July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
A first-in-man trial assessing robotic surgery inside the human eye to perform a subretinal injection
Author Affiliations & Notes
  • Thomas L Edwards
    Nuffield Laboratory of Ophthalmology, University of Oxford, East Melbourne, Victoria, Australia
  • Kanmin Xue
    Nuffield Laboratory of Ophthalmology, University of Oxford, East Melbourne, Victoria, Australia
  • Thijs Meenink
    Technical University of Eindhoven, Eindhoven, Netherlands
  • Maarten Beelen
    Technical University of Eindhoven, Eindhoven, Netherlands
  • Gerrit Naus
    Nuffield Laboratory of Ophthalmology, University of Oxford, East Melbourne, Victoria, Australia
  • Matthew P Simunovic
    Nuffield Laboratory of Ophthalmology, University of Oxford, East Melbourne, Victoria, Australia
  • Marta Latasiewicz
    Oxford Eye Hospital, Oxford, United Kingdom
  • Andrew Farmery
    Nuffield Department of Anaesthesia, Oxford, United Kingdom
  • Marc D De Smet
    Technical University of Eindhoven, Eindhoven, Netherlands
  • Robert E MacLaren
    Nuffield Laboratory of Ophthalmology, University of Oxford, East Melbourne, Victoria, Australia
  • Footnotes
    Commercial Relationships   Thomas Edwards, None; Kanmin Xue, None; Thijs Meenink, Preceyes (E); Maarten Beelen, Preceyes (E); Gerrit Naus, Preceyes (E); Matthew Simunovic, None; Marta Latasiewicz, None; Andrew Farmery, None; Marc De Smet, Preceyes (C); Robert MacLaren, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 5936. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Thomas L Edwards, Kanmin Xue, Thijs Meenink, Maarten Beelen, Gerrit Naus, Matthew P Simunovic, Marta Latasiewicz, Andrew Farmery, Marc D De Smet, Robert E MacLaren; A first-in-man trial assessing robotic surgery inside the human eye to perform a subretinal injection
      . Invest. Ophthalmol. Vis. Sci. 2018;59(9):5936.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : To assess the surgical efficacy and safety of a master-slave telemanipulation robotic device (Preceyes BV, Eindhoven, the Netherlands) used to inject a therapeutic drug, recombinant tissue plasminogen activator (rt-PA), under the retina in order to displace sight-threatening haemorrhage.

Methods : Six patients with acute submacular haemorrhage were recruited for subretinal rt-PA injection and randomised to either robot (n = 3) or standard (n = 3) surgery. The robotic device consisted of a 4-axis motion controller for hand motion input by the surgeon, and a 4-axis instrument manipulator/holder that enabled instrument movement. Following 23 gauge standard vitrectomy, a Teflon-tipped retractable 41 G cannula (DORC BV, Zuidland, the Netherlands) connected to a 1 ml Luer lock syringe containing 200 µg/ml of rt-PA (Alteplase, Boehringer Ingelheim, Germany) was mounted on the instrument manipulator (robot group), or was handheld (standard group), and connected to the viscous fluid control (VFC) port of the Alcon Constellation Vision System (Alcon, Fort Worth, USA). Injection of 0.025 to 0.10 ml of subretinal rt-PA was performed adjacent to the submacular haemorrhage.

Results : The instrument manipulator was used to move the cannula tip towards the retinal surface under visual and intra-operative OCT guidance (Zeiss Rescan 7000, Carl Zeiss Meditec AG, Jena, Germany). Incremental advancements in the z-axis were performed to a pre-defined depth consistent with retinal thickness (~250 µm) before initiation of subretinal injection. The injection durations (min:sec) were 8:31 and 3:12 for the robot group and 4:00, 6:32 and 4:22 for the control group. In one of the three patients who received robot-assisted rt-PA injections, transient intra-operative exacerbation of cataract precluded a clear view of the cannula tip against the retina and the injection was completed manually.

Conclusions : Using the virtual z-axis boundary, tremor filtering and clutch mechanism to freeze instrument position, the Preceyes robot allowed precision delivery of a drug into the delicate subretinal tissue plane. This provides proof-of-principle for future applications including robotic assisted delivery of sub-retinal gene therapy.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×