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Angle Examination Gonioscopy and Minimally Invasive Glaucoma Surgical Training on Human Eyes in Wet Lab. J Glaucoma 2022; 31:839-845. [PMID: 35882034 DOI: 10.1097/ijg.0000000000002075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To understand the feasibility, utility and efficacy of a low-cost model for performing anterior chamber angle gonioscopy and micro-surgery on human corneo-scleral tissues in wet lab on resident skill enhancement. METHODS Post-keratoplasty residual corneo-scleral rims and/or the expired donor corneo-scleral buttons were included for the purpose of this study. Initially, inverted rims were used to demonstrate the basic angle anatomy on a slit lamp bio-microscope. Central hazy cornea was then replaced with an artificial cornea and an artificial anterior chamber to simulate indirect gonioscopy, direct gonioscopy, goniotomy and other angle-based surgeries. Direct gonioscopy and goniotomy exercises (as a means to simulate intra-operative gonioscopy and other angle-based surgeries respectively) were evaluated quantitatively, and the rest qualitatively. RESULTS A total of 65 residents were included in the exercise. The mean age was 26.69±1.74 years. Amongst these, 55 ophthalmology residents performed the basic examination, that is, slit lamp mounted angle anatomy examination (n=55) and artificial chamber mounted indirect gonioscopic examination through artificial cornea (n=55). In the second exercise, 10 glaucoma fellows performed the direct gonioscopic and the goniotomy exercises on artificial chamber. The fellows demonstrated a statistically significant improvement in interpretation and surgical skill enhancement concurrent with reduction in time taken with increasing number of attempts (P<0.05). In the third simulation exercise, micro-stent placement within the Schlemm's canal, sub-conjunctival space, and the supra-choroidal space was re-produced successfully on multiple occasions. CONCLUSIONS The residual human corneo-scleral rims proved to be an important resource for teaching both the basic examination skills as well as those required for transitioning to advanced intraoperative gonioscopy and goniotomy skills. These low cost, easy to adapt models can be incorporated within the curriculum for improved glaucoma training of both the residents and the glaucoma fellows.
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Dormegny L, Neumann N, Lejay A, Sauer A, Gaucher D, Chakfe N, Bourcier T. Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1740065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Purpose This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing.
Methods An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents' skills in corneal suturing during dedicated training sessions.
Results Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon's fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback.
Conclusion This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors' experience.
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Affiliation(s)
- Lea Dormegny
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
- GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
| | - Nicole Neumann
- GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
| | - Anne Lejay
- GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
- Department of Vascular Surgery and Kidney Transplantation, Strasbourg University Hospital, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
- GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
- GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
| | - Nabil Chakfe
- GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
- Department of Vascular Surgery and Kidney Transplantation, Strasbourg University Hospital, France
| | - Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
- GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
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Gupta PC, Singh R, Khurana S, Behera RK, Thattaruthody F, Pandav SS, Ram J. Reworking protocols of ophthalmic resident surgical training in the COVID-19 era - Experiences of a tertiary care institute in northern India. Indian J Ophthalmol 2021; 69:1928-1932. [PMID: 34146058 PMCID: PMC8374778 DOI: 10.4103/ijo.ijo_566_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Coronavirus Disease 2019 (COVID-19) pandemic has negatively impacted medical professionals in all fields of medicine and surgery in their academic, clinical and surgical training. The impact of surgical training has been described as ‘severe’ by most ophthalmology residents worldwide due to their duties in COVID-19 wards, disruption of outpatient and camp services. Methods: Ophthalmic surgery demands utmost accuracy and meticulousness. Fine motor proficiencies, stereoscopic skills and hand–eye coordination required can only be achieved by practice. So, a multileveled structured wet-lab teaching schedule was prepared for the residents and implemented to bridge this gap between theory and practice at our tertiary care institute. A semester-wise training schedule was made with the proper distribution of wet-lab and simulator training. Surgeries like phacoemulsification, scleral buckling, pars plana lensectomy and vitrectomy, trabeculectomy and intravitreal injections were practised by the residents on the goat eyes. Simulator training was provided for phacoemulsification and vitrectomy to increase the hand–eye coordination of the residents. Results: Residents noticed improvement in their surgical skills and ambidexterity post wet-lab and simulator training . It also increased their confidence and provided essential surgical skills required to be used in the operation theater later. Conclusion: It is imperative that wet-lab training be included in the residency training programme in this COVID-19 era.
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Affiliation(s)
- Parul Chawla Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjan Kumar Behera
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Faisal Thattaruthody
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Pandav
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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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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Helke KL, Meyerholz DK, Beck AP, Burrough ER, Derscheid RJ, Löhr C, McInnes EF, Scudamore CL, Brayton CF. Research Relevant Background Lesions and Conditions: Ferrets, Dogs, Swine, Sheep, and Goats. ILAR J 2021; 62:133-168. [PMID: 33712827 DOI: 10.1093/ilar/ilab005] [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: 10/15/2020] [Revised: 11/17/2020] [Accepted: 01/06/2021] [Indexed: 01/01/2023] Open
Abstract
Animal models provide a valuable tool and resource for biomedical researchers as they investigate biological processes, disease pathogenesis, novel therapies, and toxicologic studies. Interpretation of animal model data requires knowledge not only of the processes/diseases being studied but also awareness of spontaneous conditions and background lesions in the model that can influence or even confound the study results. Species, breed/stock, sex, age, anatomy, physiology, diseases (noninfectious and infectious), and neoplastic processes are model features that can impact the results as well as study interpretation. Here, we review these features in several common laboratory animal species, including ferret, dog (beagle), pig, sheep, and goats.
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Affiliation(s)
- Kristi L Helke
- Department of Comparative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David K Meyerholz
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Amanda P Beck
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric R Burrough
- Veterinary Diagnostic and Production Animal Medicine Department, Iowa State University, Ames, Iowa, USA
| | - Rachel J Derscheid
- Veterinary Diagnostic and Production Animal Medicine Department, Iowa State University, Ames, Iowa, USA
| | - Christiane Löhr
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Elizabeth F McInnes
- Toxicologic Pathology, Toxicology Section, Human Safety at Syngenta, in Jealott's Hill, Bracknell, United Kingdom
| | - Cheryl L Scudamore
- ExePathology, Pathologist at ExePathology, Exmouth, Devon, United Kingdom
| | - Cory F Brayton
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Selvan H, Pujari A, Kishan A, Behera AK, Sidhu T, Gupta V, Dada T, Sihota R. Trabeculectomy on Animal Eye Model for Resident Surgical Skill Training: The Need of the Hour. Curr Eye Res 2020; 46:78-82. [PMID: 32478613 DOI: 10.1080/02713683.2020.1776880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To describe a goats' eye training model for teaching of trabeculectomy and releasable suture techniques for Ophthalmology residents. Methods: A descriptive report explaining the methodology for setting up a goats' eye wet-lab model for teaching trabeculectomy for Ophthalmology residents. It details the approaches to eyeball preparation, steps of surgery, application and release of two representative types of 'releasable sutures' in a step-by-step manner. Conclusion: A systematic approach using goats' eye model to teach trabeculectomy and releasable suture techniques can enhance residents' understanding, confidence and expertise to operate upon human eyes.
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Affiliation(s)
- Harathy Selvan
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
| | - Amar Pujari
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
| | - Azmira Kishan
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
| | - Aswini K Behera
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
| | - Talvir Sidhu
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
| | - Viney Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
| | - Tanuj Dada
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
| | - Ramanjit Sihota
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi, India
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Pujari A, Basheer S, Rakheja V, Gagrani M, Saxena R, Phuljhele S, Sharma P. Extraocular muscle surgery on goats' eye: An inexpensive technique to enhance residents' surgical skills. Indian J Ophthalmol 2020; 67:1688-1689. [PMID: 31546509 PMCID: PMC6786173 DOI: 10.4103/ijo.ijo_89_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hands-on resident surgical training for various ocular procedures is essential to impart good surgical skills to the budding ophthalmologists. Here in this report, we demonstrate a simple and inexpensive technique of performing extraocular muscle surgery on goats’ eye. These animal eyes possess soft tissue resemblance to that of human eyes to a greater extent in terms of scleral rigidity, muscle elasticity, its width, thickness, and its insertion onto the sclera. Therefore, rectus muscle recession, resection, and plication surgeries can be performed repeatedly to improve an individual's orientation and practical experience before performing the procedure on human eyes.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shabeer Basheer
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Rakheja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meghal Gagrani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Phuljhele
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Acharya M, Farooqui JH, Dave A. Commentary: Training in wet labs and on surgical simulators: Need of the hour. Indian J Ophthalmol 2019; 67:549-550. [PMID: 30900594 PMCID: PMC6446623 DOI: 10.4103/ijo.ijo_1940_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Manisha Acharya
- Department of Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Marg, Daryaganj, New Delhi - 110 002, India
| | - Javed Hussain Farooqui
- Department of Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Marg, Daryaganj, New Delhi - 110 002, India
| | - Abhishek Dave
- Department of Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Marg, Daryaganj, New Delhi - 110 002, India
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