Table 2 Assessment Scale of Corneal Rupture Suturing
DATE _____ RESIDENT _____ EVALUATOR _____ | 1 | 2 | 3 | 4 | 5 | Score |
|---|---|---|---|---|---|---|
Preoperative preparation | Failed to wear hat, mask and gloves | Failed to wear two of the three | Failed to wear one of the three | Wearing hat, mask and gloves correctly | Wearing hat, mask and gloves smoothly | |
Microscope use | Out of center and focus constantly | Out of center and focus frequently | Out of center and focus occasionally | Stay in center and focus constantly | Fluid moves with microscope | |
Instrument handling | Constantly makes tentative and awkward moves with instruments by impropriate use | Frequently makes tentative and awkward moves with instruments | Fair use of instruments but occasionally stiff or awkward | Competent use of instruments | Fluid moves with instruments | |
Hands coordination | Severely hands tremor and constantly instruments collision | Hands tremor and frequently instruments collision | Mild hands tremor and occasionally instrument collision | No hands tremor and instrument collision | Steady hands and perfect hands coordination | |
Suturing | Sutures are done in an awkward, slow fashion with much difficulty. Bent needles | Sutures are done with difficulty | Sutures are done with little difficulty | Sutures are done properly. Loads needle 1/2 to 2/3 from tip. Approaches eye with flat portion of needle. Needle enters perpendicular to cornea | Smooth and perfect suturing. Always loads needle 1/2 to 2/3 from tip. Always approaches eye with flat portion of needle. Needle enters perpendicular to cornea | |
Suturing order | Suture the rupture randomly | Suture the rupture in one direction | Selectively suture the rupture. Close the center first | Selectively suture the rupture. Close the angle first | Selectively suture the rupture. Surgical exploration of the limbus. Close the limbus first, then the angle | |
Stitches interval | Awfully uneven | Uneven | Almost even | Even | Perfectly even, around 2 mm | |
Stitches width | Awfully uneven | Uneven | Almost even | Even | Perfectly even, around 2 mm | |
Stitches depth | Awfully uneven | Uneven | Almost even | Even | Perfectly even, around 2/3 of the cornea thickness | |
Knotting | Knots are placed in an awkward, slow fashion with much difficulty | Knots are placed with difficulty | Knots are placed with little difficulty | Knots are placed properly with seldom breaking sutures | Knots are placed perfectly with no breaking sutures | |
Knots tightness | Suture tightness is awfully uneven. Sutures are too tight or loose | Suture tightness is uneven. Sutures are tight or loose | Suture tightness is almost even. Sutures are a little bit tight or loose | Suture tightness is proper and even | Suture tightness is perfectly even. Sutures are placed tight enough to maintain the wound closed, but not too tight as to induce astigmatism | |
Knots rotation | No suture rotation at all | Most of the sutures are not rotated | Parts of the sutures are not rotated | Most of the sutures are rotated | Complete suture rotation. No knots exposure | |
Wound closure and anterior chamber formation | No wound closure and no anterior chamber formation | Part of wound closure and no anterior chamber formation | Questionable wound closure and anterior chamber formation | Complete wound closure and anterior chamber formation | Neat and watertight wound closure. Perfect anterior chamber formation with no anterior synechia of iris | |
Postoperative clean up | Failed to clean up the pig eyes. Failed to settle the microscope and instruments. Failed to take off the hat, mask and gloves properly | Failed to do two of the three things | Failed to do one of the three things | Complete all the three things | Throw the pig eye in the yellow bag. Settle the microscope and instruments. Take off the hat, mask and gloves correctly | |
Overall performance | Unable to finish the operation independently | Hesitant, frequent starts and stops. Finish the operation with difficulty | Occasional starts and stops. Finish the operation within 20mins | Competent, finish the operation within 15mins | Confident and fluid, finish the operation within 10mins |