Posters

The Queens Hospital model for simulated anterior vitrectomy: a pilot study of a novel wetlab training tool amongst UK ophthalmology residents

Poster Details

First Author: J. Wawrzynski UNITED KINGDOM

Co Author(s):    V. Zygoura   B. Paul                 

Abstract Details

Purpose:

Posterior capsular rupture (PCR) with anterior vitreous prolapse is an infrequent but serious complication of cataract surgery. Its poor management can lead to sight threatening sequelae such as retinal detachment. It is therefore essential that cataract surgeons are proficient at anterior vitrectomy. However, anterior vitrectomy is a skill that is difficult for ophthalmic trainees to acquire because it occurs infrequently and consultants often take over from trainees after PCR due to its sight threatening nature. We present a novel wet-lab simulation for anterior vitrectomy. We test its realism, feasibility and usefulness when introduced into the North-London ophthalmic residents’ training programme.

Setting:

The North London ophthalmology specialist training programme: Ophthalmic operating theatre at Queens Hospital, London

Methods:

A plastic training eye [Phillips Studio,UK] had its anterior chamber partially filled with a toy gel product [“Crazy Slime”,OOTB,Germany] to simulate anterior vitreous prolapse. Preliminary investigations revealed a viscosity low enough to inject into the anterior segment, good visibility under the microscope and its biomechanical properties were similar to those of vitreous. In particular it had a high tensile strength. After instruction on vitrectomy machine settings, trainees were supervised performing simulated vitrectomy. Trainees were surveyed about their previous experience of vitrectomy and asked for feedback on the realism and usefulness of the model on a five point Likert scale.

Results:

Eight trainees from first year to seventh (final) year attended. The mean number of vitrectomies performed before the session was 1.3 (range 0-7) and 63% had never performed a vitrectomy. Consultants were found to perform the majority of vitrectomies when trainees encountered PCR. Trainees’ mean confidence about performing anterior vitrectomy improved from 2.4/5 to 4/5; a statistically significant improvement (Wilcoxon signed-rank test, p<0.05). 63% of trainees also felt confident or very confident that they were more likely to gain exposure to anterior vitrectomy. Trainees graded the realism of the model at 4.1/5. 100% thought the session should run regularly.

Conclusions:

Despite anterior vitrectomy being an essential skill for cataract surgeons, only 37% of North London ophthalmology residents attending the course had performed one. There is therefore a training gap. The Queens Hospital anterior vitrectomy model is a realistic training tool that enables residents to learn anterior vitrectomy in a safe environment. When integrated into the training programme as a structured teaching session, trainees thought it improved their confidence at performing anterior vitrectomy and their chances of exposure to the procedure in real patients. The session will now form a regular part of the North London ophthalmology residents’ training programme.

Financial Disclosure:

NONE