[Evaluation of surgical simulation sessions of the French society of ophthalmology. A new surgical instruction method]. / Évaluation des sessions sur simulateurs chirurgicaux de la Société française d'ophtalmologie. Une nouvelle pédagogie chirurgicale.

INTRODUCTION: Since 2013, at the French society of ophthalmology (FSO) meetings, two simulators for intraocular surgeries have been available. The goal of this study was to assess the satisfaction of the participants in these organized training sessions. MATERIALS AND METHODS: A questionnaire was mailed to participants in the FSO sessions as well as those carried out during the annual congress. This questionnaire collected data on the participants and the practical modalities of the sessions, and assessed participants' feelings and satisfaction with these sessions. RESULTS: The participants in the SFO sessions were young members of the SFO (31.8±12.3 years). 53.8 % were in training, looking to improve a problematic surgical step (capsulorhexis in 51.5 %). They spent nearly 5hours on simulators (4.8hours) and were alone on a simulator 50 % of the time. The sessions held during the annual congress were used by older physicians (41.9±26.4 years) already in practice (66.6 %). The goal of such training was curiosity in a third of the cases (to try the simulators). The majority spent less than an hour on the devices and were at least two participants per machine. Despite these differences, participants cited a role for their surgical learning curve and recommended such training to their colleagues. CONCLUSIONS: The participants' enthusiasm for this new training technique is highlighted by the results of this study.

MY EXPERIENCE OF TEACHING PHACOSURGERY ON VISALIS 100 IN SUDAN AND NIGERIA.

At the invitation of the director of The National Eye Center, Kaduna, Nigeria and The Makkah Eye Hospital of Khartoum, Sudan I visited both these institutions to teach phacoemulsification surgery to their aspiring surgeons on Visalis 100 (Carl Zeiss Meditec, Germany). This article highlights the experience of teaching phacoemulsification surgery in foreign African countries like Nigeria and Sudan. In Nigeria I had the opportunity to give training in both wet lab and live surgery settings whereas in Sudan only hands-on live surgery. Sudan being an Islamic nation pigs are not slaughtered there and hence no pig eyes. Goat eyes differ significantly from human eyes and hence have almost no value in wet lab teaching. The training program included theoretical discussions, wet lab, surgery and finally discussions related to the days' surgery. It became clear that quality of learning depends on three main factors. Thorough understanding of theory and observation of senior surgeons in operation room Good wet lab and finally doing the surgery oneself in step by step manner. Dedicated teachers and instructors can make all the difference. The learning curve also significantly shortens if the trainees are exposed to all types of cataract surgery like ECCE, SICS and phacoemulsification surgery. The main problem faced by those surgeons who have done only ECCE/SICS is that they are not used to handling microscope and instruments in both hands at the same time. Hence I strongly recommend them wet lab where they can sit and practice using both hands and feet and microscope simultaneously and in coordinated fashion.

Quantification of intraocular surgery motions with an electromagnetic tracking system.

Motion tracking was performed during a combined phacoemulsification (PKE) and pars plana vitrectomy (PPV) procedure on a pig eyeball. The UCLA Laparoscopic Training System (UCLA-LTS), which consists of electromagnetic sensors attached to the surgical tools to measure three-dimensional spatial vectors, was modified to enable quantification of intraocular surgery motions. The range of motion and time taken to complete the given task were successfully recorded.

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.

The learning curve for primary vitrectomy without scleral buckling for pseudophakic retinal detachment.

BACKGROUND: To assess the functional and anatomical outcome of primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment (RRD) in pseudophakic patients and to present the learning curve for this surgery in less experienced surgeons. METHODS: We reviewed the charts of pseudophakic patients treated with primary vitrectomy without scleral buckling for a rhegmatogenous retinal detachment with PVR

[Training program for vitreoretinal surgery in Nairobi, Kenya from 2000 - 2006]. / Trainingsprogramm zur vitreoretinalen Chirurgie in Nairobi, Kenia, in den Jahren 2000 - 2006.

BACKGROUND: After the U. S. Embassy bombing in 1998 in Nairobi, Kenya, a relief operation was immediately initiated by the Department of Ophthalmology of the Ludwig Maximilians University (LMU) Munich, Germany. Surgical devices and material (such as a vitrectomy unit, silicon oil, perfluorodecalin, intraocular lenses, sutures) were supplied to operate on 42 ocular-injured victims of this bombing attack. Apart from these specific operations in Kenya, there is a big need for vitreoretinal surgery in East Africa, as in all other developing countries. Therefore, a vitreoretinal training program was started in 2000 in Nairobi, Kenya. We report about the first 7 years of collaboration between the Ludwig Maximilians University of Munich, Germany and the University of Nairobi in cooperation with the Kenyatta National Hospital, Kenya. MATERIAL AND METHODS: The training program was based on an annual project week in which the author (CLS) carried out vitreoretinal surgery himself and assisted and supervised surgery done by the local Kenyan colleagues at the Kenyatta National Hospital. Within the observation period of the present work (2000 - 2006) the following data were collected: number and kind of surgery, indications, surgeons, grading of eye pathology and the surgical procedure, time to prepare for surgery and duration of surgery. RESULTS: In total, 293 vitreoretinal surgeries were performed during the observation period. Surgeries carried out by the local Kenyan colleagues independently, without intervention of the author, increased from 29.4 % (2000) to 78.6 % (2006). Due to a constant development in the learning process during the project week more severe cases were treated and preparation time for surgery from the nursing side has shortened. CONCLUSIONS: By initiating a project week with high frequency surgery, supported by a highly experienced visiting surgeon, vitreoretinal surgery can be successfully set up in an ophthalmic clinic of a developing country. This approach has some advantages when compared to long-period projects, especially for the purposes of sustainability. However, to be successful it requires systematic planning which is described in this article.

Computer-assisted training system for pars plana vitrectomy.

PURPOSE: To evaluate whether microsurgical steps in vitreoretinal surgery can be taught by a computer-assisted training system. METHODS: This prospective, randomized experimental study included 14 ophthalmic residents and medical students who were completely inexperienced in microsurgery. They were randomized into two groups. The study group underwent training programmes in a computer-assisted training system for simulation of pars plana vitrectomy. The control group did not participate in any in vitro training. In the second phase of the study, participants of both groups performed a pars plana vitrectomy in three pig eyes, which included picking a metallic foreign body from the retinal surface. RESULTS: The amount of retinal detachment and the number of retinal defects at the end of the vitrectomies were smaller, the time needed to remove the foreign body was shorter, the number of retinal lesions associated with the foreign body removal was lower, and the mark given was better in the trained study group than in the untrained group. The relatively small number of study participants did not allow the differences between the study and control groups to reach the 5% level of error probability. CONCLUSIONS: In an animal model, training by a computer-based medical work station for simulation of pars plana vitrectomy showed better outcome measures for trained study participants compared with untrained study participants. Future studies may show whether further refinements of such training programmes will result in statistically significantly better results in surgical outcome parameters.

A contact lens as an artificial cornea for improved visualization during practice surgery on cadaver eyes.

OBJECTIVE: To describe the use of a polymethylmethacrylate contact lens as an artificial cornea to enhance visualization for practice surgery using cadaver eyes. DESIGN: The opaque cornea of a cadaver eye is removed by trephination. Cyanoacrylate glue is used to secure a large-diameter polymethylmethacrylate contact lens to the corneal rim. RESULTS: Excellent visualization for practice surgery is achieved with this technique. The adhesion of the contact lens to the cadaver eye maintains the anterior chamber sufficiently to perform phacoemulsification cataract extraction or pars plana vitrectomy. CONCLUSIONS: This technique improves visualization of the intraocular structures during practice surgery, thereby enhancing the ability of the learning surgeon to perform and practice delicate surgical maneuvers. The procedure is simple, effective, and inexpensive.