-assisted training eyes for ophthalmic wet lab practice. Indian J Ophthalmol 2021; 69:3752-3755. [PMID: 34827038 PMCID: PMC8837316 DOI: 10.4103/ijo.ijo_1058_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The foundation of an ophthalmologists’ microsurgical career begins in the wet lab. Training on donor cadaveric, animal like goat or pig eyes provide the most realistic surgical environment, however, the availability of a donor’s eyes for practice is limited. This scarcity is further escalated in this current coronavirus disease 2019 pandemic where eye donations have decreased. Even among those eyes which find their way into the wet lab, quite a few would have collapsed significantly making training difficult. Therefore, we looked at ways to salvage these collapsed globes. We describe a novel way of salvaging the collapsed eyeballs by injecting formalin in slow boluses into the vitreous cavity. The longer maintenance of the globe integrity without necessitating repeated injections facilitates better quality of surgical training and optimal utilization of these eyes.
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Affiliation(s)
- Annamalai Odayappan
- Medical Consultant, Glaucoma Services, Aravind Eye Hospital, Pondicherry, India
| | | | - Sivagami Nachiappan
- Resident, Indira Gandhi Govt. General Hospital and Post Graduate Institute, Pondicherry, India
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Mak M, Hong Y, Trask WM, Thompson R, Chung H, Warrian KJ. Novel open-source 3D-printed eye mount (TEMPO) for the ophthalmology wet lab. BMJ Open Ophthalmol 2021; 6:e000685. [PMID: 34786484 PMCID: PMC8587504 DOI: 10.1136/bmjophth-2020-000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/03/2021] [Indexed: 11/03/2022] Open
Abstract
Objective Procuring an affordable eye mount that can stabilise a cadaveric eye and simulate a patient's normal facial contours represents an ongoing challenge in the ophthalmology simulation wet lab, with notable limitations to all currently available commercial options. This project uses computer-assisted design and three-dimensional (3D)-printing techniques to tackle these challenges for ophthalmologic surgical training. Methods and Analysis Proof-of-concept study. Using Autodesk Fusion 360, we designed and 3D-printed a modular device that consists of 11 pieces forming a head structure. Standard OR tubing and syringes were adapted to create an adjustable-suction system to affix cadaveric eyes. Further modular inserts were customised to house non-cadaveric simulation eyes. Results Three-dimensional eye mount for procedures in ophthalmology (TEMPO) reliably fixed a cadaveric eye in stable position throughout surgical manipulation. Trainees were able to drape and practice appropriate hand positioning while corneal suturing. Overall, this model was affordable, at a cost of approximately $C200 to print. The modular nature renders individual pieces convenient for replacement and customisable to simulate regional anatomical variation and accommodate non-cadaveric eyes. Conclusions TEMPO represents an affordable, high-fidelity alternative to existing commercially available eye mounts. It reliably fixates cadaveric and simulation eyes and provides an enhanced surgical training experience by way of its realistic facial contours. It is released as an open-source computer-aided design file, customisable to interested trainees with appropriate software and 3D-printing capacity.
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Affiliation(s)
- Michael Mak
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Yejun Hong
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William Murray Trask
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Helen Chung
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Kevin J Warrian
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Radhakrishnan N, Pathak N, Prajna NV. Recycled femtosecond patient interface device and nasal aspirator for eye fixation in wet-lab training. J Cataract Refract Surg 2021; 47:674-675. [PMID: 33017343 DOI: 10.1097/j.jcrs.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022]
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Pujari A, Saluja G, Bhaskaran K, Modaboyina S, Asif MI, Agarwal T, Sharma N, Titiyal JS. Animal and cadaver human eyes for residents' surgical training in ophthalmology. Surv Ophthalmol 2021; 67:226-251. [PMID: 33992664 DOI: 10.1016/j.survophthal.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/19/2022]
Abstract
In ophthalmology residency programs surgical training plays a vital role in creating confident and skillful surgeons. As almost all ophthalmic surgery needs microscope training, creating a well-taught environment for hand-eye coordination, ocular tissue handling, and anticipation of complications is essential. Wet lab training with animal or cadaver human eyes offers diverse possibilities. We conducted a thorough literature search on various databases to identify the existing literature on wet labs. The results revealed constructive efforts for training novice surgeons in all surgical ophthalmology subspecialties. Wet lab models were initially used only to practice cataract surgery; however, now various complex ocular procedures can be practiced. Ocular surface, corneal, iris, lenticular, scleral, vitreoretinal, extraocular, eyelid, and other adnexal surgeries were reproduced and mastered in many ways. Importantly, with repeated surgical practice, residents gained an increasing level of confidence with enhanced surgical accuracy. In addition, we propose a few novel techniques of various other procedures.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Gunjan Saluja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Karthika Bhaskaran
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sujeeth Modaboyina
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Mishra D, Bhatia K, Verma L. Essentials of setting up a wet lab for ophthalmic surgical training in COVID-19 pandemic. Indian J Ophthalmol 2021; 69:410-416. [PMID: 33463600 PMCID: PMC7933840 DOI: 10.4103/ijo.ijo_3298_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Wet labs are an extremely important training tool, especially in times of a global COVID-19 pandemic, where surgical training can be minimal. They help the trainee learn and practice in a risk-free environment, without an imminent of a complication or failure, also allowing them the chance to execute the steps of a surgery repeatedly. We summarize all the key ingredients required from setting up a wet lab to improve the surgical skill of the trainees. The review also discusses various eyeball fixating devices, preparation of the eye for various types of ocular surgeries, and the role of simulation-based training in today's scenario.
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Affiliation(s)
- Deepak Mishra
- Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Karan Bhatia
- Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
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Lee R, Raison N, Lau WY, Aydin A, Dasgupta P, Ahmed K, Haldar S. A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology. Eye (Lond) 2020; 34:1737-1759. [PMID: 32203241 PMCID: PMC7609318 DOI: 10.1038/s41433-020-0832-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/23/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022] Open
Abstract
To evaluate all simulation models for ophthalmology technical and non-technical skills training and the strength of evidence to support their validity and effectiveness. A systematic search was performed using PubMed and Embase for studies published from inception to 01/07/2019. Studies were analysed according to the training modality: virtual reality; wet-lab; dry-lab models; e-learning. The educational impact of studies was evaluated using Messick's validity framework and McGaghie's model of translational outcomes for evaluating effectiveness. One hundred and thirty-one studies were included in this review, with 93 different simulators described. Fifty-three studies were based on virtual reality tools; 47 on wet-lab models; 26 on dry-lab models; 5 on e-learning. Only two studies provided evidence for all five sources of validity assessment. Models with the strongest validity evidence were the Eyesi Surgical, Eyesi Direct Ophthalmoscope and Eye Surgical Skills Assessment Test. Effectiveness ratings for simulator models were mostly limited to level 2 (contained effects) with the exception of the Sophocle vitreoretinal surgery simulator, which was shown at level 3 (downstream effects), and the Eyesi at level 5 (target effects) for cataract surgery. A wide range of models have been described but only the Eyesi has undergone comprehensive investigation. The main weakness is in the poor quality of study design, with a predominance of descriptive reports showing limited validity evidence and few studies investigating the effects of simulation training on patient outcomes. More robust research is needed to enable effective implementation of simulation tools into current training curriculums.
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Affiliation(s)
- Roxanne Lee
- GKT School of Medical Education, King's College London, London, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, King's College London, London, UK
| | - Wai Yan Lau
- School of Medicine, St George's, University of London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, UK
| | - Shreya Haldar
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK.
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Ezeanosike E, Azu-Okeke JC, Achigbu EO, Ezisi CN, Aniemeka DI, Ogbonnaya CE, Chuka-Okosa CM. Cost-Effective Ophthalmic Surgical Wetlab Using the Porcine Orbit with a Simple Dissection Protocol. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojoph.2019.94020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Partitioning an Artificial Anterior Chamber With a Latex Diaphragm to Simulate Anterior and Posterior Segment Pressure Dynamics: The “DMEK Practice Stage,” Where Surgeons Can Rehearse the “DMEK Dance”. Cornea 2017; 37:263-266. [DOI: 10.1097/ico.0000000000001435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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