par Rosen, Richard B.;Ladha, Reza ;de Smet, Marc D
Référence American Society of Retina Specialists Meeting - technology Symposium(24 juillet 2020: Seattle)
Publication Publié, 2020-07-24
Abstract de conférence
Résumé : OBJECTIVE Demonstrate the advantages of high precision robotics in retinal delivery over manual techniquePURPOSE Robotics provides high positional stability as well as micrometer precision and accuracy in XYZ. This removes any time constraint on drug delivery within the retinal space, whether intracannular or subretinal. It also allows for a detailed analysis of each phase of a surgical procedure and its optimization.METHODS The following exemplifies our approach to procedure optimizations. To optimize subretinal delivery, first in vitro models are used such as freshly harvested porcine eyes, in which a standard pars plana vitrectomy with IOP control under microscopic visualization through a Rescan 700 Zeiss device was performed. Subsequently, subretinal injection using a 41G Teflon needle, was executed with or without the Preceyes Surgical System (PSS). The following parameters were recorded: absence of a Bruch’s membrane breech, initiation success and duration to subretinal bleb creation. Surgical iOCT and microscopic recording where analyzed and categorized after completion of the surgery . Surgical success was defined as a creation of a subretinal bleb confirmed by intraoperative oct, while avoiding reflux. These were followed by studies in live anesthetized animals using similar parameters.RESULTS No breech of Bruch’s membrane was observed using either manual or robotic assistance. While static positioning was possible manually in the subretinal space, repeated contact with Bruch’s was observed due to physiologic hand tremor. There was no motion while using the PSS. Surgical success was achieved in 80% of PSS assisted surgeries (blebs creation in 100%, with leakage in 20% at the time of retraction). With manual surgery, leakage was observed in all cases, in only 40% of cases could a bleb be successfully created. Leakage was observed at all stages of bleb initiation, injection and retraction of the needle. Time involved in belb generation was longer while using the PSS which may have bearing on the success.CONCLUSION Removing any time constraint on delivery, providing high precision positioning allows for controlled delivery of substances to the appropriate targeted space. Given the stability of the robotic system, it is possible to carefully analyze the surgical procedure using existing iOCT technology. In fact, combining the robot with an iOCT appears to be the ideal optimal use of both technologies and requires further exploration.HUMAN RESEARCH No: Study does not involve human research

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