The Utility Of Surgical Simulation In Developing Ophthalmology Resident Competency In Managing Zonular Dialysis During Cataract Surgery

To evaluate the effectiveness of a structured simulation course in enhancing ophthalmology residents’ competency in managing zonular dialysis of varying severity during cataract surgery. While existing cataract complication courses primarily focus on posterior capsule rupture management, there is a lack of training specifically tailored to managing zonular instability during ophthalmology residency in the United Kingdom, which this course aims to address.

This prospective educational study was conducted in December 2024 at King’s College Hospital, a tertiary referral centre and teaching hospital in London. All ophthalmology residents training within King’s College Hospital NHS Foundation Trust during the 2024-2025 academic year were invited to participate.

Ophthalmology residents participated in a simulation-based course featuring focused instruction, procedural demonstrations, and hands-on training with faculty-led feedback. Simulation stations covered the use of capsular retractor hooks, capsular tension rings, and capsular tension segments, using SimulEYE aphakia and capsule support model eyes (InsEYEt, Westlake Village, CA). Participants self-assessed their competence in managing intraoperative zonular dialysis before and after the course using a 10-point scale (1 = not competent, 10 = highly competent).

Nine residents, ranging from ST1 to ST7, participated in the course. Mean self-assessed competence scores significantly improved from 4.0 before the course, to 7.0 after the course (p = 0.0041). Participants rated the overall utility of the course highly, with a mean score of 9.0 out of 10. Qualitative feedback indicated high satisfaction, with residents appreciating the course’s educational value. However, some participants suggested that capsular tension segments may be more appropriate for advanced cataract surgeons rather than general ophthalmology residents.

A simulation-based course significantly improves ophthalmology residents’ self-perceived competency in managing zonular dialysis during cataract surgery. This approach provides a realistic, safe, and effective training method for addressing a rare but critical complication, the mismanagement of which can lead to further complications such as vitreous loss and aphakia. These findings support the integration of zonular dialysis workshops into cataract complication training during surgical ophthalmology residency.