Evaluation of ophthalmic surgical simulators for continuous curvilinear capsulorhexis training

Raval, Nilesh; Hawn, Vivian S.; Kim, Mimi; Xie, Xianhong; Shrivastava, Anurag

doi:10.1097/j.jcrs.0000000000000820

Cited by 6 publications

(2 citation statements)

References 5 publications

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“…The workflow and software tools presented here may help to easily establish at least some opportunities to provide such a visual feedback and simulation of surgical procedures and instrument action in eyes of different species often used in experimental settings. In addition to surgical training with porcine cadaveric eyes or surgical eye models [ 41 ], this approach may also help to support the 3R principle of animal research, namely Replacement , Reduction , and Refinement proposed by Russel and Burch [ 42 ]. This concept is broadly considered as a systematic approach to animal experimentation that emphasizes laboratory animal welfare.…”

Section: Discussionmentioning

confidence: 99%

A workflow to visualize vertebrate eyes in 3D

Wang,

Baumgarten,

Balcewicz

et al. 2023

PLoS ONE

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Purpose To establish a workflow to visualize the surgical anatomy in 3D based on histological data of eyes of experimental animals for improving the planning of complex surgical procedures. Methods Four C57BL/6J wild-type(wt) mouse eyes, three Brown Norway rat eyes and four Chinchilla Bastard rabbit eyes were enucleated and processed for standard histology with serial sections and hematoxylin and eosin staining. Image stacks were processed to obtain a representation of the eye anatomy in 3D. In addition, virtual image stacks and 3D point clouds were generated by processing sagittal sections of eyes with stepwise 180° rotation and projection around the eye axis to construct a rotationally symmetric 3D model from one single sagittal section. Results Serial sections of whole eyes of mice, rats and rabbits showed significant artifacts interfering with a practical image stack generation and straightforward 3D reconstruction despite the application of image registration techniques. A workflow was established to obtain a 3D image of the eye based on virtual image stacks and point cloud generation by rotation of a single sagittal section of the eye around the symmetry axis. By analyzing the tissue shrinkage during histological processing true biometric reconstructions of the eyes were feasible making the resulting model usable for 3D modeling and simulation, e.g. for planning of complex surgical procedures in different species. Conclusion Because serial sections of the eye with standard histological protocols yielded too many artifacts for a straightforward 3D visualization we reconstructed a pseudorealistic 3D model based on virtual image stacks and point cloud generation calculated from a single sagittal section of the eye. Such a model detailing microscopic structures of the whole eye will allow for a specific planning of surgical procedures in small animal eyes in order to prevent surgical complications in a very early stage of an experiment and it will support the design and development of complex intraocular implants. It will therefore be helpful in surgical teaching and improve laboratory animal welfare by an expected reduction of experimental animal numbers. Further processing including integration of mechanical tissue properties is needed to convert these 3D models into a practical virtual reality teaching and simulation platform for eyes of several species.

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Section: Discussionmentioning

confidence: 99%

A workflow to visualize vertebrate eyes in 3D

Wang,

Baumgarten,

Balcewicz

et al. 2023

PLoS ONE

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“…[ 5 6 ] Most virtual-reality simulators and tissue simulators for cataract surgery have been primarily developed for training in phaco-emulsification, including the Eyesi simulator, MicroVisTouch, PhacoVision, Bioniko, Kitaro, SimulEYE, and the Phantom Phaco simulator, among others. [ 11 18 19 20 21 22 23 ] As a surgical procedure, MSICS has been found to be more economical than phaco-emulsification. Additionally, it was also reported to be as safe and nearly as effective as phaco-emulsification.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a high-fidelity, virtual reality-based, manual small-incision cataract surgery simulator

Nair

Ahiwalay

Bacchav

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To establish the face and content validity of the HelpMeSee Eye Surgery Simulator – a virtual reality-based cataract surgery simulator for manual small-incision cataract surgery (MSICS). Methods: The face and content validity were assessed on the sclero-corneal tunnel construction course. A questionnaire with 11 questions focused on the visual realism, with resemblance to real life surgery, and the training value of the simulator was developed. Thirty-five experienced MSICS surgeons participated in the study. Responses were recorded using a seven-point scoring system. Results: Overall, 74.3% (26/35) of the respondents agreed that the overall visual representation of the eye and the instruments in the simulator were realistic. The task of injecting a visco-elastic through the paracentesis was reported to be the most visually realistic task with a mean score of 5.78 (SD: 1.09; range: 2–7). With regard to content validity, 77.1% (27/35) of the subjects felt agreed that the errors and complications represented throughout the entire tunnel construction module were similar to those encountered in real life; the task of entering the anterior chamber with the keratome had a mean score of 5.54 (SD: 0.98; range 1–7), being rated the highest in that aspect. Overall, 94.3% (33/35) of the subjects agreed that the simulator would be useful in developing hand–eye co-ordination. A similar number of 94.3% (33/35) agreed that based on their experience, they would recommend cataract surgical training on this simulator. Conclusion: The results suggest that the HelpMeSee Eye Surgery Simulator appears to have sufficient face and content validity for cataract surgical training.

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