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

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.

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.

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.

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.