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Maierhofer NA, Jablonka AM, Roodaki H, Nasseri MA, Eslami A, Klaas J, Lohmann CP, Maier M, Zapp D. iOCT-guided simulated subretinal injections: a comparison between manual and robot-assisted techniques in an ex-vivo porcine model. J Robot Surg 2023; 17:2735-2742. [PMID: 37670151 PMCID: PMC10678791 DOI: 10.1007/s11701-023-01699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
The purpose of this study is to compare robot-assisted and manual subretinal injections in terms of successful subretinal blistering, reflux incidences and damage of the retinal pigment epithelium (RPE). Subretinal injection was simulated on 84 ex-vivo porcine eyes with half of the interventions being carried out manually and the other half by controlling a custom-built robot in a master-slave fashion. After pars plana vitrectomy (PPV), the retinal target spot was determined under a LUMERA 700 microscope with microscope-integrated intraoperative optical coherence tomography (iOCT) RESCAN 700 (Carl Zeiss Meditec, Germany). For injection, a 1 ml syringe filled with perfluorocarbon liquid (PFCL) was tipped with a 40-gauge metal cannula (Incyto Co., Ltd., South Korea). In one set of trials, the needle was attached to the robot's end joint and maneuvered robotically to the retinal target site. In another set of trials, approaching the retina was performed manually. Intraretinal cannula-tip depth was monitored continuously via iOCT. At sufficient depth, PFCL was injected into the subretinal space. iOCT images and fundus video recordings were used to evaluate the surgical outcome. Robotic injections showed more often successful subretinal blistering (73.7% vs. 61.8%, p > 0.05) and a significantly lower incidence of reflux (23.7% vs. 58.8%, p < 0.01). Although larger tip depths were achieved in successful manual trials, RPE penetration occurred in 10.5% of robotic but in 26.5% of manual cases (p > 0.05). In conclusion, significantly less reflux incidences were achieved with the use of a robot. Furthermore, RPE penetrations occurred less and successful blistering more frequently when performing robotic surgery.
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Affiliation(s)
- Niklas A Maierhofer
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Anne-Marie Jablonka
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hessam Roodaki
- Translational Research Lab, Carl Zeiss Meditec AG, Munich, Germany
| | - M Ali Nasseri
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Abouzar Eslami
- Translational Research Lab, Carl Zeiss Meditec AG, Munich, Germany
| | - Julian Klaas
- Klinik und Poliklinik für Augenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Chris P Lohmann
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Mathias Maier
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel Zapp
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Zhao Y, Jablonka AM, Maierhofer NA, Roodaki H, Eslami A, Maier M, Nasseri MA, Zapp D. Comparison of Robot-Assisted and Manual Cannula Insertion in Simulated Big-Bubble Deep Anterior Lamellar Keratoplasty. Micromachines (Basel) 2023; 14:1261. [PMID: 37374846 DOI: 10.3390/mi14061261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
This study aimed to compare the efficacy of robot-assisted and manual cannula insertion in simulated big-bubble deep anterior lamellar keratoplasty (DALK). Novice surgeons with no prior experience in performing DALK were trained to perform the procedure using manual or robot-assisted techniques. The results showed that both methods could generate an airtight tunnel in the porcine cornea, and result in successful generation of a deep stromal demarcation plane representing sufficient depth reached for big-bubble generation in most cases. However, the combination of intraoperative OCT and robotic assistance received a significant increase in the depth of achieved detachment in non-perforated cases, comprising a mean of 89% as opposed to 85% of the cornea in manual trials. This research suggests that robot-assisted DALK may offer certain advantages over manual techniques, particularly when used in conjunction with intraoperative OCT.
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Affiliation(s)
- Yinzheng Zhao
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Anne-Marie Jablonka
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Niklas A Maierhofer
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Hessam Roodaki
- Translational Research Lab, Carl Zeiss Meditec AG, 81379 München, Germany
| | - Abouzar Eslami
- Translational Research Lab, Carl Zeiss Meditec AG, 81379 München, Germany
| | - Mathias Maier
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Mohammad Ali Nasseri
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
| | - Daniel Zapp
- Klinik und Poliklinik für Augenheilkunde, Technische Universität München, 81675 München, Germany
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Maierhofer NA, Friedrich J, Lanzl I. [37-year-old male patient with painful conjunctival efflorescences]. Ophthalmologie 2022; 119:1313-1316. [PMID: 36416920 DOI: 10.1007/s00347-022-01763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Niklas A Maierhofer
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Julia Friedrich
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Ines Lanzl
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland
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