First-in-human study of the safety and viability of intraocular robotic surgery
Open accessAbstract
Microsurgery of the retina would be dramatically improved by instruments that offer supra-human precision. Here, we report the results of a first-in-human study of remotely controlled robot-assisted retinal surgery performed through a telemanipulation device. Specifically, 12 patients requiring dissection of the epiretinal or inner limiting membrane over the macula were randomly assigned to either undergo robot-assisted-surgery or manual surgery, under general anaesthesia. We evaluated surgical success, duration of surgery and amount of retinal microtrauma as a proxy for safety. Surgical outcomes were equally successful in the robotic-surgery and manual-surgery groups. Differences in the amount of retinal microtrauma between the two groups were statistically insignificant, yet dissection took longer with robotic surgery (median time, 4 min 5 s) than with manual surgery (1 min 20 s). We also show the feasibility of using the robot to inject recombinant tissue plasminogen activator under the retina to displace sight-threatening haemorrhage in three patients under local anaesthesia. A safe and viable robotic system for intraocular surgery would enable precise and minimally traumatic delivery of gene therapy or cell therapy to the retina.
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One avenue to further improve surgical precision and to reduce reflux during direct subretinal injection is to use robotic assistance.
“One avenue to further improve surgical precision and to reduce reflux during direct subretinal injection is to use robotic assistance (Edwards et al., 2018; Cehajic-Kapetanovic et al., 2022).”
From Gene Therapy-Associated Uveitis (GTAU): Understanding and mitigating the adverse immune response in retinal gene therapy (2025) · cites this paper as Edwards et al., 2018
The Introduction describes robotic assistance as a way to overcome tremor and improve precision, and the Results describe controlled robot-assisted subretinal injection. Neither those passages nor the Discussion reports that robotic assistance reduces reflux during injection. (LLM, conf=0.88)
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References 34 · Cited by 231
- Authors
- Edwards, T. L., Xue, K., Meenink, H. C. M., Beelen, M. J., Naus, G. J. L., Simunovic, M. P., Latasiewicz, M., Farmery, A. D., de Smet, M. D., & MacLaren, R. E.
- Affiliations
- University of Oxford (GB)
- Oxford University Hospitals NHS Trust (GB)
- Corresponding author
- MacLaren, R. E.
- ORCID
- Venue
- Nature Biomedical Engineering
- Published
- 2018-06-18
- Volume
- 2
- Issue
- 9
- Pages
- 649-656
- ISSN
- 2157-846X (ISSN-L)
- PMC
- PMC6155489
- OpenAlex
- W2808253872
- Cited by
- 231
- References
- 34
- Citations by year
- 2026: 32 · 2025: 37 · 2024: 23 · 2023: 30 · 2022: 29 · 2021: 24 · 2020: 22 · 2019: 28 · 2018: 6
- FWCI
- 13.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Nature Biomedical Engineering (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- TU/e Research Portal (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0515-10047, II-C2-0713-20005)
- University of Oxford
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Health Sciences › Medicine › Ophthalmology › Intraocular Surgery and Lenses
- Physical Sciences › Engineering › Mechanical Engineering › Teleoperation and Haptic Systems
- Keywords
- teleoperation, epiretinal membrane, internal limiting membrane, macula, operative time, subretinal hemorrhage, gene therapy delivery, cell therapy delivery, first-in-human safety
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