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Editors Selection IGR 16-1

Surgery: Improved visualization in anterior segment model

Comment by Malik Kahook on:

23354 A practice model for trabecular meshwork surgery, Patel SP; Sit AJ, Archives of Ophthalmology, 2009; 127: 311-313

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Use of ex vivo models of the human eye during surgical wet labs has been faced with many obstacles. Accessing tissue in a timely manner, preserving the architecture of the eye, avoiding corneal edema and maintaining ability to use the expensive tissue over time have all remained major dilemmas for the clinician scientist. Patel and Sit (465) describe a novel technique to improve visualization in an anterior segment model for drainage angle surgery. The technique as described is similar to previous reports by Castellano and colleagues as well as Lenart and colleagues with important modifications.1,2 Cadaveric eyes, either fresh or fixed in formalin, are mounted and trephination of the cornea is completed followed by application of cyanoacrylate glue to the 'host' corneal rim. A hard contact lens, in this case 8.5 mm in diameter, is then affixed to the anterior surface of the corneal rim and allowed to set until firmly adherent. The authors offer helpful hints to improve fixation of the contact lens and state that different size trephines and contact lenses can be used with similar results. Strengths of this technique include the ability to reuse formalin fixed eyes until the tissue of interest has been exhausted and easy access with clear view to the anterior chamber using a goniolens. Limitations of this model include loss of adherence of the contact lens to the cornea (although the authors found this to be minor), decreased ability to maneuver instruments placed in the eye and peripheral swelling of the corneal rim in non-fixed eyes that likely would lead to decreased visualization of the target tissue after time. While the report focused on

Surgical devices and techniques targeting the drainage angle are on the rise

Trabectome (NeoMedix Inc, Tustin, California) surgery, the authors acknowledge that other laser and device techniques can benefit from this model. This manuscript comes at a time when surgical devices and techniques targeting the drainage angle are on the rise and offers a valuable method for accessing this space. The authors should be commended for sharing this technique that I personally have found to be reproducible and quite simple to perform.

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