Simulator training improves surgical scores and reduces complications in cataract surgery training

To explore the application and effectiveness of surgical simulation training in phacoemulsification cataract surgery training. A randomized controlled trial was conducted. A total of 10 attending ophthalmologists who received cataract surgery training in our hospital from April 2022 to October 2025 were enrolled as the study subjects. After completing theoretical training and assessment related to phacoemulsification cataract surgery, the participants were randomly divided into a simulator training group and an animal eye training group according to the training protocol, with 5 participants in each group. The simulator training group and the animal eye training group trained using the HelpMeSee surgical simulation system and pig eyes, respectively. After training, each trainee performed step-by-step operations on real human eyes and was assessed with scoring. The overall training effectiveness of the two groups was evaluated, including surgical time, best corrected visual acuity, intraocular pressure and corneal edema on the first postoperative day,, and corneal endothelial cell count at one month postoperatively. The mean age of physicians in the simulator training group and the animal eye training group was (36.40±5.18) years and (35.40±3.85) years, respectively, and the male-to-female ratios were 2∶3 and 3∶2, respectively. During the step-by-step assessment, the scores of continuous curvilinear capsulorhexis, phacoemulsification, and cortical removal in the simulator training group were (5.64±0.56), (6.04±1.56), and (5.82±0.87), respectively, which were higher than those in the animal eye training group [(5.22±0.82), (5.20±2.20), and (5.26±1.43), respectively], and the differences were statistically significant (all <0.05). The incidence of posterior capsule rupture during phacoemulsification and cortical removal in the simulator training group was 4% and 2% (2/50 and 1/50), respectively, which was lower than that in the animal eye training group [12% and 6% (6/50 and 3/50), respectively], but the differences were not statistically significant (all >0.05). When independently performing surgeries, the surgical time of the simulator training group was (17.15±1.50) min, which was shorter than that of the animal eye training group [(18.81±1.08) min] (<0.001). On the first postoperative day, intraocular pressure was within the normal range in both groups, but was higher in the animal eye training group than in the simulator training group (<0.05); corneal edema in the simulator training group (0.60±0.50) was also better than that in the animal eye training group (1.12±0.67) (<0.05). At one month postoperatively, the corneal endothelial cell count in the simulator training group was (2 257.52±300.05) cells/mm, which was higher than that in the animal eye training group [(2 077.40±179.52) cells/mm] (<0.05). Compared with animal eye training, the application of the HelpMeSee surgical simulation system in phacoemulsification cataract surgery training can significantly improve surgeons' microsurgical skills in cataract extraction, shorten surgical time, reduce surgical trauma and complications, and provide a new model, idea and approach for establishing standardized cataract extraction surgery training.