Ophthalmic surgical simulator: an effective and safe approach for trainees in vitreoretinal surgery

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PURPOSE: This study aims to evaluate the safety and efficacy of the EyeSi Surgical Simulator (VRmagic, Mannheim, Germany) in enhancing surgical proficiency among trainees performing vitreoretinal procedures. METHODS: Trainees underwent a comprehensive ophthalmic and orthoptic examination at baseline (T0) and 30 min after completing the simulation session (T1), which included the cover-uncover test, ocular motility assessment, fusional amplitudes, convergence measurements, and stereopsis evaluation using the TNO stereotest. A questionnaire evaluated 18 symptoms for frequency, severity, and bothersomeness. Performance scores from the first and final 15 min on the same module were compared. RESULTS: Orthoptic examinations were conducted before and 30 min after virtual reality (VR) simulator use on 34 trainees. Far fusional amplitude increased significantly both without (19.4 ± 8.8 Δ vs. 23.9 ± 9.7 Δ, p = 0.003) and with striated lenses (18.2 ± 10.4 Δ vs 20.5 ± 9.1 Δ, p = 0.02). Near fusional amplitude remained unchanged, regardless of striated glasses (p = 0.52). At baseline, TNO score was 60 arcsec in 82% of trainees and 120 arcsec in 18%. After VR simulation, 52% of eyes scored 60 arcsec, 41% scored 120 arcsec, and 7% scored 240 arcsec (p = 0.02). Ocular discomfort was reported by 32% of trainees, with symptoms rated as mild. All trainees' performance score improved from initial to the final simulation session. CONCLUSIONS: The EyeSi surgical simulator enhances surgical proficiency in vitreoretinal procedures with a minor, short-term reduction on stereopsis and a low incidence of mild discomfort.

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