方法：前瞻性对照研究。选取2019/2021年在南京医科大学附属眼科医院已完成3a住院医师规范化培训的20名年资相同的眼科住院医师为研究对象，通过理论考核后随机分为虚拟-现实手术操作训练(Dry-lab)组和实体动物手术操作训练(Wet-lab)组，每组各10名。Dry-lab组和Wet-lab组医师分别使用Eye SI虚拟手术模拟器和猪眼进行训练。训练结束后使用Eye SI虚拟手术模拟器和实体猪眼操作对两组住院医师的总体培训效果进行评分，使用虚拟手术模拟器对两组住院医师的模块培训效果进行评分，并采用问卷调查对两种培训方式进行客观评价。

结果：Dry-lab组医师两项操作考核总评分、模拟器考核评分、实体猪眼操作考核评分均显著高于Wet-lab组(88.03±1.34分 vs 80.35±2.87分，87.50±3.03分 vs 77.60±5.62分，88.57±1.89分 vs 83.10±3.22分，均P<0.01)。模拟器模块考核结果显示，Dry-lab组医师各模块考核评分及用时均显著优于Wet-lab组(P<0.01)。问卷调查结果显示，在培训新颖性、是否贴近真实手术体验、对显微手术技能提高的帮助程度、经过该培训是否有信心进行真实手术及手术培训的整体满意度方面，Dry-lab组医师对于培训方式的效果评价均优于Wet-lab组(P<0.05)。

结论：将虚拟-现实手术操作训练应用于眼科住院医师白内障手术技能培训可以显著提升住院医师的白内障显微手术操作技能，提高培训整体满意度，帮助住院医师在执业初期提升真实手术时的信心、心理素质、决策及处理能力，为建立眼科住院医师正式、规范化的白内障手术培训体系提供了新的标准和模式。

METHODS:Twenty ophthalmology residents with equal seniority who had completed 3a standardized residency training in the Affiliated Eye Hospital of Nanjing Medical University from 2019 to 2021 were prospectively enrolled. After passing the theoretical examination, residents were randomly divided into virtual surgery exercise(Dry-lab)group(n=10)and real animal surgery exercise(Wet-lab)group(n=10). Dry-lab and Wet-lab group residents performed training using the Eye SI surgical simulator and pig eye respectively. At the end of the training, the overall training effects of the residents in both groups were rated using the Eye SI surgical simulator and the real pig eye operation, and the module training effects of the residents in both groups were rated using the virtual surgical simulator. Furthermore, a questionnaire survey was used to objectively evaluate the two training methods.

RESULTS:Residents in Dry-lab group had significantly higher total scores on both operation assessments,simulator assessment and real pig eye operation assessment than Wet-lab group(88.03±1.34 vs 80.35±2.87, 87.50±3.03 vs 77.60±5.62, 88.57±1.89 vs 83.10±3.22, all P<0.01). The simulator module assessment results showed that the residents in Dry-lab group scored significantly better than Wet-lab group in terms of scores and completion time on each module(P<0.01). The questionnaire results showed that Dry-lab group rated better than Wet-lab group in terms of the novelty of training, the proximity to the real surgical experience, the degree of help to the improvement of microsurgery skills, the confidence to perform real surgery, and the overall satisfaction of surgical training(P<0.05).

CONCLUSION:Applying virtual-reality surgery exercise to cataract surgery skills training for ophthalmology residents can significantly improve the cataract skills, increase overall training satisfaction, and help residents enhance their confidence, psychological quality, decision-making, and processing ability during real surgery at the initial stage of practice. This provides a new standard and model for establishing a formal and standardized cataract surgery training system for ophthalmology residents.