Pigs' eyes, real skills: surgeons practise with cutting-edge technology in Prague

A tiny surgical needle, a thread and a pig's eye positioned under a microscope. This is not an ordinary operating theatre, but a training facility in Prague, where eye surgeons from across Europe have gathered to practise delicate surgical techniques without putting patients at risk.

Among the participants is Klára Cenková, an ophthalmologist at Prague's Central Military Hospital. She is practising how to place a stitch during cataract surgery. "This course is extremely useful because we can try out different techniques and ways of dealing with complications here, rather than encountering them for the first time while operating on a patient," she explains.

The training is part of iSCOPE: Prague Ophthalmic Wetlab, an international event held in the Czech capital from October 14 to 17, bringing together beginner and more experienced eye surgeons from 11 countries.

Learning from mistakes without risking patients

One of the international instructors is Johnson Neo, a consultant ophthalmic surgeon at Barts Health NHS Trust in London, who also has an appointment at the renowned Moorfields Eye Hospital. He specialises in cataract and corneal surgery.

He believes that practical simulation should be an essential part of training young ophthalmologists. "Doctors should never learn or experiment surgical techniques on real patients," he says. "Nothing beats refining the techniques, learning how to make mistakes in a simulation lab like this before they actually apply the same surgical skills onto patients." According to Johnson Neo, the days when surgeons learned new techniques through trial and error on actual patients should be firmly in the past.

The Prague course offered an opportunity to practise precisely those situations that can make an operation difficult. Organiser Andrea Janeková explains that modern cataract surgery usually involves an incision just 2.2 millimetres wide. Thanks to its special design, the incision normally does not require stitching. But complications can occur, or the incision may need to be enlarged. Surgeons must therefore know how to place a stitch with exactly the right shape and length.

Artificial eyes and 3D microscopes

The training facility is equipped with 40 surgical workstations, each with its own operating microscope. Instructors can observe the participants' movements and provide immediate feedback. In another room, beginners are working with artificial eyes instead of animal tissue. Their microscopes are connected to large three-dimensional screens, allowing instructors wearing 3D glasses to follow the operations.

Among the instructors is Swiss ophthalmologist Fabián Vozár, who praises the sophisticated technology available at the Prague course. The microscopes provide different types of illumination and exceptionally detailed views of the delicate structures inside the eye, he explains. "The procedure is just easier to learn because you're seeing so much better," Vozár says.

Some microscopes also feature intraoperative optical coherence tomography, or OCT, which can provide detailed images of structures inside the eye during surgery. Although this particular feature was not being used during the course, participants could familiarise themselves with some of the latest equipment available to ophthalmologists.

The technology is particularly valuable for young surgeons who must learn to coordinate extremely precise movements while looking through a microscope or watching a three-dimensional display.

Practising difficult procedures

The training is not limited to cataract operations. In a neighbouring room, more experienced surgeons are practising procedures involving the vitreous body and retina at the back of the eye. Working close to the retina, the light-sensitive tissue responsible for detecting visual information, requires exceptional precision.

For Czech eye surgeon David Korda, the training provides an opportunity to become familiar with structures he will eventually need to operate on. "When you see how these structures behave, it's easier to perform the actual procedure on a human eye," he says.

Participants can repeat individual procedures, correct mistakes and receive guidance from experienced international instructors. The Prague course offered up to 30 hours of practical training, with the aim of helping surgeons become more confident in handling complicated situations.

For Johnson Neo, however, the most important advantage of the training is not simply access to sophisticated instruments. It is the opportunity to learn from mistakes without compromising patient safety. The principle is straightforward: the more experience surgeons can gain in a realistic training environment, the better prepared they will be when someone's eyesight depends on their skills.