Integration of simulation-based sclerocorneal tunnel construction course (STCC) into ECCE (extra capsular cataract extraction) to MSICS (manual small incision cataract surgery) conversion training: a pilot study

Session Details

Session Title: Cataract
Session Date/Time: Friday 21/02/2020 | 10:30-13:00
Paper Time: 11:48
Venue: Fes 1.

First Author: J.Andre FRANCE
Co Author(s): A. Bacchav  K. Odusote  V. Lansingh  C. Ahiwalay  T. Sheth     

Abstract Details

Purpose:

To demonstrate that simulation-based training in sclerocorneal tunnel construction (STC) can be successfully integrated into traditional training in manual small incision cataract surgery (MSICS) with shortened duration and excellent outcome.   With the traditional apprenticeship training, it normally takes about four weeks for conversion training from Extracapsular Cataract Extraction (ECCE) to MSICS and about 12 weeks for training of a novice to competence in MSICS.

Setting:

The simulation-based training (SBT) was done with the HelpMeSee Eye Surgery Simulator (HESS) in the Learning Development Centre (LDC) of HelpMeSee in Mumbai, whilst the “live” surgery training was done in Eye Department of a secondary care facility in Madagascar and in a dedicate specialist eye institute in Cameroon.

Methods:

Two experienced ECCE surgeons from Madagascar and two ophthalmologists with minimal ECCE experience from Cameroon were selected for the study.  They all had 6-day SBT in Sclerocorneal tunnel construction (STC) after which they proceeded almost immediately to have “live” surgery training (LST).  The LST was at Centre Hospitalier Universitaire, Mahajanga (CHU-M), Madagascar and at Magrabi ICO Cameroon Eye Instituten (MICEI), Cameroon.  A trainer from each Institutions participated as observer during the SBT.  The end-point of training was the completion of ten (10) MSICS independently.  The 24-hour post-operative visual acuity (VA) was the measure of the quality of surgery.

Results:

All  four completed SBT and were certified competent to proceed to LST. At the CHU-M, the two ophthalmologists completed LST in one week.  At MICEI, the two ECCE “novice” ophthalmologists required additional three-day laboratory training in capsulorrhexis and nucleus delivery, which are tasks not covered during the SBT yet . They completed the training in four weeks.  Intra-operative complications were difficulties in delivery of the nucleus (4 eyes) and rupture of the posterior capsule (3 eyes). The 24-hour post-operative VA was >3/10 in 25 of the 40 eyes (62.5%).  Post-operative complication was corneal oedema in 14 of the 40 eyes (35%).

Conclusions:

This pilot study shows that experienced ECCE surgeons and “novice” ophthalmologists with limited ECCE experience can be trained to achieve good surgical outcome within a short period by integrating simulation-based training in Sclerocorneal tunnel construction into traditional live surgery training in MSICS.  Considering that STC is the most difficult task in MSICS, the use of simulator-based training with HESS of HelpMeSee to perfect this task is germane to efforts to rapidly increase the number of competent MSICS surgeons for the elimination of avoidable blindness in low resource countries.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented