We appreciate the thoughtful comments from Simpson et al, regarding our article on simulating anterior vitrectomy (AV) during the removal of silicone oil (ROSO) procedures. We address their key concerns as follows:

1.

Safety concerns

While Simpson et al. question the safety of our proposed technique compared to the standard ROSO through a pars plana approach, we emphasise that patient safety is paramount in our model. The described technique is designed to provide practical training in a controlled manner, with the supervision of experienced vitreoretinal surgeons. We recognise that silicone oil removal involves inherent risks, including endothelial failure and glaucoma, as noted in the literature. However, our approach aims to mitigate these risks by ensuring trainees are adequately supervised and trained in the nuances of AV, potentially reducing the incidence of uncontrolled posterior capsule rupture (PCR) during routine cataract surgeries.

We agree that further comparative safety studies would strengthen our proposal, and we are committed to conducting such research.

2.

Ethical considerations

The ethical aspect of patient consent is crucial. We fully support the necessity of obtaining specific informed consent from patients, highlighting the involvement of trainees and the additional procedures being performed. The benefits to the patient, including potentially reduced postoperative complications due to better-trained surgeons, must be clearly communicated. The Montgomery ruling emphasises the importance of patient autonomy and informed consent, and our practice adheres strictly to these principles.

3.

Necessity and alternatives

Simpson et al. advocate for the use of bespoke ocular simulation models to improve trainee confidence and competence in managing PCR. While these models are indeed valuable and should be part of a comprehensive training programme, they cannot fully replicate the complexities and pressures of real-life surgery. Our proposed model provides an intermediate step, offering hands-on experience in a real but controlled environment, which we believe is essential for bridging the gap between simulation and independent practice. Additionally, incorporating these practical experiences can complement existing simulation training, ultimately enhancing surgical proficiency and patient outcomes.