Development and preliminary validation of a hybrid three-dimension printed model for glaucoma drainage device surgery training: a prospective simulation-based study.

BACKGROUND

We aimed to develop a three-dimensional (3D) printed glaucoma drainage device (GDD) surgery model and evaluate its realism and procedural performance compared with a commercially available GDD.

METHODS

This prospective, simulation-based pilot feasibility study assessed preliminary face and content validity evidence for a 3D-printed GDD model. Fourteen glaucoma specialists (eight fellows and six consultants) were recruited using a convenience sample from a single tertiary eye hospital. Participants performed two simulated GDD surgeries on ovine eyes in a surgical training wet lab, first using the 3D-printed model and then using a commercially available Baerveldt glaucoma implant (BGI). Procedure time was measured using a stopwatch for comparative analysis, and participants evaluated technical realism, visual realism, and overall utility relative to the BGI on a 5-point Likert scale (1 = not at all similar/not useful at all to 5 = extremely similar/extremely useful). The study was non-randomized, and participant blinding was not feasible because of visible differences between the devices.

RESULTS

Total procedure duration was longer for the 3D-printed model than for the BGI (median interquartile range [IQR], 530.5 [302.5] vs. 342 [132.5] s; p < 0.001), with significantly longer times for plate insertion (p = 0.039), tube insertion (p = 0.001), and tube fixation (p = 0.025), except for plate fixation (p = 0.078). Technical realism was rated highest for plate and tube fixation, with median [IQR] scores of 4.00 [1] and 4.00 [0], respectively, and overall model utility was rated 4.00 [1]. When comparing consultants and glaucoma fellows, only BGI plate fixation time differed significantly (112.5 [101] vs. 180 [94] s; p = 0.023).

CONCLUSIONS

Although procedure times were longer with the 3D-printed model than with the commercial implant, the model demonstrated acceptable moderate-to-high ratings for realism and high overall utility, supporting its potential role as a feasible simulation-based training tool for GDD surgery.