Course Report on

1^st Phacoemulsification Simulators and

Ophthalmic Microscopic

12-17 December 2015 (1-6 Rabi Al Awal1437)

Course type

Wet-lab Course

Provided for

Second Year Residents In KAUH

Course Organizer

Dr. Saeed Al Wadani, MD

 

Contents:

1. Courses Organizing Team
2. Introduction
3. Objective and Courses fees
4. Overall evaluation report for 1^st Phacoemulsification Simulator and Ophthalmic Wet-lab Course at King Abdul-Aziz University hospital
5. Conclusion
6. Future recommendation & Acknowledgment

 

Course Organizing Team:

Course Organizer: Dr. Saeed Alwadani

Speakers and Instructor Supervisors:

-Dr. Abdullah Assiri                     -Dr. Sabah Jastaneiah 

-Prof. Essam Osman                     -Dr. Hatem Kalantan

-Dr. Majed Al Kharashi               -Senior Residents        

-Mr. Hussam - Alcon                   -Mr. Rajab Hariz

 

Administrative Coordinator: Mrs Monasheryl Pineda

 

Courses Provider:

Department of Ophthalmology, College of Medicine

King Saud University

Introduction

Eye surgery is a complex operation requiring accurate hand-eye coordination and fine motor movements for handling of delicate instruments. So it’s difficult to learn, expensive and time-consuming (Binenbaum & Volpe 2006). Slight carelessness may even lead to blindness. Many years of education and training experience, are required to become a specialist in ophthalmology (Choi, Soo et al. 2009). Patient’s safety and surgical efficacy cannot be sacrificed for educational purposes. Hence other methods of training are used outside the operation room (OR), such as wet laboratory training and simulation training.

Surgical simulators and wet-lab represent an important step in reducing the gap between clinical practice and simulator practice. With increase in computing power and advanced stereoscopic techniques, more realistic and dynamic hand-eye movements can be imitated (Sikder et al.). Virtual simulators have been widely used in medical and surgical training, including ophthalmology. Multiple studies have reported that simulator training and wet laboratory training improve the surgical performance in ophthalmology (Feudner et al. 2009), shorten the residents’ learning curve along with less time consumption (Belyea et al. 2011; Pokroy et al. 2013) and decrease the surgical morbidity or risk for iatrogenic traumas (Solverson et al. 2009). The utilization of simulators in the residency training has been reported to decrease complications in cataract surgeries (Sikder et al 2014).

The utilization of surgical simulation technology and wet-lab training would allow a great flexibility in training process to gradually reduce the training difficulties, to expose trainees to rare events that can be risky for patients and to quantify performance and surgical skills.

 

General objectives:

1. To improve and build up the surgical skills of the cataract phacoemulsification surgery for Resident’s in Ophthalmology.
2. To have training within a proficiency-based virtual reality and wet-lab course may reduce errors during real surgical procedures and improves cataract surgery performance.
3. To acquire the skills of suturing, fine motor and proprioceptive skills under an operating microscope.
4. To give general principles of phacoemulsification machines and dynamics.
5. Identify and handling the instruments used for cataract surgery.
6. Successfully complete a cataract case, using appropriate phacoemulsification settings on the goat eyes and Eye Simulator.

 

Learning specific objectives for each day were:

1. First day simulator and wet-lab objectives:

1. Demonstrate proper placement and length of corneal incisions.
2. Demonstrate paracentesis with a 3-step entry and proper placement of corneal incision that is neither too long causing corneal striae nor too short causing iris prolapse.
3. Demonstrate a scleral tunnel incision of adequate length and its 3 steps entrance procedure.
4. Demonstrate creation of a scleral tunnel of adequate length that does not cause decreased visibility through the cornea, neither entering into anterior chamber nor posterior, causing iris prolapse.
5. Perform a continuous curvilinear capsulorhexis of appropriate size on the EYESI Simulator and goat eye.
6. Describe the pedal settings on a phacoemulsification machine.
7. Understand different categories of OVDs, their properties, preferred use.
8. Review the different types of ophthalmic suture and needles.
9. Understand principles of suture placement and needle passage.
10. Inject viscoelastic into the eye before capsulorhexis.
11. Identify the instruments used for cataract surgery.

1. Second Day Objectives:

1. Understand the differences in phacoemulsification machines and settings.
2. Demonstrate the ability to create an adequate sized capsulorhexis with easy insertion of IOL and its good fixation on artificial and sheep eyes.
3. Understand principles of the technique and the difference between hydrodissection and hydrodelineation.
4. Demonstrate the ability to do hydro-dissection, hydro-delineation using BSS.
5. Complete "groove" of appropriate depth, length, and width with minimal stress on zonules.
6. Crack nucleus and rotate nucleus with minimal stress on zonules.
7. Remove quadrants, taking care to keep quadrant in iris plane (away from capsule and endothelium).
8. Demonstrate the ability of load and inserting a 1-piece PCIOL into the capsular bag.
9. Learn how to handling instruments used for cataract surgery.

1. Third Day Objectives:

1. Successfully complete a cataract case using appropriate phacoemulsification settings and iris hook retraction on the goat eyes.
2. Successfully complete a cataract case using appropriate phacoemulsification setting on the EYESI Simulator.
3. Demonstrate the ability of load and inserting a 3-piece PCIOL into the sulcus.
4. Learn about IOL designs.
5. Understand principles of how to choose a lens for a patient.
6. Learn about different IOL formulas and biometry.

1. Fourth and five Day Objectives:

The Residents should master the 1^st, 2^nd& 3^rd day objectives

 

 

1. Sixth Day Objectives:

• By the end of the course, the residents had Best answers MCQs and Objective Structure Practical Examination (OSPE).

 

Courses fees:

Registration fee of 3,000 Saudi Riyals

Note:  Saudi Board Residents will pay 50% (1,500SR) and Saudi Commission will pay for him the remaining 50%.

 

Methodology and material:

 

• Two Phacoemulsification machine with bag.
• Simulator machine.
• 2 laptop with headphone.
• Three microscopic with complete cataract instrument setting.
• Training staff: two consultants and one senior resident supervisor for each session.
• Two operation room nurse for the whole course.
• Twenty goat eyes each day.
• Ultrasound course
• Four tables and 10 chairs.
• Ophthalmic viscoelastic devices, iris hooks retraction, single, three pieces IOL.
• Evaluation of the residents including Best answers MCQs and Objective Structure Practical Examination (OSPE).

 

Course Description:

Course period and location: 12 - 17 December 2015 (Saturday-Thursday) from 8:00AM until 4:30PM in the Function Hall, building 1-level 4, King AbdulAziz University Hospital.

Participants: There are nine (9) residents who participated in the course with the specific objectives in each day.

Course programme: the course program had 6 days, first two days had lectures and theory in the morning and practical session hands on training in the afternoon. Monday, Tuesday and Wednesday would be practical session hands on training for the whole day.

The morning sessions are plainly lectures given by our invited speakers and in the afternoon is the practical hand-on training.

In the practical sessions (hands on training) five stations were provided, and each station had two residents to be trained for two hours. First station had two phacoemulsification machines and full ophthalmic theater requirements, second station had ECCE procedure facilities including a microscope, suturing and ophthalmic instruments. Third station had video demonstration of number of cataract surgeries and managements of intraoperative complication. Fourth station had Eye simulator and the last station location was in the US department and the participants had a hands on training on real patients.

Last day was evaluation day for the resident and it was divided into two parts: First part was MCQs consisting of 12 single best answers and the score range between 66% to 100%
Second part was Objective Structure Practical Examination (OSPE) on check list.
Overall, the result was very good and all resident passing the MCQs and OSPE.

Regarding the resident assessment of the course:

In general, most of the participants were happy to complete the course successfully, gaining the aimed skills of the course. They admitted that’s the Eye simulator machine was greats teaching and training method and its enforced their self confidence. Beside, they feel that they had polished their surgical skills and gained new fine motor and proprioceptive skills by the end the course.

On the other hand, some of the participants complained about grade of the cataract in module eye (goat eye) where the lens was pretty soft so it was difficult for participant to performed the divided, conquer and chopping. Other complained was about the shape of goat lens which was hard for them to do capsulorhexis as required. We will try to get artificial cataract eyes which are good for capsulorhexis and divided as well as chopping.

 

 

Conclusion:

Wet laboratory and eye simulators course are effective to improve the resident’s surgical skills and subsequent patient outcomes.

 

 

Future Recommendation:

• To repeat this course three times at least per year and priority will be for level two and three residents in Ophthalmology Saudi Board and Non-Resident Ophthalmologist on

1. 28 February - 3 March 2016 (Sunday-Thursday)
2. 17 -21 April 2016 (Sunday-Thursday)
3. 15 -19 May 2016 (Sunday-Thursday)

 

• To increase the number the trainee from 10 to 12
• Add one more microscope with complete ophthalmic theatre set.
• Fridge to collects the used viscoelastic material from OR every after surgery.
• To add two senior resident for each day and from duty clinic not from R time
• To bring the artificial cataract eyes at least 10 for each day in addition to 20 goat eyes per day

 

 

Acknowledgment:

I would like to thank the Curriculum Committee including Prof. Adel Alsuhaibani, Prof. Hani Almezeani and Dr. Abdullah Alfawaz.  All the speakers including Dr. Sabah Jastaniah, Dr. Abdullah Assiri, Dr. Majed Alkharashi, Prof. Essam Osman, Mr. Rajab Hariz and Mr. Hussam from Alcon Co.

To our Supervisors, Prof. Essam Osman and Dr Hatem Kalantan and our Senior Residents. I would like also thank Michelle Rasonabe and Mona Pineda our secretary.