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Nitasha Gupta, Kamran Riaz; Resident outcomes of trabecular micro-bypass stent placement surgery after a targeted surgical curriculum. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4982.
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© ARVO (1962-2015); The Authors (2016-present)
To illustrate a surgical curriculum, combining a wet lab model and deliberate practice during routine phacoemulsification cases, to train residents in the iStent® (Glaukos, San Clemente, CA). We present the results of the first ten cases performed by residents in the final year of their training.
A wet lab was held for senior ophthalmology residents. The residents were educated about the design of the trabecular micro-bypass stent and inserter. Residents then used the operating microscope to insert the stent into a synthetic pad whose texture simulates trabecular meshwork (TM) (Figre 1A) followed by artificial trabecular meshwork that was created using a 3D printer (Figure 1B). They next practiced inserting and removing the stent into trabecular meshwork of human cadaveric tissue (Figure 1C). The final station involved using the gonioprism with a synthetic eye model (Figure 1D) to practice globe manipulation and placement of the gonioprism to view the angle. After successful completion of this wet lab, residents began targeted practice to visualize angle anatomy during routine phacoemulsification cases. The viscoelastic cannula was used to simulate the inserter and was advanced into the angle directed at the trabecular meshwork The final stage of training involved residents placing the stent in patients under attending supervision.
All residents completed the surgical curriculum successfully. The first ten cases performed by the residents were successful with respect to appropriate placement and reduction of intraocular pressure (IOP). There were no significant intraoperative complications including loss of stent, iris or anterior segment trauma, or hyphema. Mean follow up time is 6.2 months (range 3-10). Mean IOP reduction was 2.3 mmHg (range 0-4) or 12.6% (range 0-25%). All pre-operative hypotensive medications were continued with a mean of 2.2 medications (range 1-4).
The described surgical curriculum is an efficient and successful model that incorporates both wet lab training and supervised practice in live patients for residents to learn trabecular micro-bypass stent placement. The first ten procedures done by residents who completed the curriculum had successful anatomical placement and IOP reduction. This surgical curriculum may be an effective method to introduce residents to novel procedures and may be a useful model for residency programs.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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