Resident-performed neodymium:YAG laser posterior capsulotomy.

OBJECTIVE: To investigate the outcomes of resident-performed Nd:YAG laser posterior capsulotomy. DESIGN: Combined retrospective and prospective study. PARTICIPANTS: Patients (N = 301) who underwent Nd:YAG capsulotomy by ophthalmology residents at Rassoul Akram Hospital, Tehran, Iran. METHODS: Assessment of visual outcomes and complications and the results of second- and third-year residents. RESULTS: In the retrospective arm, 131 eyes of 129 patients were enrolled. Mean best-corrected visual acuity (BCVA) improved significantly from 1.15 ± 0.26 to 0.54 ± 0.39 logMAR (p < 0.001). Mean intraocular pressure (IOP) before capsulotomy and at the final visit was 13.1 ± 2.34 mm Hg and 13.6 ± 2.17 mm Hg, respectively (P = 0.30). Retinal detachment occurred in 2 eyes (1.5%). No case of intraocular lens decentration or endophthalmitis was detected. In the prospective arm on 173 eyes of 172 patients, mean pre-YAG BCVA was 1.14 ± 0.25 logMAR and increased to 0.51 ± 0.37 logMAR after surgery (p < 0.001). There was no significant difference between pre-laser IOP measurements compared with the 1-month IOP measurements (P = 0.32). The postoperative changes in mean BCVA and IOP between the second- and third-year residents were not significant; however, the applied laser power, the number of laser spots, rate of incomplete capsulotomies, and the amount of total and central laser-induced IOL pits were significantly higher among the second-year residents. CONCLUSIONS: Resident-performed capsulotomy appears to be effective with a low complication profile. Despite the lower levels of surgical skills, second-year residents could achieve good visual outcomes. The laser parameters and IOL-related complications improved with increasing surgical experience.

Design and Validation of a Training Simulator for Laser Capsulotomy, Peripheral Iridotomy, and Retinopexy.

BACKGROUND AND OBJECTIVES: Ophthalmology trainees commonly learn laser procedures on live patients. A simulator for learning peripheral iridotomy (PI), posterior capsulotomy, and retinopexy may improve patient outcomes. MATERIALS AND METHODS: A model eye with artificial tissues was designed. The tissues reacted to laser similarly to human tissues. Inexperienced (n = 6; first- to third-year residents) and experienced (n = 7; fourth- to fifth-year residents and staff) ophthalmic personal were compared on performance of the above laser procedures. RESULTS: The inexperienced group required more shots (P = .04) and caused more lens markings (P = .04) during capsulotomy and had more incomplete retinopexy results (P = .04) than the experienced group. The groups did not differ in total shots for PI, average power for retinopexy, or the total time required for any of the procedures. CONCLUSION: Our model effectively simulates common ophthalmic laser procedures and is practical for the training of ophthalmology residents. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:56-61.].

Simulation of neodymium:YAG posterior capsulotomy for ophthalmologists in training.

UNLABELLED: We describe a new method for training ophthalmologists to perform a neodymium:YAG (Nd:YAG) posterior capsulotomy. Our model consists of an artificial anterior chamber that can be adjusted to fit any laser instrument and houses an intraocular lens (IOL). The posterior surface of the IOL is coated with a crust simulating posterior capsule opacification (PCO). This model PCO reacts similarly to real PCO when the Nd:YAG laser is applied to it. It creates conditions simulating near-real posterior capsulotomy and has been used successfully to train 3 novice residents who had not performed the procedure. The model is simple, reusable, and inexpensive. We believe it may be a valuable tool in training ophthalmologists to perform an Nd:YAG posterior capsulotomy. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.