Wet & Dry Lab

Upon completion of this wetlab, participants should be able to:

• Understand phacoemulsification principles
• Create self-sealing corneal incisions
• Perform a continuous curvilinear capsulorhexis (CCC)
• Perform hydrodissection and hydrodelineation
• Safely rotate the nucleus
• Execute basic nucleus removal
• Perform cortical aspiration
• Implant a foldable intraocular lens (IOL)
• Recognize and manage common complications

By the end of the wet lab, participants should be able to:

• Identify appropriate indications and contraindications for DALK.
• Understand relevant corneal anatomy and the surgical planes used during DALK.
• Select the appropriate trephination depth and safely perform partial-thickness trephination.
• Perform air injection using the big-bubble technique.
• Recognize different big-bubble patterns and confirm successful bubble formation.
• Perform safe anterior and deep stromal dissection.
• Create a controlled entry into the big bubble and expose Descemet membrane.
• Apply manual layer-by-layer dissection when the big-bubble technique is unsuccessful.
• Prepare the donor cornea and safely remove the donor Descemet membrane and endothelium.
• Position and secure the donor graft using interrupted, continuous, or combined suturing techniques.
• Recognize and manage microperforation, macroperforation, double anterior chamber, and other common complications.
• Understand when conversion to penetrating keratoplasty is required.

• Identify the relevant anatomy: posterior iris, ciliary sulcus, ciliary processes, valleys between processes, pars plicata and relationship to the lens/IOL.
• Set up and orient the endoscopic probe and interpret the endoscopic image correctly.
• Obtain controlled intraocular access without damaging cornea, iris, capsule, zonules, lens/IOL or ciliary body.
• Maintain an appropriate working distance and treat ciliary processes sequentially under direct visualization.
• Recognize an appropriate tissue response and distinguish it from excessive whitening, popping, charring or tissue disruption.
• Plan treatment extent while avoiding unintended overlap or excessive cyclodestruction.
• Recognize common intraoperative problems and state appropriate stop/management principles.

At the completion of this wetlab, participants should be able to:

• Understand indications and contraindications for phakic
• Perform proper preoperative planning
• Select appropriate lens size and power
• Create safe corneal incisions
• Inject and position the phakic
• Correctly place haptics behind the iris
• Assess postoperative vault
• Manage intraoperative complications

• Aphakia without capsular support
• Dislocated IOLs
• Dislocated crystalline lenses
• Complicated cataract surgery
• Traumatic lens loss

By the end of this wetlab participants should be able to:

• Select appropriate cases for Yamane fixation
• Understand scleral fixation anatomy
• Perform accurate needle entry
• Dock haptics safely
• Externalize haptics
• Create proper flanges
• Achieve stable IOL centration
• Avoid tilt and decentration
• Manage common complications

• Identify causes of inadequate pupil dilation
• Recognize cases requiring mechanical expansion
• Perform safe iris hook placement
• Optimize pupil size for phacoemulsification
• Minimize iris trauma
• Handle complications associated with pupil expansion devices

By the end of this wetlab, participants should be able to:

• Identify epithelial vs stromal side of amniotic membrane
• Handle fresh AM without damaging its structure
• Perform:
  • 1) Inlay (graft) technique
  • 2) Overlay (patch) technique
  • 3) Combined (sandwich) technique
• Select appropriate technique based on pathology
• Secure AM using sutures and/or glue

• Recognize when tissue adhesive is an appropriate temporizing option and when to escalate.
• Prepare a dry, stable recipient bed without enlarging the perforation.
• Apply the smallest effective amount of cyanoacrylate in a controlled fashion.
• Restore globe integrity, reform/maintain the anterior chamber, and confirm a watertight seal.
• Protect the glue with a bandage contact lens when appropriate and institute cause-specific treatment.
• Recognize glue failure, infection, intraocular glue contact, pressure problems, and need for tectonic surgery.

• Recognize and explore the full extent of a corneoscleral wound
• Restore limbal anatomy and select appropriate sutures for cornea and sclera
• Achieve good corneal wound apposition while minimizing tissue distortion
• Close an irregular scleral rupture extending posteriorly
• Manage simulated iris and vitreous prolapse without tissue incarceration
• Reform the globe and confirm a watertight final closure

By the end of the station, the trainee should be able to:

• Describe the purpose and defining characteristics of an SBK flap and distinguish flap thickness from residual stromal bed planning.
• Perform a pre-cut safety check and identify factors that may alter flap diameter, hinge geometry, or cut quality.
• Assemble and inspect the microkeratome system according to the device IFU.
• Center and apply the suction ring, confirm stable suction, and maintain globe stability.
• Perform a smooth, uninterrupted forward pass and controlled return pass without forcing the device.
• Inspect the flap immediately after creation and recognize incomplete, irregular, buttonhole, free-cap, epithelial, or interface problems.
• Handle and reposition the flap atraumatically while preserving orientation and hinge integrity.
• State when the procedure should be stopped rather than attempting to complete an unsafe flap.