Background While most cataract surgery cases are uneventful, it is not unusual for the ophthalmologist to encounter weakness of the zonules, ligaments supporting the lens capsule. This can compromise the stability of the intraocular lens implant (IOL) that is placed in the capsule after cataract removal, affecting the visual outcome. Insertion of a support device such as a capsular tension ring (CTR) mitigates this risk.
In a survey of 21 senior ophthalmic trainees, fifteen (71%) believed training in managing weak zonules is inadequate. Sixteen (76%) had performed 5 or fewer CTR insertions, of whom 8 (38%) had never performed this. We have therefore developed a cost-effective, high-fidelity simulation for learning and practising this skill.
Description of innovation Our design builds on the commercially available Kitaro Wet-Lab training system (Frontier Vision, Japan), used for training in basic surgical steps. Within this we secured a single cell of bubble wrap, with a circular aperture on its flatter aspect representing a capsulotomy. An orange lining placed in the Kitaro cup behind the cell simulated the red reflex. Zonule weakness was reproduced by incompletely securing the cell. The deflated cell simulated an empty capsule and accommodated a standard 11 mm CTR. This set-up was easily assembled and reusable, and was used with real surgical instruments and devices.
Outcomes Our simulation was assessed by seven consultant ophthalmologists. All seven agreed that: the simulation is visually convincing (7/7 strongly agreed); CTR insertion is technically accurate (6/7 strongly agreed); instrument handling is realistic (6/7 strongly agreed); all senses are normally engaged when using it (7/7 strongly agreed); the simulation is useful for training (7/7 strongly agreed).
Conclusion We have developed a cost-effective simulation for training in CTR insertion, with robust face and content validity. We will incorporate this simulation in an advanced techniques simulation course in August 2016.
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