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Dr. Florian Sutter
Address: Kasernenstrasse 41,
9100 Herisau, Switzerland
A contribution from our main test doctor: Dr. Florian Sutter (Bild)
This contribution relates to our product: eye 4 cataract
How to use eye4phaco, formerly called “the synthetic cataract eye for phaco training.”
Cataract surgery is the most frequently performed surgical procedure worldwide. In the form of small incision phacoemulsification it has attained an extreme level of excellence with minimal impact on the organ and excellent outcome for the patient with fast recovery and minimal risk.
To learn phacoemulsification, however, remains a challenge since inexperienced surgeons may cause complications that lead to poor outcome. In the light of the excellent results of experienced surgeons, a high number of these complications are inacceptable even during training, especially in developed countries.
Thus, phaco teaching has to aim for efficient training with a minimum of complications, although a certain number of complications in the later stages of teaching are needed in order to allow the aspiring surgeons to learn how to manage these complications.
Based on this it becomes evident that the aspiring surgeons have to develop the maximum skills possible before starting supervised hands-on training in real patients. This is where the role of the wetlab kicks in. In order to train young surgeons in cataract surgery, wetlabs with pig’s (or goat’s) eyes are used. This is an excellent option to train certain steps and procedures like general tissue handling, use of the instruments and wound construction. But there are clear limits to the porcine model. While the pig eye matches the adult cataract eye quite well in size and shape, there are significant differences in tissue features, mainly because of the age difference. While the typical cataract patients is in his or her seventies, a pig is only a couple of months old when it is slaughtered for meat production. The tissues of the porcine model eyes are therefore similar to pediatric cataracts, not cataracts of the elderly patient. The lens capsule is very elastic and resistant to tearing. The capsulorhexis, as needs to be done in adult eyes, cannot be practiced properly. Further, the lens is clear and very soft. After hydrodisection, lens removal is more a lens aspiration, a proper “divide and conquer” technique cannot be learnt, not even a proper rotation of the nucleus. Unfortunately, it is exactly the capsulorhexis and the nucleus management that cause most of the problems (and complications) during early phaco training.
This is why the synthetic cataract eye has been developed. This model eye overcomes some of the limitations of the porcine eye model. Special focus was put on the surgical steps that are not well modeled in the pig’s eyes, namely the lens capsule and the nucleus.
We therefore recommend aspiring phaco surgeons to use porcine eyes and synthetic cataract eyes in conjunction for training.
While the size of the eye has been designed according to the human eye, the cornea is made out of silicone. Next to the outlined limbus you see some marks around it. Always use these marks for your incisions. This helps a lot in reentering your incisions after they were made.This allows easy entry to the eye while enabling a rather tight fit for the phacotip. But the tissue rigidity will be that of silicone and not of natural cornea. This is, however, only a minimal issue since tissue handling and wound construction can be learnt and trained perfectly using pig’s eyes. Also you have to be careful not to damage the sleeve of your phacotip because silicon and silicon will always stick together if you do not use enough visco.
Another difference is that the transparency of the eye4 series is optimal with a dry surface, while the porcine eye needs to be kept moist at all times as much as the human eye in the real surgical situation. Please be advised to use surgical sponges to wipe the corneal surface dry during training.
After expanding one of our two different artificial cataracts your are able to implant any common IOL. This is in all manner possible but you have to know that the capsule bag of the eye4 series is always fixed in diameter. This is because of development design. IOLs are designed to stretch the capsule bag to gain a firm fit. Stretching in our case is not possible as especially with the newer designed plate haptics you see light curvature.