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Use of an in vitro model to compare manual and robotic assistance in subretinal injections

par Ladha, Reza ;Smit, Jorrit;Meenink, Thijs;Caspers, Laure ;de Smet, Marc D
Référence Euretina Meeting (September 2020: Amsterdam, The Netherlands)
Publication Non publié, 2020-09

Poster de conférence

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Résumé :

Purpose: To compare manual positioning and injection using a phantom retina model for subretinal delivery and compare it to the same procedure assisted by the Preceyes Surgical SystemSetting/Venue: Randomized comparative trial in a simulated settingMethods: Ten vitreoretinal surgeons carried out a simulated subretinal injection on a phantom retina model, under microscopic visualization through a Rescan 700 OCT Zeiss device. The procedure was carried out using a syringed fitted with a 41 G needle and an integrated distance sensor. The surgeon was asked to perform the surgery manually or with the assistance of the Preceyes Surgical System (PSS; Preceyes, Eindhoven, the Netherlands). Prior to the experiment, participants received a 15 minutes introduction to the surgical protocol and how to manipulate the robotic system. Each surgery was recorded by Rescan video, iOCT and with the distance sensor. Success in creating a subretinal bleb, presence of reflux, subretinal injection duration and depth precision were subsequently analyzed. Depth precision quantification was obtained by analyzing drift (defined as the total displacement over the entire injection time) and tremor at the needle extremity using OCT A-scan recording obtained from the distance sensor. Manual and robotic approaches were compared.Results: Subretinal bleb creation was achieved in 90% of PSS assisted surgeries with associated reflux in 70% of the cases. With manual surgery, bleb formation was succesful in 50% of the cases, and reflux was noted in 80%. In manual surgery, mean tremor was 55 μm (SD 40 μm), mean drift was 256 μm (SD 103 μm) and mean subretinal injection time was 25 sec (SD 9 sec). In robot-assisted surgery, mean tremor was 3 μm (SD 2 μm), mean drift was 25 μm (SD 23 μm) and mean subretinal injection time was 50 sec (SD 23 sec).Conclusions: Robotic assistance increases subretinal injection success in this in vitro model with higher rate of bleb formation and lower rate of reflux compared to manual surgery. The use of the PSS is also associated with improvement in the depth precision, the ability to remain a non-limited time into the subretinal space and the possibility to use an iOCT to guide the injection process which allows a better control of subretinal delivery .Theme: New Drug Treatment and Technology