Hand tremor skills

In this exercise, the user should try to steer an object in the specified trajectory. If it deviates from the path, the object is released and must try again to grasp it. During the operation, the hand tremor is calculated along with the movement of the tip of the measuring instrument. At the end, the path of the object and the tip of the tool are shown graphically to the user. After the exercise, the user can see the evaluation of performance on the scoreboard.

Forceps instrument skills

In this exercise, a number of objects are embedded in the intraocular space. The user must be able to pick up any of the objects without damaging the surrounding tissues and place them in the embedded basket. Due to the special shape of the objects and their embedded space, the way of working with forceps and the accuracy of doing the work near the sensitive tissues are taught.

Bimanual navigation skill

One of the most important skills is working with two tools in the intraocular space. In this exercise, the user practices the skill of working with two instruments in the intraocular space. The user must be able to touch two interconnected objects simultaneously with the two instruments. Coordination of both hands is essential for the operation. During this exercise, he must perform the assigned tasks without vibration of hands and without interruption.

Retinal Endolaser

In this exercise, Endolaser-related skills are considered. Retinal breaks are treated after the retina is internally reattached. This is performed with laser photocoagulation through an endoprobe. Two to three rows of burns must place around each break. The user must be able to adjust the size and location of the laser spot by setting the parameters of the laser machine and placing the tool in the right place and angle.

Posterior vitreous detachment (PVD)

It is necessary to induce a posterior vitreous detachment if a natural one has not already occurred. In this step, the user learns how to perform Induced posterior vitreous detachment.

Induced posterior vitreous detachment involves high vacuum at the edge of the optic nerve followed by slow elevation to induce centripetal separation. Also, it is difficult in cases where the posterior hyaloid is attached tightly to the retina.

Epiretinal membrane removal

In this exercise, the user practices how to remove the epiretinal membrane. The epiretinal membrane should be grasped by a suitable forceps and gently peel off. Proximity to sensitive areas of the eye makes it sensitive. Touching retina and errors during operation will be monitored at any time and will affect the calculation of the final score.

Retinal Detachment

In this exercise, treatment is taught for retinal detachment. In first stage Heavy per fluorocarbon (PFCL) may be used to help reattach the retina. It is injected into the vitreous cavity over the posterior retina. As PFCL is heavier than water, it forces sub retinal fluid peripherally and then forces it out of the retinal break(s), at the same time pressing the retina against the wall of the eye.

Vitrectomy for routine retinal detachment usually includes infusion of air to internally tamponade the retina. In most cases, surgeons begin the air infusion while the PFCL remains posterior to the equator and/or retinal breaks. In this situation, the air pushes residual sub retinal fluid toward the break from the front of the eye, while the PFCL pushes it toward the break from the back, forcing it out of the break. After the anterior retina is completely flat, the PFCL is aspirated as the air bubble expands to fill the vitreous cavity. Retinal breaks are treated after the retina is internally reattached. This is performed with laser photocoagulation through an endoprobe.

Core Vitrectomy

At this stage, the user becomes familiar with the core vitrectomy process. The vitreous gel and associated vitreous hemorrhage are initially removed centrally, where a fluid space is created.

The remaining vitreous gel is then excised to remove intravitreal opacities and allow for identification of the posterior vitreous surface.

In this process, the central vitreous gel should be removed from the intraocular space.