Abstract
Purpose :
Uptake of robotic systems for ocular surgery is impeded by the challenges of a rotationally mobile field, rapid surgery in awake patients, and little tolerance for aberrant motion. However, as surgical outcomes and innovation are becoming limited by human physiology, robotic assistance offers a means by which the therapeutic repertoire of ophthalmologists may be expanded. This systematic review aimed to identify how robotic systems have been applied in eye surgery, and to appraise their effectiveness, practicality, and safety.
Methods :
The Cochrane Library, Embase, MEDLINE, Scopus, and Web of Science were searched with records fulfilling the following criteria included: English language; primary research article; human patients; eye surgery; robot-assisted or robot-mediated surgery. Joanna Briggs Institute Tools for Critical Appraisal were used for quality assessment. Data extraction captured study design, location, surgical procedures, and outcome measures of clinical effectiveness, safety, and practicality for surgeons. The study was pre-registered on PROSPERO (CRD42023449793).
Results :
12 studies were identified: three randomised-control trials (RCTs), seven case series, and two case reports. Robotic systems have been used to assist with a variety of tasks in corneal, orbital, and vitreoretinal surgery. All RCTs trialled the Preceyes BV system. RCT results indicated no significant differences in clinical outcomes or adverse events between patients undergoing robot-assisted and conventional surgery but were underpowered to appraise non-inferiority or superiority (Nmax = 15). Robotic assistance was associated with longer duration of surgery in 2/3 RCTs (p < 0.05). One study reported lesser movement distance of robot-assisted instruments, indicating greater efficiency. Surveyed surgeons were positive regarding ergonomics and intuitiveness. Preceyes has received CE marking approval to assist trained vitreoretinal surgeons in theatre.
Conclusions :
Robotic systems have safely assisted with ophthalmic surgery in proof-of-concept studies, including some that extend human capability such as retinal vessel cannulation. However, robot-assistance increases procedure duration. Further technological refinements are necessary to design interventions to improve clinical outcomes and justify adoption of robotic systems in ophthalmology.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.