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Simulated ocular surgery: a novel approach for teaching the insertion and removal of Malyugin Rings and iris hooks

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Session Details

Session Title: Cataract Surgery Complications Management. OVDs, Cataract Surgery Equipment

Session Date/Time: Monday 07/09/2015 | 08:00-10:00

Paper Time: 08:24

Venue: Main Auditorium

First Author: : M.Buckle UK

Co Author(s): :    W. Dean                    

Abstract Details


This study aimed to demonstrate how Simulated Ocular Surgery (SOS) model eyes can be used to teach trainees how to safely insert (and remove) Malyugin rings and iris hooks in eyes with small pupils. This study also aimed to demonstrate how an Ophthalmic Simulated Surgery Competency Assessment Rubric (OSSCAR) can be used to assess a surgeon's competence with these techniques, before they use Malyugin rings or iris hooks in live surgery.


Cheltenham General Hospital, Cheltenham, UK


SOS model eyes with 4 mm pupils were used. The trainee was shown how to inject the Malyugin ring (MicroSurgical Technology, Redmond, USA) into the anterior chamber and safely engage the iris. Following capsulorrhexis the trainee was shown how to safely disinsert the ring from the iris, re-engage it in the injector and retract it from the anterior chamber. This process was repeated for insertion and removal of iris hooks. An OSSCAR was developed, and validated for face and content validity. This was used to assess the trainee's progress towards competence in these techniques.


The insertion and removal of Malyugin rings and iris hooks can be technically challenging. Porcine eyes tend to have large pupils and anterior chambers and do not lend themselves to realistic simulation of these manoeuvres. It has therefore been difficult for trainees to practice these techniques before performing live surgery. The SOS small pupil model eyes allow trainees to repeatedly practice these techniques to enlarge small pupils and then to perform phacoemulsification surgery, prior to removing the Malyugin ring or iris hooks. The OSSCAR scoring system allows trainers to judge a surgeon's progression towards competence before moving to live surgery.


Simulated Ocular Surgery model eyes offer high-fidelity and safe simulation training for the insertion of Malyugin rings and iris hooks to enlarge small pupils, prior to cataract surgery.

Financial Interest:


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