Buckling surgery on a goat's eye: A simple technique to enhance residents' surgical skill.

Buckling surgery is one of the common procedures performed by the retinal surgeons for visual rehabilitation at the earliest in cases of retinal detachment. The optimal surgical skill in this section can only be achieved with repeated practices and clinical experiences. Here, we describe an easy and inexpensive way to perform, practice, and refine surgical skills by demonstrating this complicated surgery in a simple manner on goat's eyes. The advantages of this technique are real-tissue handling experiences and repeatability of the procedure with almost similar practical implications. Thus, whenever feasible, every attempt should be made to refine the residents or budding ophthalmologists surgical skills by undertaking this technique in their routine curriculum.

SCLERAL BUCKLING WITH WIDE-ANGLED ENDOILLUMINATION AS A SURGICAL EDUCATIONAL TOOL.

PURPOSE: To describe a technique of wide-angle viewing as an educational tool in scleral buckling for rhegmatogenous retinal detachment. METHODS: Retrospective comparative study of the reported technique was performed. Fourteen consecutive patients each who underwent Chandelier-assisted scleral buckling (CSB) or standard scleral buckling (SSB) using indirect ophthalmoscope were included. The primary outcome measure was the proportion of eyes that had successful reattachment of retina. RESULTS: Mean study eye baseline visual acuity was 20/160 in the CSB group and 20/320 in SSB group. The primary reattachment rate was similar, with 13 of 14 eyes (92.85%) successfully attached in the CSB group and 12 of 14 eyes (85.71%) in the SSB group. The mean visual acuity improved from 20 of 160 to 20 of 80 in the CSB group, and 20 of 320 to 20 of 160 in the SSB group. The surgical time was significantly less in the CSB group (77.85 ± 16.37 minutes) compared with the SSB group (95.71 ± 26.59 minutes, P = 0.037). CONCLUSION: Chandelier-assisted buckling had similar outcomes compared with standard buckling. It could be used as a valuable educational tool for teaching fellows by allowing them to simultaneously view the operative steps along with the surgeon.

Learning curve of the scleral buckling operation: lessons from the first 97 cases.

BACKGROUND/AIMS: To provide an insight into the learning curve associated with scleral buckling surgery for an ophthalmologist on a fellowship course and to evaluate risk factors affecting outcomes during this period. METHODS: Retrospective data were collected on 97 consecutive scleral buckling procedures (divided into 3 consecutive groups) performed by one surgeon (W.C.) beginning his first fellowship year. We evaluated the anatomic results, operative times and complications, and sought to identify risk factors of anatomic failure. RESULTS: The single-operation success rate was 71.9% (23 of 32 eyes) in the first group, which was lower than 87.5% (28 of 32 eyes) in the second and 84.8% (28 of 33 eyes) in the third. The operative time was 106.3 min in the first, which is longer than 86.5 min in the second and 73.8 min in the third group. Factors predictive of unfavorable anatomic outcome were multiple breaks and multiple buckling procedures in the first 32 cases, and multiple breaks and breaks located posterior to the equator in the latter 65. CONCLUSION: Surgical experience of approximately 30 cases was required to achieve stable clinical results. Thus, a retinal surgeon at the beginning of his career may increase his success rate by careful case selection avoiding high-risk groups until he reaches the level of experience indicated by the learning curve.

Resident surgical practice patterns for vitreoretinal surgery in ophthalmic training programs in the United States.

PURPOSE: To assess resident surgical experience in vitreoretinal surgery (VRS) in the United States. DESIGN: Anonymous electronic survey over 2 consecutive years. PARTICIPANTS: A total of 287 third-year ophthalmology residents from US residency programs were included. METHODS: To determine the type and amount of surgical experience in VRS. Residents were contacted via e-mail to complete the survey. A series of follow-up e-mails were sent to nonresponders. E-mail correspondence was sent to program directors of the US residency programs to encourage survey participation. An electronic survey instrument (Survey Monkey) was used to distribute the survey and collect the results. Participants were asked about vitrectomy and scleral buckle procedures as primary surgeon and about office procedures (e.g., intravitreal injections and retinal laser procedures). Questions regarding the self-described "comfort" level of the resident and the Accreditation Council for Graduate Medical Education (ACGME) vitreoretinal requirements for ophthalmology were also included. MAIN OUTCOME MEASURES: Vitreoretinal office and surgical procedures. RESULTS: Of the 114 ophthalmology residency programs in the United States, 3 programs declined to participate and 103 of 228 programs (114 programs per year) did not respond to requests during a 2-year period. Of the 287 total respondents, approximately 59.1% had performed vitrectomy and 40.8% had performed a scleral buckle as the primary surgeon. In the survey of office procedures, 96.7% had performed intravitreal injections, 94.8% had performed macular laser therapy, and 99.6% had performed panretinal photocoagulation. In the self-reported resident "comfort" level section, 59% were "fairly comfortable" knowing the theoretic steps for VRS and 55.4% were "fairly satisfied" with VRS training. However, 72% of respondents were unaware of the correct ACGME minimum operative numbers for VRS. CONCLUSIONS: This self-reported electronic survey of third-year residents suggested that VRS experience at ACGME-accredited programs as primary surgeon was suboptimal for surgeries. A modest majority of residents reported comfort and satisfaction with VRS training for surgery, but a majority was satisfied and had adequate experience with office procedures such as intravitreal injection and laser treatment. Unfortunately, the majority of residents were unaware of the actual numeric ACGME VRS requirements for ophthalmology residency programs.