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PURPOSE: To study the feasibility and efficacy of a new remote wet lab for microsurgical education using a corneal suturing task. SETTING: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA. DESIGN: Prospective randomized controlled study. METHODS: Ten ophthalmology residents were stratified by postgraduate year and randomized to perform a corneal suturing task consisting of placing the 4 cardinal sutures for a penetrating keratoplasty in porcine eyes with or without remote ophthalmology attending feedback. Subsequently, both groups repeated the same task without remote feedback to test whether initial remote feedback affected subsequent performance. Finally, the group without feedback was crossed over to repeat the same corneal suturing task with remote feedback. The effectiveness of the remote wet lab was assessed subjectively by survey and objectively by grading each suture pass. RESULTS: Resident-reported comfort with corneal suturing improved significantly after the remote wet lab for all residents. Residents and attendings rated the remote wet lab as equally or more effective compared with previous in-person wet labs and overall effective in corneal suturing. Attendings rated the remote wet lab as effective in multiple domains of microsurgical education using a modified microsurgical global rating scale. Objective corneal suturing performance was similar for both groups. CONCLUSIONS: The remote wet lab was feasible and effective for training ophthalmology residents in corneal suturing. This represents a new social distancing compliant platform for microsurgical education during the COVID-19 pandemic.
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COVID-19/epidemiología , Córnea/cirugía , Educación a Distancia , Internado y Residencia , Queratoplastia Penetrante/educación , Microcirugia/educación , SARS-CoV-2 , Técnicas de Sutura/educación , Adulto , Animales , Competencia Clínica , Evaluación Educacional , Femenino , Humanos , Masculino , Oftalmología/educación , Estudios Prospectivos , PorcinosRESUMEN
OBJECTIVE: The Flying Eye Hospital (FEH) of ORBIS International is a capacity-building platform that trains ophthalmologists throughout the developing world on-board a fully functional eye hospital based in an airplane and in the local hospitals of developing countries. Corneal blindness (CB) is the second leading cause of blindness in most developing countries. Treatment of existing global CB requires effective eye banking and surgeons trained in corneal transplant. ORBIS International has programs that addressed both those needs. This study reports the clinical outcome of all keratoplasty training programs of the FEH from January 2010 to December 2014. METHODS: Surveys were sent to all local ophthalmologists trained on FEH to perform keratoplasty in the relevant time period. The survey included patient demographics, procedure performed, indications for surgery, postoperative steroid regiment, and visual acuity (VA). RESULTS: Keratoplasty was undertaken in 87 eyes as follows: penetrating keratoplasty (PK) in 66 (75.9% of our population), deep anterior lamellar keratoplasty (DALK) in 6 (6.9%), Descemet's stripping endothelial keratoplasty (DSEK) in 14 (16.1%), and Boston keratoprosthesis (KP) in 1 (1.1%). Corneal clouding was the indication in 83 (95.4%) of patients. Forty-seven (54%) patients returned for long-term care with the mean follow-up (FU) of 32.0 months (range 6-60 months). Thirteen (27.7%) were not using any steroids at last the FU. Eleven (23.4%) patients had signs of graft rejection. Best-corrected VA in meters and feet, respectively, was 6/6 to 6/18 (20/20 to 20/60) in 12 (25.5%) patients, 6/18 to 6/60 (20/60 to 20/200) in 19 (40.4%) patients, 6/60 to 3/60 (20/200 to 20/400) in 4 (8.5%) patients, and less than 3/60 (20/400) in 12 (25.5%) patients. CONCLUSION: Clinical outcomes delivered by FEH keratoplasty training are acceptable compared to results in the developing world and to some reports of training programs in the developed world, though our study is limited by its retrospective nature and the poor rate of FU.
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Enfermedades de la Córnea/cirugía , Educación de Postgrado en Medicina/métodos , Cooperación Internacional , Queratoplastia Penetrante/educación , Oftalmología/educación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Reports on keratoplasty by residents are rare compared to those on cataract surgery. The aim of this study was to compare the results and surgery time of penetrating keratoplasty performed by residents and an experienced cornea surgeon. METHODS: The medical records and surgery videos of the first 5 penetrating keratoplasty procedures by 4 residents were reviewed and compared with those in 20 penetrating keratoplasty procedures by an experienced cornea surgeon. Patients underwent penetrating keratoplasty at the Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. The main outcome measures are graft survival, best-corrected visual acuity, postoperative astigmatism, decreased rate of graft endothelial cell density, and details of surgery time. RESULTS: Graft survival, best-corrected visual acuity, and postoperative astigmatism were not significantly different between residents group and the experienced surgeon group. The average decrease of graft endothelial cell density owing to surgery in residents and the experienced surgeon were 19.0 ± 17.5 and 18.5 ± 12.1%, respectively (p = 0.27, Mann-Whitney U test). The average surgery time taken by residents was 66.9 ± 18.1 minutes, and that by the experienced surgeon it was 28.2 ± 7.9 minutes (p = 0.0071, Mann-Whitney U test). Residents required the most time for running suture technique. CONCLUSIONS: The results of keratoplasty by residents were similar with those done by the experienced surgeon. Surgery time was the only statistically significant difference (p = 0.0071), which did not influence surgical results.