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Parekh M, Wallace AG, Airaldi M, Ruzza A, Ferrari S, Romano V, Ahmad S. Performance outcomes from a DMEK peeling and preparation wet lab. BMJ Open Ophthalmol 2024; 9:e001540. [PMID: 38272533 PMCID: PMC10824027 DOI: 10.1136/bmjophth-2023-001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To evaluate the Descemet membrane endothelial keratoplasty (DMEK) preparation performance of trainee surgeons in an ex vivo human donor cornea DMEK wet lab simulation setting. METHODS Human donor corneoscleral rims unsuitable for transplantation were obtained from Moorfields Lions Eye Bank. At the wet lab, graft stripping was performed by scoring the peripheral endothelium. The trypan blue positive cells (TBPC) and cell density (cells/mm2-reticule count) were counted manually before and after stripping. The procedural time, peripheral and central tears and complete peel-off were also recorded and analysed. RESULTS Eight trainee surgeons attended the wet lab each attempting three DMEKs. Between the first and last attempts a significant decrease was seen in the procedural time (17.6 min vs 10.6 min (p<0.05)) and the TBPC % (12.9% vs 3.8% (p<0.05)). The percentage of tears peripherally and centrally also reduced between the first and the last trials (50% vs 13% (p=0.2226) and 38% vs 0% (p=0.1327)). A significant correlation was found between longer peeling times and higher TBPC % (p<0.001) with a 0.7% endothelial mortality increase for each additional minute required to complete the peel. CONCLUSIONS DMEK wet labs provide a controlled risk-free learning opportunity for trainee surgeons to improve confidence and competence. Wet labs improve the success rate of DMEK graft preparation as well as flatten the learning curve. This emphasises the importance of continued support for the expansion of this valuable learning resource, promoting wider uptake of DMEK surgery.
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Affiliation(s)
- Mohit Parekh
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - Matteo Airaldi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Stefano Ferrari
- Fondazione Banca degli Occi del Veneto, Mestre, Venice, Italy
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Saluja G, Bhatia P. A novel smartphone-assisted model for resident surgical training. Indian J Ophthalmol 2024; 72:128-129. [PMID: 38131584 PMCID: PMC10841807 DOI: 10.4103/ijo.ijo_1660_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: 06/25/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 12/23/2023] Open
Abstract
Wet lab sessions during residency play an important role in developing the surgical skills of trainee residents. However, establishing a wet lab requires funds and equipment. Moreover, they might not be accessible to all the residents. The smartphone magnifying lens can magnify the images 8-10 times, sufficient to practice suturing techniques. Hereby, we describe a novel model for resident surgical training using a smartphone.
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Affiliation(s)
- Gunjan Saluja
- Department of Ophthalmology, Bhatia Netralaya, Bhilai, Chhattisgarh, India
| | - Priyavrat Bhatia
- Department of Ophthalmology, Bhatia Netralaya, Bhilai, Chhattisgarh, India
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3
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Parekh M, Ruzza A, Rovati M, Tzamalis A, Romano D, Gupta N, Vaddavalli P, Bhogal M, Jhanji V, Sawant O, Semeraro F, Ponzin D, Jacob S, Dragnea DC, Rodriguez-Calvo-de-Mora M, Dhubhghaill SN, Fogla R, Sharma N, Jurkunas UV, Ferrari S, Romano V. DMEK surgical training: An instructional guide on various wet-lab methods. Surv Ophthalmol 2023; 68:1129-1152. [PMID: 37392969 DOI: 10.1016/j.survophthal.2023.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplantation procedure that involves selective transplantation of the Descemet membrane and endothelium. DMEK offers significant advantages over other keratoplasty techniques, such as faster visual rehabilitation, better final visual acuity due to minimal optical interface effects, lower risk of allograft rejection, and less long-term dependence on topical steroids. Despite all its advantages, DMEK has been found to be more challenging than other corneal transplantation techniques, and its steep learning curve appears to be an obstacle to its widespread use and adoption by corneal surgeons worldwide. DMEK surgical training laboratories (wet labs) provide a window of opportunity for surgeons to learn, prepare, manipulate, and deliver these grafts in a risk-free environment. Wet labs are a significant learning tool, especially for those institutions that have limited tissue availability in their local centers. We provide a step-by-step guide for preparing DMEK grafts using different techniques on human and nonhuman models with instructional videos. This article should eventually help the trainees and the educators understand the requirements for performing DMEK and conducting a DMEK wet lab and develop their skills and interests from a wide variety of available techniques.
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Affiliation(s)
- Mohit Parekh
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Marco Rovati
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Davide Romano
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Nidhi Gupta
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Pravin Vaddavalli
- Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Onkar Sawant
- Department of Research and Development, Center for Vision and Eye Banking Research, Eversight, Cleveland, OH, USA
| | - Francesco Semeraro
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Soosan Jacob
- Department of Cataract and Glaucoma Services, Dr. Agarwal's Refractive and Cornea Foundation, Chennai, India
| | | | | | | | - Rajesh Fogla
- Department of Ophthalmology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Namrata Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Ula V Jurkunas
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Vito Romano
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Eye Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
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Hoxha K, Alikhani A, Inagaki S, Ferle M, Maier M, Nasseri MA. Modelling and Development of a Mechanical Eye for the Evaluation of Robotic Systems for Surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082703 DOI: 10.1109/embc40787.2023.10340226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Ophthalmic surgery, which addresses critical eye diseases such as retinal disorders, remains a formidable and arduous surgical pursuit. Nevertheless, with the advent of cutting-edge robotics and automation technology, significant advancement has been made in recent years to enhance the safety and efficacy of these procedures through meticulous research and development efforts. Ensuring the safe and effective execution of micro-surgical procedures requires stringent quality control measures, notably concerning evaluating and testing the devices utilized. During the development phase, these instruments must undergo extensive and continual evaluation by clinical practitioners to guarantee their safety and efficacy. Ideally, the test conditions should be identical to those of an actual operation. When testing robotic systems for ophthalmology, essential variables of the human eye, such as tissue properties and movement mechanisms, should be addressed. To minimize the discrepancy of tests and actual eye surgery conditions, in this paper, we propose a developed mechanical eye model to enable the realistic evaluation of ophthalmic surgical systems. After developing a virtual and physical model, the model was tested by an eye surgeon. The eye surgeon rated the model with four out of five possible points.Clinical relevance- This method ensures minimal discrepancy in verification of ophthalmic surgical devices by allowing the mechanical eye model to behave similar to the human eye, thus providing a realistic surgical procedure.
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Singh Parmar UP, Singh T, Ichhpujani P. Reliability of open globe injury repair surgical videos on the internet for resident education. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231161867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction This study aimed to assess quality of surgical training videos for management of open globe injury (OGI) on online platforms. Material and Methods Twenty-three websites with surgical training videos were queried using the search keyword “open globe repair.” Video content characteristics and quality assessment scores using Sandvik score, Health on the Net Foundation Code of Conduct (HON code), mDISCERN scoring, and global quality score (GQS) were recorded. To evaluate the relevance of the surgical videos to the surgical procedure, steps were analyzed as per the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management. Results One hundred and twenty-three videos were evaluated, and 63 analyzed. Majority videos were uploaded by solitary ophthalmologists (53/63; 84.13%). Mean video quality score (VQS) and GIS scores were 6.55 ± 1.59 and 7.95 ± 1.39, respectively. Mean mDISCERN, GQS, HON Code and Sandvik scores for all the videos were 2.87 ± 1.07, 3.77 ± 1.08, 5.14 ± 1.67, 12.06 ± 1.84, respectively. Videos with background audio and descriptive subtitles had significantly better quality ( p < 0.05). All Quality assessment scores showed a statistically significant ( p < 0.000) positive correlation with each other. On linear regression analysis, number of video likes, comments and views had a significant ( p < 0.05) positive relation with quality of video, whereas video length showed a negative relation with different scores. Conclusion Nearly two-thirds of surgical videos showing OGI repair had good quality assessment scores. Consensus guidelines should be developed to guide uploaders as regards the essential features required for good quality surgical videos using a standardized rubric.
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Affiliation(s)
| | - Tanu Singh
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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Sankarananthan R, Prasad RS, Koshy TA, Dharani P, Bacchav A, Lansingh VC, Ahiwalay C, Balagiri K, Shekhar M. An objective evaluation of simulated surgical outcomes among surgical trainees using manual small-incision cataract surgery virtual reality simulator. Indian J Ophthalmol 2022; 70:4018-4025. [PMID: 36308148 PMCID: PMC9907272 DOI: 10.4103/ijo.ijo_1600_22] [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
Purpose The purpose of this study was to evaluate trainee performance across six modules of a virtual reality (VR) simulator. Methods A retrospective observational study was conducted on 10 manual small-incision cataract surgery (MSICS) trainees who practiced cataract surgery on an MSICS VR simulator for one month. They were assessed in six major steps which included scleral groove, tunnel dissection, keratome entry, capsulorhexis, nucleus delivery, and intraocular lens (IOL) insertion under a trainer's supervision. The information included in their score metrics was collected, and their overall performance was evaluated. Results Thirty attempts were evaluated for scleral groove, tunnel dissection, and capsulorhexis and 15 attempts for keratome entry. Candidates had varied results in the dimensional aspects and their rates of complications with a mean satisfactory score of 3.1 ± 4.17, 6.8 ± 5.75, 5.8 ± 7.74, and 1.8 ± 2.57, respectively. Nucleus delivery (n = 5) had more of iris pull and IOL insertion (n = 5) had more of lost IOL as complications but both had a higher satisfactory outcome. Conclusion A VR simulator is a useful tool for training surgeons before their entry into live surgery. It is an effective method for evaluating objectively the structural characteristics of each phase in MSICS and their associated complications, helping them anticipate it earlier during live surgery by giving them a near real world experience.
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Affiliation(s)
- R Sankarananthan
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - R Senthil Prasad
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Tony Alex Koshy
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Padam Dharani
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Ashish Bacchav
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Van Charles Lansingh
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Chetan Ahiwalay
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Madhu Shekhar
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India,Correspondence to: Dr. Madhu Shekhar, Chief, Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India. E-mail:
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Almaliotis D, Athanasopoulos GP, Almpanidou S, Papadopoulou EP, Karampatakis V. The contribution of wet labs in the education of ophthalmologists. Ann Med Surg (Lond) 2021; 72:103034. [PMID: 34824838 PMCID: PMC8604746 DOI: 10.1016/j.amsu.2021.103034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background The need for pre-training in experimental eye surgery is considered necessary. It is an essential way to assess trainees in ophthalmology based on their instrument and tissue handling and skills. This article aims to underline this necessity and demonstrate the ocular health professionals' opinion on this issue. Methods 74 participants (45 females and 29 males) were included in the study. Ophthalmology residents, ophthalmologists participated in the wet lab session. The evaluation of the contribution of the wet labs were provided by filling a new questionnaire form. In this way, an interactive questionnaire was developed. Results Regarding trainees' grading of wet labs' significance as a first step for guiding their surgical career, it was positively correlated with their subjective view of labs' utility to both improve their surgical skills (p = 0.001) and maintain pre-existing ones (p < 0.001). We should also note that all of them (100%) stated that wet labs were necessary during residency, especially in repeated sessions, and that they would recommend them to their colleagues. Conclusion The surgical skills improved significantly after participation in a wet lab, according to participants, who rated the experience as highly educational. Wet labs can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency, and treat patients safely and effectively. Pre-training in experimental eye surgery is considered to be necessary. Health professionals evaluated the role of wet labs by filling a new questionnaire. Participants had a positive opinion on wet labs' role, especially during residency. Wet labs can reduce the learning curve of difficult surgical techniques. Safe and effective treatment of ophthalmology patients is more feasible.
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Affiliation(s)
- Diamantis Almaliotis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Georgios P Athanasopoulos
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Stavroula Almpanidou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Eleni P Papadopoulou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Vasileios Karampatakis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
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Sarkar S, Kasturi N, Jayasri PP, Kaliaperumal S. Comments on: 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; 69:2545-2546. [PMID: 34427268 PMCID: PMC8544038 DOI: 10.4103/ijo.ijo_1837_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: 11/13/2022] Open
Affiliation(s)
- Sandip Sarkar
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - P P Jayasri
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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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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Ng JY, Vaideanu-Collins D, Schofield S. Comments on: Essentials of setting up a wet lab for ophthalmic surgical training in COVID-19 pandemic. Indian J Ophthalmol 2021; 69:1333-1335. [PMID: 33913896 PMCID: PMC8186575 DOI: 10.4103/ijo.ijo_277_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jia Y Ng
- Sunderland Eye Infirmary, Sunderland, United Kingdom
| | | | - Susie Schofield
- Centre of Medical Education, University of Dundee, United Kingdom
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