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PubMed · 15885793

Developing a model system for teaching goniotomy.

Himanshu I Patel·Alex V Levin
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Abstract

PURPOSE: To design a model-system instruction course to prepare trainees for performing goniotomy on patients. DESIGN: Experimental study. PARTICIPANTS: Three pediatric ophthalmology fellows and 1 recent graduate of the fellowship program. METHODS: We piloted 3 model systems: human cadaver eyes with and without Marty the Surgical Simulator (Iatrotech Inc., Del Mar, CA, hereafter referred to as Marty Head) eye supporting system and artificial eyes in Marty Head. For improving intraocular view in cadaver eyes, we used epithelial scrapping, intracameral viscoelastic, and/or intracameral lubricating jelly. Each trainee underwent a training course, including background reading, didactic lecture, and video review followed by goniotomy on model systems with the operating microscope. MAIN OUTCOME MEASURES: Each trainee evaluated each step of the course using modified 5-point Likert scales. Reading material and videos were evaluated for usefulness, readability/quality, and new information obtained. Each model system was evaluated for visibility, ease of setup, surgical feel, and transferability to live surgery. In the end, each trainee was asked to assess the overall course for usefulness. RESULTS: Trainees rated the reading materials and video highly for their usefulness and quality, yet they believed they did not learn substantial amounts of new information. Visibility and ease of setup was best with artificial eyes in the Marty Head model. Human cadaver eyes in the Marty Head provided somewhat less visibility and ease of setup, but the perceived feel and transferability to live surgery was slightly better than with artificial eyes. Cadaver eyes without the Marty Head got the lowest rating in all categories. At the end of the course, all participants felt more confident and ready to perform goniotomy on patients. All recommended this course as part of pediatric ophthalmology fellowship training programs. CONCLUSIONS: This model system instruction course can assist trainees in learning to perform goniotomy while potentially lessening the risks to patients.

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GonioscopyHumansIntraocular PressureModels, AnatomicModels, BiologicalOphthalmologyTeachingJournal ArticleResearch Support, Non-U.S. Gov't

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Himanshu I Patel, Alex V Levin. 2005. Developing a model system for teaching goniotomy.. https://doi.org/10.1016/j.ophtha.2004.11.064

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Gonioscopic evaluation of haptic position in transsclerally sutured posterior chamber lenses.

PURPOSE: To determine the haptic position in transsclerally sutured posterior chamber lenses. METHODS: Fifty eyes with transsclerally sutured posterior chamber lenses were evaluated gonioscopically to determine the superior haptic position using previous peripheral iridectomies. RESULTS: The superior haptic of the transsclerally sutured posterior chamber lens was visualized in 31 (62%) of the eyes. In 24 (77%) of the 31 eyes, the haptic was within the ciliary sulcus, and in seven (23%), it was located posterior to the sulcus. A fibrotic membrane was detected around the sutured haptic in 20 (83%) of the 24 lenses located within the sulcus, whereas no fibrosis was seen surrounding the seven haptics outside the sulcus (P < .0001). CONCLUSIONS: Proper positioning of the haptics may be correlated with the development of fibrosis surrounding the haptic and therefore may be an important factor in the long-term stability of transsclerally sutured posterior chamber lenses.

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