Advancing Surgical Skills in Ophthalmology: A Journey through Phaco and Vitrectomy Training

Martina Milkovska shares her experience with phaco training at PhacoHub Academy. When I finished residency, I began performing cataract surgery on my own, excited yet slightly afraid. Aware of the possible complications and without a mentor to call in a crisis, I sought a way to turn fear into a skill. I had already trained at Agarwals Eye Hospital in India, where I gained valuable experience with both basic phacoemulsification and extracapsular cataract extraction. Still, I knew I needed the next level: structured, complication-focused training with real mentorship.

Surgical Training at Phacohub Academy

That is when I read about Phacohub Academy in Cairo in Ophthalmology24. I reached out to international colleagues who had trained there and received excellent feedback. Encouraged, I contacted Phacohub directly and planned a seven-day intensive surgical course, becoming the first Bulgarian ophthalmologist to train there. My mentor, Dr. Ahmed Naggar was a remarkably talented surgeon with vast experience. What struck me most was not only his skill but also his approach to training. He understood my goals from the very beginning and tailored everything to match them.

The Mentorship and Methodology

We began with straightforward cases and gradually advanced to more complex situations: white and brunescent cataracts, small pupils, and deliberate complication exercises. Before each case, Dr. Naggar would give me clear instructions – what to focus on, what to practice; then watch as I carry out the steps. Practicing complication management in such a controlled and supportive environment was an experience that reshaped the way I approach surgery.

By my third day, I was performing more than ten cataract surgeries per day. Between cases, I also began doing PRK procedures, as well as a few pterygium excisions and trabeculectomies. I even attempted the Yamane scleral fixation technique. The variety kept the training dynamic and allowed me to gain confidence in handling different types of anterior segment surgeries.

The Transition to Vitreoretinal Surgery

On the fourth day, I stepped into uncharted territory – the vitrectomy operating room. I began by observing two surgeries performed by Dr. Naggar, before it was my turn. Although I had never performed a vitrectomy before, I had observed many. To my surprise, once I sat down at the microscope, everything felt natural. It was as though I unlocked a new level of my surgical potential. Over the next days, I had the chance to perform several basic vitrectomies from start to finish, as well as manage complex situations such as dropped IOLs and dropped nuclei or nuclear fragments.

Core Principles of Surgical Excellence

Dr. Naggar gave me guidance that has stayed with me even after my training. He encouraged me to observe carefully, saying, ‘If you see well, you do well.’ He emphasized that attention to detail and careful observation are the foundation of surgical skill. He also urged me to practice as much as possible and to believe in myself, reminding me that confidence built through experience is essential.

The following structure highlights the typical progression in advanced surgical education:

• Step 1: Training at Home
• Step 2: Lab & Simulation Training
• Step 3: Hands-On Training

The following table summarizes the intensive surgical activities performed during the training course:

This setup creates a great experience for surgeons and gives a better return than traditional video based portals for training. Johnson & Johnson Ethicon embarked on an innovative training approach with Meplis, using structured training of surgical skills by decomposing into teachable components, following the science of learning. MyVirtualSurgery was able to train thousands of surgeons worldwide and improve their technical skills for the rest of their careers.