A New Device for Ocular Surgical Training on Enucleated Eyes Giovanni Porrello, MD, Andrea Giudiceandrea, MD, Tommaso Salgarello, MD, Ciro Tamburrelli, MD, Luigi Scullica, MD Objective: To develop a reliable inexpensive device for teaching ocular surgical procedures and practicing experimental techniques on enucleated eyes. Design: Teaching device trial. Participants: Thirty enucleated porcine eyes. Methods: A Plexiglas ocular bulb holder was secured with its base support to a polyvinylchloride pillar on a modified polystyrene trial head. Main Outcome Measure: The convenience and reproducibility of both laser and surgical ocular techniques performed with this new device were evaluated. Results: This model allows curvilinear capsulorrhexis and phacoemulsification of porcine lenses through a corneal tunnel incision and insertion of a soft foldable acrylic intraocular lens into the capsular bag. Argon and neodymium:YAG laser iridotomy and retinal argon laser photocoagulation can also be performed with this model. Conclusions: This inexpensive device is useful for teaching both surgical and laser ocular procedures. Ophthalmology 1999;106:1210 –1213 Previous studies have described human autopsy ocular mod- els for teaching not only anterior and posterior segment surgeries 1–4 but also laser applications. 5,6 A synthetic tissue teaching system has also been designed to simulate phaco- emulsification and small-incision intraocular lens (IOL) in- sertion techniques. 7 However, performing surgery on liv- ing 8,9 or enucleated animal eyes 10,11 is a popular training method because of animal availability and economics com- pared with surgery in which artificial eyes or eyes from human autopsies are used. The opportunity to repeatedly perform procedures is essential for acquiring skills needed to perform delicate microsurgical maneuvers in ophthalmology. With this in mind, we developed a simple, inexpensive, and reusable Plexiglas ocular bulb holder that is connected to a polysty- rene trial head, which allows the maintenance of correct hand positions for comfort and stability. This ocular device may be used to facilitate teaching a wide variety of anterior and posterior segment surgical procedures, such as corneal refractive surgery, modern cataract surgery, pars plana vit- rectomy, and laser procedures, such as corneal photoabla- tion, peripheral iridotomy, and retinal photocoagulation. Material and Methods Figure 1 shows the principal components of our prototype. A hollow bulb holder made of transparent Plexiglas (element 1) was secured to a polyvinylchloride (PVC) base support (element 2) by two lateral screws. A red reflector plate (element 3) was inserted between these two circular elements to simulate the red ocular fundus reflex and enhance the view of the anterior lens capsule during capsulorrhexis and following cataract surgical maneuvers. After removing the peribulbar fat, an enucleated porcine eye was filled with balanced salt solution injected with a 30-gauge needle through the optic nerve stump to maintain posterior segment pressure. A transparent Plexiglas circular cover with a central annular hole (element 4) allowed adequate stabilization of the eye in the bulb holder (element 1). The assembled device was screwed to the upper face of a PVC pillar (element 5) by means of its PVC base support (element 2). This artificial ocular socket was fixed by a bolt (element 6) and a nut (element 7) to the modified polysty- rene trial head (element 8). To practice laser procedures, the ocular system was taped to a slit lamp (Fig 2). Results After securing the enucleated porcine eye inside the bulb holder, phacoemulsification, argon and neodymium:YAG laser iridotomy, and retinal argon laser photocoagulation were performed. All stages of modern cataract surgery, including corneal tunnel incision, capsulorrhexis, nucleus phacoemulsification, and implan- tation of a soft foldable acrylic IOL (Alcon, Fort Worth, TX) into an intact capsular bag, were performed. To protect the corneal endothelium and obtain pupil dilatation, the anterior chamber was deepened by injecting intraocular viscoelastic fluid through a stab incision made at the 10 o’clock position with a 15-degree knife (Alcon). A self-sealing corneal tunnel was created at the 12 o’clock position with a disposable crescent knife (Alcon) angled Originally received: August 4, 1998. Revision accepted: February 25, 1999. Manuscript no. 98410. From the Institute of Ophthalmology, Catholic University, Rome, Italy. No authors, including Giovanni Porrello and Andrea Giudiceandrea, who hold patent-pending rights, have a commercial interest in marketing this ocular surgical system. Address correspondence to Andrea Giudiceandrea, MD, Institute of Oph- thalmology, Catholic University, Largo F. Vito 1, 00168 Rome, Italy. E-mail: agiudiceandrea@getnet.it or gporrello@pelagus.it. 1210