Performance Of Capsulorhexis Research Articles

Validity and Reliability of Farra Eye Model as a Surgical Simulator for Capsulorhexis Training

Abstract
 Introduction & Objectives : Various simulation models are available for cataract surgery training. Farra Eye Model, a new cataract surgery simulator, was developed to provide the resident with more affordable options. This study aims to determine the validity and reliability of the Farra Eye Model as a surgical simulator for capsulorhexis training.
 Methods : A cross-sectional pilot study was performed among ophthalmology residents and consultants to assess face, content, and construct validity of a new surgical simulator. Subjects were divided into novice, intermediate, and expert groups according to their level of expertise. Face and content validity was assessed using a validated questionnaire with a 5-point Likert scale response. Construct validity was done by comparing capsulorhexis performance between the three groups. Two raters assessed performance using capsulorhexis indices in ICO-OSCAR: Phaco assessment tool, number of forceps grabs, and duration of capsulorhexis.
 Results : A total of 33 subjects were recruited and divided equally into three groups. The overall face validity score was favorable (3.67 ± 0.67). However, the capsule elasticity was rated poor (2.73 ± 1.1) among the intermediate group. The content validity was favorable regarding the overall score (4.15± 0.58) and each assessment component. In the construct validity test, intermediate and expert groups showed better capsulorhexis performance than the novice group on all parameters (p<0.001), with good inter-rater reliability (ICC>0.7).
 Conclusion : Farra Eye Model has a good face and content validity for capsulorhexis training and is able to differentiate the novice group from intermediate and expert groups. However, it remains a challenge to replicate human lens capsule elasticity.

Training ambidexterity - A survey-based analysis on the dexterity of ophthalmologists in performing standard ophthalmic procedures.

Our study was designed to determine ophthalmologists' dexterity in performing standard ophthalmic procedures at various levels of expertise via a structured questionnaire. A structured questionnaire was administered via the Google platform from August 20 to September 19, 2022, to assess the perspectives and preferences of ophthalmologists concerning their proficiency in using their right hand, left hand, or both hands to perform routine tasks required in the practice of ophthalmic medicine and surgery. Two hundred and three participants took part in the survey. A majority (n = 162, 79.8%) of the clinicians considered themselves right-handed, nine (4.4%) considered themselves left-handed, and 32 (15.7%) considered themselves ambidextrous. Also, 86% (n = 174) of the participants considered ambidexterity an essential trait in the practice of ophthalmic medicine and surgery. The number of cataract surgeries performed had an impact on the comfort of using both hands for performing anterior vitrectomy (P < 0.001), injection of viscoelastic (P < 0.001), and toric marking (P < 0.05), but not on the performance of capsulorhexis and switching of foot pedals. The number of procedures carried out had an impact on the comfort of using both hands in gonioscopy (P < 0.001), 90 D evaluation (P < 0.001), and 20 D evaluation (P < 0.05). More years of experience had an impact on skills involving the use of both hands for slit lamp joystick usage (P < 0.05) and laser procedures (P < 0.001). Irrespective of a person's handedness, trained ambidexterity in the required fields is achievable and has a significant impact on one's ability to perform the required skill optimally and appropriately.

Вариант использования лазерной фемтосекундной факофрагментации без лазерной капсулотомии в случае осложненной катаракты

Purpose. To evaluate the effectiveness of using femtosecond phacofragmentation without laser capsulotomy in cataract phacoemulsification with a relatively narrow pupil against the background of pseudoexfoliation syndrome in combination with grade I lens subluxation. Material and methods. The subject of the study was a case of complicated cataract in patient Ya., 74 years old, with complaints of decreased vision in the right eye. Standard preoperative and postoperative examinations were performed. The patient underwent surgery using a phacoemulsifier (CenturionVisionSystem, Alcon, USA) with preliminary laser femtosecond support (Catalys TM Precision Laser System-Johnson&amp;Johnson Vision). A three-part IOL AcrySof MA60AC (Alcon, USA) with an optical power of 22.0 diopters was implanted. The peculiarity of the operation was that at the stage of laser femtosecond support, only phacofragmentation was performed without capsulotomy. Result. In this case, only phacofragmentation was performed without the formation of capsulorhexis with laser femtosecond support of phacoemulsification against the background of a rigid, relatively narrow pupil, which made it possible to safely use the usual methods of mechanical pupil dilation followed by manual performance of capsulorhexis of the optimal diameter. On the 2nd day after the operation, visual acuity without correction was 0.5, with a correction of –0.75 diopters – 0.7. The result of surgical treatment in this case indicates that a separate use of femtosecond laser fragmentation of the lens without anterior capsulotomy is possible. In this case, it was applied taking into account the combined pathology: pseudoexfoliation syndrome, lens subluxation, relatively narrow pupil and the objective need to use the Malyugin ring, the planned method of fixing the IOL. The preserved anterior capsule made it possible to perform standard implantation of the Malyugin ring without any special features, followed by capsulorhexis of the optimal diameter. Conclusion. This example demonstrates the possibility of safely and effectively performing phacofragmentation without capsulorhexis at the stage of laser femtosecond support during cataract phacoemulsification, when the pupil diameter does not allow programming the optimal capsulorhexis size. Key words: ciliocapsular fixation, intraocular lens, pseudoexfoliation syndrome, femtosecond laser

Efficacy of Eyesi surgical simulator training in improving high-tension capsules capsulorhexis performance

Purpose: To evaluate if Eyesi cataract surgical simulator using its standard course curriculum is effective in improving performance of cataract surgery trainees on creating capsulorhexis on high-tension capsules on the simulator. Methods: We retrospectively analyzed reports of ophthalmic surgery trainees (2nd and 3rd year residents and cataract fellowship trainees) that have accomplished the standard Eyesi cataract surgery simulator course version 2.1 between May 2012 and August 2013 at Instituto de Diagnostico e Terapia Ocular, Rio de Janeiro, Brazil. We compared the mean score (from 0 to 100) attributed by the simulator on performing the same task, a capsulorhexis on a high-tension capsule, on the surgical simulator before training (during beginning of the course) and after training (at later stages of the course). Results: Thirty-seven trainees' reports were analyzed. Mean and standard deviation before training high-tension capsulorhexis score was 41.73 ± 27.08 points and the mean after training score was 72.55 ± 16.40 points, a difference of +30.82 points (p value <0.001 on Paired t test), representing a 73% improvement on performance. Conclusions: Eyesi surgical simulator on course version 2.1 curriculum was effective in improving performance of cataract surgery trainees on creating capsulorhexis on high-tension capsules.

Effectiveness evaluation of a new surgical marker for anterior capsulorhexis

Purpose: To evaluate the effectiveness of a surgical device that intented to help in the preparation of the anterior capsulorhexis analyzing the design and shape, comparing with capsulorhexis made by free hand. Methods: Three ophthalmology residents(R3) at the HUOL and one surgeon in training, participate in this research as volunteers. Each surgeon perform 5 capsulorhexis in porcine eyes using the device, and five others by free hand as a control. All capsulorhexis were photographed having a ruler as reference to guide and calibrate a computer application for morphometric evaluation (Cambui Labs, Natal, Brazil). All surgeons aimed to produce a circular continuous capsulorhexis of 5 mm diameter that represents 15,7mm in perimeter and 19,652mm2 in area. Each wet-lab capsulorhexis was evaluated in regard to these criteria: diameter (mean, maximum and minimum), perimeter, area, deviation from the ideal diameter and ideal shape. Results: Compare to control groups, capsulorhexis with the aid of the surgical device showed: 5,44mm ±0,89 vs 6,37mm ±0,67, for capsulorhexis diameter (p=0,001); 17,52mm ±1,92 vs 20,14mm ±2,09 for capsulorhexis perimeter (<0.001); 24,73mm2 ±1,92 vs 32,62mm2 ±6,36 for capsulorhexis area (p<0,001). A tendency for better result with the aid of the surgical device was observed for deviation of an ideal diameter or ideal aspect were appreciated: 0,87mm ±0,05 vs 0,9 ±0,04 for deviation of a curve (p=0,06); 1,26mm ±0,12 vs 1,21mm ±0,7 for the capsulorhexis aspect (p=0,09). Conclusion: Capsulorhexis produced with the aid of the surgical device, significantly improved wet-lab capsulorhexis performance.

Efficacy of Eyesi® surgical simulator training in improving high-tension capsules capsulorhexis performance

Objetivos: Avaliar se o realizado com o simulador cirurgico de catarata Eyesi e o seu curriculo de exercicios padrao sao efetivos em melhorar o desempenho de cirurgioes de catarata em formacao na confeccao de capsulorrexe em capsulas de alta tensao realizadas no simulador. Metodos: Analisamos retrospectivamente relatorios de de residentes de 2o e 3o ano e fellows de catarata que realizaram o curso versao 2.1 de com o simulador cirurgico de catarata Eyesi no periodo de maio de 2012 a agosto de 2013 no Instituto de Diagnostico e Terapia Ocular, Rio de Janeiro, Brasil. Comparamos o escore medio (de 0 a 100 pontos) atribuido na confeccao de capsulorrexe em capsula de alta tensao no simulador antes do treinamento (durante inicio do curso) e depois do treinamento (nos estagios finais do curso). Resultados: Trinta e sete relatorios de cirurgioes em foram analisados. O escore medio e desvio padrao da capsulorrexe em capsula de alta tensao antes do treinamento foi de 41,73 ± 27,08 pontos e depois do treinamento de 72,55 ± 16,40 pontos, uma diferenca de +30,82 pontos (p <0.001 no teste t pareado), representando uma melhora de 73% no desempenho. Conclusao: O realizado com o simulador cirurgico de catarata Eyesi seguindo o curriculo do curso versao 2.1 foi eficaz em melhorar o desempenho de cirurgioes em na confeccao de capsulorrexe em capsulas de alta tensao.

The use of a virtual reality surgical simulator for cataract surgical skill assessment with 6 months of intervening operating room experience

PurposeTo evaluate a haptic-based simulator, MicroVisTouch™, as an assessment tool for capsulorhexis performance in cataract surgery. The study is a prospective, unmasked, nonrandomized dual academic institution study conducted at the Wilmer Eye Institute at Johns Hopkins Medical Center (Baltimore, MD, USA) and King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia).MethodsThis prospective study evaluated capsulorhexis simulator performance in 78 ophthalmology residents in the US and Saudi Arabia in the first round of testing and 40 residents in a second round for follow-up.ResultsFour variables (circularity, accuracy, fluency, and overall) were tested by the simulator and graded on a 0–100 scale. Circularity (42%), accuracy (55%), and fluency (3%) were compiled to give an overall score. Capsulorhexis performance was retested in the original cohort 6 months after baseline assessment. Average scores in all measured metrics demonstrated statistically significant improvement (except for circularity, which trended toward improvement) after baseline assessment. A reduction in standard deviation and improvement in process capability indices over the 6-month period was also observed.ConclusionAn interval objective improvement in capsulorhexis skill on a haptic-enabled cataract surgery simulator was associated with intervening operating room experience. Further work investigating the role of formalized simulator training programs requiring independent simulator use must be studied to determine its usefulness as an evaluation tool.

Ophthalmic Surgery Simulator Training Improves Resident Performance of Capsulorhexis in the Operating Room

To assess the effect of a Capsulorhexis Intensive Training Curriculum (CITC) on the rates of errant, continuous, curvilinear capsulorhexes (CCCs) during cataract surgery among resident surgeons at a teaching hospital. Retrospective educational interventional case series. A total of 1037 consecutive cataract surgeries performed at Harbor-UCLA Medical Center during 4 consecutive academic years were considered. The baseline cohort consists of 434 cataract surgeries performed during the 2 academic years before the intervention. The postintervention cohort consists of 603 cataract surgeries performed during the following 2 consecutive academic years. The principal intervention was the introduction of the CITC for residents on the Eyesi (VRmagic, Mannheim, Germany) ophthalmic virtual reality surgical simulator. The main outcome measure was the rate of errant CCCs among the capsulorhexes performed during resident surgical cases. Errant CCCs were defined as attempted CCCs that resulted in the attending physician taking over, radialization of the CCC, conversion to can-opener capsulorhexis, or any combination of the 3 aforementioned conditions. Secondary measures included the use of trypan blue during CCC and correlating errant CCC and surgeons' level of training (postgraduate year [PGY]). There were 68 errant CCCs (15.7%) in the baseline cohort and 30 errant CCCs (5.0%; P<0.0001) in the postintervention cohort, a 3.2-fold or 68% reduction. The use of trypan blue increased from 55.3% in the baseline cohort to 76.0% in the postintervention cohort (P<0.00001), but within each cohort there was no significant difference in the rate of errant CCCs whether trypan blue was used or not. In the baseline cohort, there was a statistical trend toward fewer errant CCCs among PGY 4 (14.6%) compared with PGY 3 (22.8%) surgeons (P = 0.12). The postintervention cohort showed no significant difference in errant CCC rates between PGY 3 (4.4%) and PGY 4 (5.1%) surgeons (P = 1.00). This study strongly suggests that virtual reality surgical simulation training with the CITC on the Eyesi reduces the rate of errant capsulorhexes. The incorporation of a formal program for surgical training via virtual reality simulation should be strongly considered in ophthalmology resident surgical education to reduce the unnecessary risk of complications for live patients.

Virtual reality training improves wet-lab performance of capsulorhexis: results of a randomized, controlled study

To investigate, whether capsulorhexis training on the EYESi surgical simulator improves wet-lab operating performance of surgical novices. Randomized, masked experimental study. Thirty-one medical students and 32 ophthalmological residents were randomized to either virtual reality (VR) training, or control. Initially and after 3 weeks each participant performed three capsulorhexis tasks in a porcine wet-lab. In between, participants from the VR training groups completed two training trials on the EYESi surgical simulator (VRmagic, Mannheim, Germany). VR training consisted of basic skill tasks and capsulorhexis tasks of increasing difficulty, and preset performance goals had to be reached for each task. All wet-lab procedures (n = 372) were recorded on DVD, and assessed by a masked observer. Each wet-lab capsulorhexis was evaluated with regard to five criteria (circularity, size, centering, time, tissue protection) using a predefined scoring system with a maximum overall score of 10 points (2 per criterion). The primary outcome measure was the intra-individual difference in the average overall performance score between the first and second wet-lab capsulorhexis procedures. Ten operation videos were additionally assessed by three further investigators to determine interobserver agreement. Inter-observer agreement regarding the overall performance score was high (ICC = 0.91). Compared to control groups, VR-trained students and residents showed significant improvement in their median wet-lab capsulorhexis overall performance score compared to controls (+3.67 vs +0.33 points, P = 0.001 and +3.33 vs +/-0.00 points, P < 0.0001). The capsulorhexis performance of VR-trained students and residents was also more consistent with a lower standard deviation of scores compared to controls (SD 1.3 vs 2.1 and 1.2 vs 1.7 points respectively). Structured capsulorhexis training on the EYESi to reach specific target criteria significantly improved wet-lab capsulorhexis performance.

Needle capsulorhexis in intumescent white cataract using slow injecting viscoelastic device through an anterior chamber maintainer

DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5282Nepal J Ophthalmol 2011; 3(2): 214-215