In order to improve surgical training for angle-based glaucoma, human corneoscleral rims can be used as a low-cost model and resource. Studying the effects of a low-cost model for anterior chamber angle gonioscopy and micro-surgery on human corneoscleral tissues in a wet lab setting in order to improve residents’ surgical skills. Corneoscleral rims left over after a keratoplasty procedure and/or buttons taken from deceased donors were included in this analysis. Inverted rims were once employed as teaching aids for slit-lamp bio-microscope lessons on fundamental angle anatomy. To mimic indirect gonioscopy, direct gonioscopy, goniotomy, and other procedures involving the angle of the eye, an artificial cornea and anterior chamber were placed over the real cornea in the model. The quantitative evaluation was reserved for direct gonioscopy and goniotomy activities (intended to mimic intraoperative gonioscopy and other angle-based procedures), while the qualitative evaluation was applied to the remaining exercises. There were a total of 65 locals that took part in the simulation. A mean age of 26.69±1.74 years was found. This included a slit-lamp examination of the angle anatomy (n=55) and an indirect gonioscopy examination of the cornea (n=55), all conducted by ophthalmology residents. 10 glaucoma fellows used a simulated eye to practise direct gonioscopy and goniotomy. For the most part, the fellows got better with practice, both in terms of their ability (P<0.05) to interpret the results and their ability to do the surgery quickly and efficiently. Micro-stent implantation within Schlemm’s canal, subconjunctival space, and suprachoroidal space was successfully reproduced several times in the third simulation exercise. The human corneoscleral rims that were removed during surgery were a valuable teaching tool for practising gonioscopy and goniotomy, as well as other inspection techniques. For better glaucoma education of both residents and glaucoma fellows, these low-cost, easily-adaptable models can be introduced into the curriculum.

Source: journals.lww.com/glaucomajournal/fulltext/2022/10000/gonioscopy_and_angle_based_glaucoma_surgical.10.aspx