Table 3.
Wet-lab studies.
| Model | Description | Reference | Area of training | Training task | Study design | Participants | Training time | Validity | Effectiveness |
|---|---|---|---|---|---|---|---|---|---|
| Rabbit eyes + human cataracts | Human cataract removed in its capsule and implanted into a rabbit eye | Tolentino and Liu [79] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eye | External tissue of a post-mortem porcine eye removed then placed in a microwave oven to induce cataract | van Vreeswijk and Pameyer [80] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes | Pig eyes filled with cooked chestnuts of varying hardness as pseudonuclei | Mekada et al. [71] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: 1 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
2 |
| Pig eyes | A range of formalin: alcohol ratios tested on pig eyes to simulate human lens | Sugiura et al. [78] | Cataract surgery | Not specified | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Goat eyes | Goat eyes injected with formalin and fixed on a stand | Dada and Sindhu [65] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes | Post-mortem pig eye injected with formalin and hydroxyethylcellulose to induce cataract | Hashimoto et al. [67] | Cataract surgery | Capsulorhexis | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Goat eyes | Goat eyes injected with formalin through the pars plana before capsulorhexis vs through a clear corneal side port into the nucleus after capsulorhexis | Sudan et al. [77] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes | Anterior chamber of pig eyes filled 75% with methylcellulose then injected with a formaldehyde-methanol solution to induce cataract | Saraiva and Casanova [75] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes + electronic sensor | Cup supporting an ex vivo human or porcine eye mounted on a 6 axis/torque sensor which detects direction and magnitude of forced applied by trainee | Leuschke et al. [69] | Cataract surgery | Not specified | Descriptive | n = 2 (ophthalmic surgeons) | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Rabbit eyes | Lens from enucleated rabbit eyes fixed with varying concentrations of paraformaldehyde | Ruggiero et al. [74] | Cataract surgery | Capsulorhexis | Experimental | n = 6 (cataract surgeons) | Not specified |
Content: 2 Response processes: 0 Internal structure: N Relations to other variables: N Consequences: N |
1 |
| Goat eyes + human lens | Human cataractous nuclear implanted into a goat lens and mounted on rectangular polystyrene | Sengupta et al. [76] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes | Assessment of wet-lab performance using a modified surgical assessment tool (ICO- OSCAR) | Farooqui et al. [66] | Cataract surgery | Phacoemulsification | Pilot study | n = 12 (3rd year residents) | 5 days |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes | Post-mortem human eyes with Karnovsky solution to induce cataract | Pandey et al. [72] | Cataract surgery | Not specified | Descriptive | N/A | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes | Medical lubricating jelly injected into in a human cadaver eye | Liu et al. [70] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Sheep + human lens | Human cataractous lens nucleus implanted in a sheep eye lens | Kayikcioglu et al. [68] | Cataract surgery | Phacoemulsification | Descriptive | N/A | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes | Survey of wet-lab training with pig eyes on residents’ perceived preparedness and difficulty with cataract surgery | Puri et al. [73] | Cataract surgery | Unspecified | Retrospective cross-sectional study | n = 116 (residents) | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
1 |
| Rabbit eye | Rabbit eye used as a replacement for human eye | Abrams et al. [81] | Vitreoretinal surgery | Pars plana vitrectomy | Descriptive | N/A | 2 h |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human/artificial eyes + Marty the Surgical Simulator | 3 model systems: artificial eye with a plastic head model; human cadaver eye with the head model; and human cadaver eye without the model | Patel and Levin [84] | Glaucoma surgery | Goniotomy | Case series study | n = 4 (paediatric ophthalmology fellows) | 2 h |
Content: 0 Response processes: 2 Internal structure: N Relations to other variables: N Consequences: N |
1 |
| Pig eyes | Pig eyes soaked in 10% formaldehyde then mounted on a dummy head | Lee et al. [83] | Glaucoma surgery | Trabeculectomy | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes | Human donor cadaveric eyes with contact lens inserted into a surgical model mannequin head | Patel and Sit [85] | Glaucoma surgery | Trabeculectomy | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes + artificial orbit | Enucleated pig eyes placed into the orbit of a styrofoam model head; microsphere-based canalograms used to measure extent of outflow tract access | Dang et al. [82] | Glaucoma surgery (microincisional) | Ab-interno trabeculectomy (trabectome) | Case series | n = 7 (ophthalmology trainees) | Not specified |
Content: 0 Response processes: N Internal structure: N Relations to other variables: 1 Consequences: N |
2 |
| Human eyes | Human cadaveric corneoscleral rims used for angle surgery simulation | Arora et al. [86] | Glaucoma surgery | Microinvasive glaucoma surgery | Descriptive study | N/A | N/A |
Content: 1 Response Process: N Internal Structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes | Human cadaver corneoscleral rims fixated with a tack through the centre of the cornea to a styrofoam base | Nazarali et al. [87] | Glaucoma surgery | Bimanual skills with gonioscopy, microbypass stent insertion + removal, gonioscopy-assisted transluminal trabeculotomy | Experimental, feasibility study | n = 10 (ophthalmic residents) | Not specified |
Content: 1 Response Process: N Internal Structure: N Relations to other variables: N Consequences: N |
1 |
| Human eye + artificial anterior chamber | Human donor corneoscleral button placed over an artificial anterior chamber | Fontana et al. [89] | Corneal surgery | Deep Anterior Lamellar Keratoplasty using the big-bubble technique | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes | Pseudo-grafts created from lens capsule of enucleated porcine eyes and implanted into an intact globe | Droutsas et al. [88] | Corneal surgery | Descemet Membrane Endothelial Keratoplasty (DMEK) | Descriptive | N/A | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human cornea + artificial anterior chamber | One human cornea for donor graft preparation + one for practising graft insertion and unfolding in an artificial anterior chamber model | Vasquez Perez and Liu [90] | Corneal surgery | Descemet membrane endothelial keratoplasty (DMEK) | Descriptive | N/A | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes + artificial anterior chamber | Human corneas mounted on an artificial anterior chamber with a 3D-printed iris. Intraoperative OCT used to validate each step of the procedure. | Famery et al. [91] | Corneal surgery | Descemet membrane endothelial keratoplasty | Prospective, feasibility study | n = 5 (ophthalmic surgeons) | 2 sessions (duration unspecified) |
Content: 1 Response Process: N Internal Structure: N Relations to other variables: 2 Consequences: N |
1 |
| Pig eyes | Cadaveric pig eyes with bacon as extraocular muscles | White et al. [92] | Strabismus surgery | Steps for strabismus surgery | Case series | 30 Residents | Not specified |
Content: 0 Response processes: 0 Internal structure: N Relations to other variables: N Consequences: N |
1 |
| Pig eyes + chicken breast model | Wet-lab session using a chicken breast model for practice, followed by pig eyes | Vagge et al. [93] | Strabismus surgery | Partial-thickness scleral suture passes | Prospective cohort pilot study | n = 12 (8 first year and 4 second year residents) | 2 h |
Content: 0 Response processes: 0 Internal structure: N Relations to other variables: N Consequences: N |
2 |
| Pig eyelid | A rubber ball used to simulate the globe; a board with 4 metal screws mimicking the canthal tendons and arcus marginalis. Corners of a pig eyelid then sutured to the screws. | Pfaff [95] | Oculoplastic surgery | Eyelid margin repair | Descriptive | Oculoplastic staff and fellow, residents (numbers not specified) | Not specified |
Content: 2 Response processes: 0 Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig head | Pig head split in half and rested on a surface for practising lid procedures | Kersey [94] | Oculoplastic surgery | Unspecified | Descriptive | Ophthalmologists of varying grades (numbers not specified) | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
1 |
| Pig eyelids | Pig eyelids with surgically induced ptosis | Zou et al. [96] | Oculoplastic surgery | Ptosis repair | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes | Lecture on lateral cantholysis followed by video-demonstration, live demonstration on human cadaver eyes by an oculoplastic surgeon and practice on the same eyes | Patel et al. [97] | Oculoplastic surgery | Lateral cantholysis | Prospective study + survey | n = 12 (residents) | Not specified |
Content: 1 Response Process: N Internal Structure: N Relations to other variables: N Consequences: N |
2 |
| Sheep cranium | Intracranial and ocular dissection of 1-week-old sheep cranium | Altunrende et al. [98] | Orbital surgery | Micro-surgical skills | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes | Iron particles placed on cadaver cornea for rust ring formation before mounting on slit lamps. Removal of rust ring photographed and analysed using open-source computer software programme | Mednick et al. [99] | Ocular trauma | Corneal rust ring removal | Prospective | n = 22 (8 medical students, 10 residents, 4 attending ophthalmologists) | Not specified |
Content: 1 Response processes: N Internal structure: N Relations to other variables: 0 Consequences: N |
1 |
| Goat eyes + artificial model head | Enucleated goats’ eyes are mounted on a model head. An incision is made using a scalpel along the corneoscleral limbus, simulating a full-thickness laceration. | Pujari et al. [100] | Ocular trauma | Corneoscleral perforation repair | Descriptive study | N/A | N/A |
Content: 0 Response Process: N Internal Structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes + artificial orbit | Enucleated porcine eyes placed inside a metal orbit created using an adjustable eye support, cylinder and removable ring | Uhlig and Gerding [101] | Diagnostic examination | Direct and indirect ophthalmoscopy; gonioscopy | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes + formalin | Human autopsy eyes with cornea cleared with hyperosmotic dextran solution and fixed with formalin | Auffarth et al. [102] | General Ophthalmic Surgery | Not specified | Descriptive | N/A | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes + contact lens | Cyanoacrylate glue used to secure polymethylmethacrylate contact lens to the corneal rim of cadaver eyes | Lenart et al. [103] | General Ophthalmic Surgery | Not specified | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eyes with keratoprosthesis | Lander wide-field keratoprosthesis placed over cadaver eyes | Borirak-chanyavat et al. [104] | Anterior and posterior segment surgeries | Phacoemulsification, vitrectomy, panretinal laser | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Human eye + Spring-action Apparatus for Fixation of Eyeball (SAFE) | Hollow iron cylinder attached to a spring-action syringe forms a vacuum for fixation of human/animal cadaveric eyes | Ramakrishnan et al. [105] | Anterior and posterior segment surgeries | Various procedures (e.g., phacoemulsification, MSICS, LASIK, DALK, DSEK and trabeculectomy) | Descriptive | n = 2 (ophthalmic surgeons) | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
1 |
| Sheep eyes | Sheep eyes mounted on an artificial orbit | Mohammadi et al. [106] | Anterior segment surgery | Range of anterior segment procedures (e.g., capsulorhexis; keratoplasty; trabeculectomy) | Descriptive | N/A | N/A |
Content: 0 Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes | Porcine eyes placed in an ocular bulb holder that is secured to a polyvinylchloride pillar on a modified polystyrene head | Porrello et al. [107] | Anterior and posterior segment procedures | Laser iridotomy, photocoagulation and all steps of cataract surgery | Descriptive | N/A | N/A |
Content: N Response processes: N Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes + SS Microscope-Integrated OCT (MI-OCT) | Real time 3D imaging to aid wet-lab microsurgery training | Todorich et al. [108] | Anterior segment surgery | Corneal suture passes and laceration repair | Randomised controlled study (with crossover) | n = 14 (6 first year, 4 second year and 4 third year residents) | Not specified |
Content: N Response processes: 0 Internal structure: N Relations to other variables: N Consequences: N |
2 |
| Pig eyes | Micro-surgical skills course using pig eye models and a video-based scoring system for assessment | Ezra et al. [109] | General ophthalmic surgery | Micro-surgical skills | Prospective longitudinal cohort study | n = 14 (residents) | 1 day |
Content: N Response processes: N Internal structure: 2 Relations to other variables: 2 Consequences: N |
2 |
| Pig eyes and foot (ESSAT) | 3-station wet-lab course: pig’s foot inserted with red plastic tubing to simulate temporal artery biopsy; pig eyes for muscle recession; pig eyes for cataract procedures. | Fisher et al. [110] | Ophthalmic surgery (a range of different areas) | Temporal artery biopsy, muscle resection and phacoemulsification | Survey | n = 22 (content experts: residency programme directors and faculty members) | N/A |
Content: 2 Response processes: 1 Internal structure: N Relations to other variables: N Consequences: N |
N/A |
| Pig eyes and foot (ESSAT) | Same as above | Taylor et al. [111] | Ophthalmic surgery (a range of different areas) | Temporal artery biopsy, muscle resection and phacoemulsification | Masked, prospective study | n = 29 (1 first year resident, 1 third year resident and 27 content experts) | N/A |
Content: N Response processes: N Internal structure: 2 Relations to other variables: 2 Consequences: 2 |
N/A |