Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0043-1768919
The Wholesome Foods Approach to Trabeculectomy Wet Lab Training
Funding None.![](https://www.thieme-connect.de/media/10.1055-s-00033285/202301/lookinside/thumbnails/10-1055-s-0043-1768919_372-1.jpg)
Abstract
Purpose In an era when trabeculectomy surgeries in the United States are on the decline, ophthalmology residents may have limited opportunities to practice surgical techniques critical to success. However, key steps of trabeculectomy surgery can be introduced in a wet laboratory using a simple surgical model based on food items.
Methods A fresh lime and chicken parts with skin, purchased from a grocery store, were utilized to practice trabeculectomy surgery. The white rind of a lime was used as a surrogate for human sclera and was incised to create a trabeculectomy flap. The flap was then successfully sewn down with 10–0 nylon suture using an operating microscope. The skin of the chicken part was used to re-create a fornix-based and limbus-based conjunctival incision, which was then sutured closed using 6–0 Vicryl suture. A survey of wet laboratory participants was conducted to assess the feasibility and efficacy of this technique.
Results Survey respondents were divided into two groups, those who had performed ≥40 incisional glaucoma surgeries and those who had performed <40. Both groups rated the simulation a 4 (mode) out of 5 in terms of how well it prepared them for glaucoma surgery on a human eye and how well the materials replicated human tissue, with 1 being not at all and 5 being very well. Similarly, both groups rated ease of setup and material acquisition a 1 out of 5, 1 being not difficult at all and 5 being extremely difficult. Also, 93.5% of the survey respondents recommended implementing this training model at other teaching hospitals, and none of the respondents recommended against it.
Conclusion This trabeculectomy teaching model is inexpensive, clean, and safe, and it provides a reasonably realistic substrate for surgical practice. It does not require cadaver or animal eyes, and no fixatives are needed, thus minimizing the risk of contact with biohazardous materials. Wet laboratory materials are easy to obtain, making this a practical model for practicing glaucoma surgery in both westernized and developing countries.
Keywords
trabeculectomy training - simulated trabeculectomy surgery - trabeculectomy wet laboratory - food surgery - resident surgical training - ophthalmology surgical trainingNote
The content is solely the responsibility of the authors and does not necessarily represent the official views of the agencies they represent.
Publication History
Received: 22 June 2022
Accepted: 04 April 2023
Article published online:
19 June 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Chan CK, Lee S, Sangani P, Lin LW, Lin MS, Lin SC. Primary trabeculectomy surgery performed by residents at a county hospital. J Glaucoma 2007; 16 (01) 52-56
- 2 Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 1968; 66 (04) 673-679
- 3 Watson PG, Jakeman C, Ozturk M, Barnett MF, Barnett F, Khaw KT. The complications of trabeculectomy (a 20-year follow-up). Eye (Lond) 1990; 4 (Pt 3): 425-438
- 4 Biggerstaff KS, Vincent RD, Lin AP, Orengo-Nania S, Frankfort BJ. Trabeculectomy outcomes by supervised trainees in a Veterans Affairs Medical Center. J Glaucoma 2016; 25 (08) 669-673
- 5 Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology 2007; 114 (12) 2265-2270
- 6 Golden RP, Krishna R, DeBry PW. Resident glaucoma surgical training in United States residency programs. J Glaucoma 2005; 14 (03) 219-223
- 7 Chadha N, Warren JL, Liu J, Tsai JC, Teng CC. Seven- and eight-year trends in resident and fellow glaucoma surgical experience. Clin Ophthalmol 2019; 13: 303-309
- 8 Rowden A, Krishna R. Resident cataract surgical training in United States residency programs. J Cataract Refract Surg 2002; 28 (12) 2202-2205
- 9 Flanagan JL, De Souza N. Simulation in ophthalmic training. Asia Pac J Ophthalmol (Phila) 2018; 7 (06) 427-435
- 10 Ruggiero J, Keller C, Porco T, Naseri A, Sretavan DW. Rabbit models for continuous curvilinear capsulorhexis instruction. J Cataract Refract Surg 2012; 38 (07) 1266-1270
- 11 Pokroy R, Du E, Alzaga A. et al. Impact of simulator training on resident cataract surgery. Graefes Arch Clin Exp Ophthalmol 2013; 251 (03) 777-781
- 12 Lee GA, Chiang MYM, Shah P. Pig eye trabeculectomy-a wet-lab teaching model. Eye (Lond) 2006; 20 (01) 32-37
- 13 Selvan H, Pujari A, Kishan A. et al. Trabeculectomy on animal eye model for resident surgical skill training: the need of the hour. Curr Eye Res 2021; 46 (01) 78-82
- 14 Lee AG, Greenlee E, Oetting TA. et al. The Iowa ophthalmology wet laboratory curriculum for teaching and assessing cataract surgical competency. Ophthalmology 2007; 114 (07) e21-e26
- 15 Porteous AM, Ahmed F. A novel wet-lab teaching model for trabeculectomy surgery. Eye (Lond) 2018; 32 (09) 1537-1550
- 16 Walkden A, Au L, Fenerty C. Trabeculectomy training: review of current teaching strategies. Adv Med Educ Pract 2020; 11: 31-36