Surgical Grant Feedback

First of all, I want to thank the EGS for giving me this amazing possibility to provide training in glaucoma surgery at Tays cadaver training centre, Tampere, Finland together with my colleauges Dr. Ana Apulava and Dr. Artémise Dugauquier.

Tays cadaver training centre is a great place to study and practice clinical skills. I was really impressed by the organization and efficiency with which things were get done. The staff is very friendly and helpful. I would also like to express my special gratitude to Dr. Gielen Fabian.

April 2023

After having been introduced to the facilities of the training center by Dr Leinonen at 8 am, the training started by a short oral introduction into principles of microsurgical dissection and suturing by the mentor. Two cadavers were already prepared by the staff of the training center and a senior ophthalmologist introduced and provided the instrumentation and sutures for eye surgery.

Some instrumentation (micro-forceps Neuhann and a used IScience catheter) were provided by the mentor to demonstrate and train Canaloplasty
A short demonstration of principles of scleral dissection and suturing by the mentor was immediately followed by a training session of the two trainees. Two fully equipped ophthalmic surgical microscopes and one fresh cadaver for each participant were available on each of the 2 days. Therefore, each of the trainees could use the full length of the training session. Operations could be trained on a total of human 8 eyes. All steps of surgery could be followed by the side microscope and the video screen. Hence, the mentor could always visualize all steps of surgery.
The total of 3 half day sessions were fully used.
The major training steps were:
(1) Corneal traction suture
(2) Fornix based conjunctival incision and blunt posterior dissection on the scleral surface
(3) Preparation of the scleral flap for trabeculectomy. Principles of scleral lamellar preparation with a crescent knife
(4) Excision of trabecular block, sequence of perforating incisions with a paracentesis needle
(5) Surgical iridectomy. Principles of handling when iris bulges forward or the pigment epithelium remains un-perforated.
(5) Suturing of the scleral flap with 10/0 nylon using spatula and round needles. Length and depth of suture bites, principles of 3/1/1 knots. Principles of cutting 10/0 nylon sutures with Vannas scissors
(6) Conjunctival closure with 10/0 nylon using the Mainz mattress suture to prevent leakage
Principles of scleral dissection for Deep Sclerectomy and Canaloplasty were demonstrated and trained.
(1) Access to Schlemm’s canal by a second scleral flap at the appropriate depth.
(2) How to visualize the scleral spur and inner wall of Schlemm’s canal.
(3) Removal of the cribriform meshwork with the microforceps
(4) Identification of Schlemm’s canal
(5) Introduction of the IScience catheter into Schlemm’s canal. Tips and tricks for advancing the catheter over areas of blockade A certain limitation was the low intraocular pressure of the cadaver eyes, as all eyes previously had large vitreous punctures resulting in hypotony. Therefore it was sometimes difficult to establish a permanent normal intraocular pressure.
We are grateful for the great hospitality by Dr. Sanna Leinonen and the other members of the surgical training center staff who peovided a very well organised stay at TAYS eye center. We experienced a lovely tour in the evening through the city guided by Dr Sanna Leinonen and were invited by the chairman Prof. Marko Kataja to a really outstanding dinner.
In summary, both trainees – although differently experienced, were very successful in experiencing and adopting details of micro surgical principles in glaucoma surgery and considered the sessions very useful and stimulating. Their assessment of the training center and of the skills achieved was extremely positive.
The TAYS surgical training center is a unique facility for further trainees and I am grateful to the EGS that this grant could be provided. I hope there will be other applicants to this grant and I am happy to help if my mentoring will be needed.

Participants
Dr. Christian Wolfram, Dept. Ophthalmology, University Hospitals Hamburg Eppendorf, Germany
Dr. Carsten Grohman, Dept. Ophthalmology, University Hospitals Hamburg Eppendorf, Germany

Mentor
Prof. Dr. Dr. h.c. Franz Grehn
Seniorprofessor, Dept. Ophthalmology, University Hospitals Wuerzburg, Germany

September 2022

The surgical training at the Tampere Surgical Education Centre at the Tampere University Hospital was a unique teaching experience. Performing surgery on fresh cadavers is as close to the true clinical setting as it can get. The two half-day surgical sessions allowed us to practice glaucoma procedures step by step. Moreover, we simulated some glaucoma surgery complications, which was ideal to teach the fellows how to deal with difficult surgical situations and how to solve these issues. Besides the surgical training, I also enjoyed lecturing to a very interested audience at the Tays Eye Center and I was very happy to share some of my research work with them. Altogether this was an unforgettable experience.

I’m convinced that this initiative will be an invaluable asset for many glaucoma specialists in training and will therefore contribute tremendously to the advancement of glaucoma surgical training in Europe.

January 2018

After our visit so it is very spontaneous and real-life ;) This absolutely wonderful experience took my already profound interest in glaucoma to the next level. The Tays Eye Hospital tour also made a great impression. I want to thank you both once more for this unique opportunity, I realise what a privilege this was. It was a splendid stay in Tampere, and I am sure this initiative will give future participants the same boost it gave me.

January 2018

With pleasure I report on my experiences in the TAYS cadaver training center.

At my visit in Tampere Eye Hospital in January 2015 I had the opportunity to experience the advantages of the cadaver surgery training unit. This department was well equipped with surgical ophthamic microscopes and two cadaver specimen were available. The set up turned out to be extremely helpful to demonstrate some special new operations to experienced coworkers of the department: It was possible to demonstrate the access to Schlemms canal and its tubing of 360 degrees circumference, a structure that measures only 200 x 70 μm in diameter. This delicate technique is needed for non-penetrating glaucoma surgery such as canaloplasty and for childhood glaucoma surgery (360 degree trabeculotomy) in buphthalmic eyes. Conventional trabeculotomy with metal probes was also demonstrated.

The situation mimics true live surgery and usually allows demonstration and proper training in the two eyes of each body with eventually multiple approaches. This training unit is extremely useful for both beginners and experienced surgeons and is far more realistic that the usual wet-labs offered with pig eyes, where major steps of the procedure such as the above mentioned cannot be simulated. I am convinced that establishing a surgical workshop in the TAYS cadaver training center is of great help for teaching basic and advanced techniques of ophthalmic microsurgery.

January 2015

I had the unique opportunity to participate in a cadaver trabeculectomy wet lab in the Tampere Surgical Education Centre in Finland. Since first-hand surgical experience was not possible during my fellowship in Leuven, due to legal restrictions, this was a fantastic complement to the fellowship.