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

Abstract

 

Purpose

 

To assess the impact of a Capsulorhexis Intensive Training Curriculum on the rates of errant continuous curvilinear capsulorhexes (CCCs) during cataract surgery among resident surgeons at a teaching hospital.

 

Methods

 

This retrospective educational interventional case series consists of all 1037 consecutive cataract surgeries performed at Harbor UCLA Medical Center during 4 consecutive academic years. The baseline cohort consists of 434 cataract surgeries performed during the two pre-intervention academic years. The post-intervention cohort consists of 603 cataract surgeries performed during the following two consecutive academic years. The principal intervention was the introduction of the Capsulorhexis Intensive Training Curriculum (CITC) for residents on the Eyesi ophthalmic virtual reality surgical simulator. The primary outcome measure was the rate of errant CCCs among the capsulorhexes performed during resident surgical cases. Errant CCCs were defined as attempted CCC which resulted in the attending taking over, radialization of the CCC, conversion to can-opener capsulorhexis, or any combination of the three aforementioned conditions.

 

Results

 

In the baseline cohort, there were 68 (15.7%) errant CCCs, while in the post-intervention cohort, there were 30 (5.0%) errant CCCs (p<0.0001). The use of trypan blue increased from 55.3% in the baseline cohort to 76.0% in the post-intervention cohort (p<0.00001), but there was no significant difference in rate of errant CCCs whether trypan blue was used or not in either cohort. 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 post-intervention cohort showed no significant difference in errant CCC rates between PGY 3 (4.4%) and PGY 4 (5.1%) surgeons (p=1.00).

 

Conclusions

 

This study strongly suggests that virtual reality surgical simulation training with the CITC on the Eyesi reduces the rate of errant CCCs among resident cataract surgeries. Virtual reality cataract surgical training should be considered for routine incorporation into ophthalmology resident surgical education.

 

 

Figure. Errant CCC rate by cohort and PGY level. Cohorts 1 and 2 are Baseline and Post-intervention, respectively.

 

Keywords: 445 cataract • 462 clinical (human) or epidemiologic studies: outcomes/complications • 737 training/teaching cataract surgery