Retinal Vein Occlusion (RVO) is a blinding disease caused by one or more occluded retinal veins. Current treatment methods only focus on symptom mitigation rather than targeting a solution for the root cause of the disorder. Retinal vein cannulation is an experimental eye surgical procedure which could potentially cure RVO. Its goal is to dissolve the occlusion by injecting an anticoagulant directly into the blocked vein. Given the scale and the fragility of retinal veins on one end and surgeons' limited positioning precision on the other, performing this procedure manually is considered to be too risky. The authors have been developing robotic devices and instruments to assist surgeons in performing this therapy in a safe and successful manner. This work reports on the clinical translation of the technology, resulting in the world-first in-human robot-assisted retinal vein cannulation. Four RVO patients have been treated with the technology in the context of a phase I clinical trial. The results show that it is technically feasible to safely inject an anticoagulant into a [Formula: see text]-thick retinal vein of an RVO patient for a period of 10 min with the aid of the presented robotic technology and instrumentation.

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PurposeTo evaluate the feasibility of robot assisted retinal vein cannulation for retinal vein occlusion.MethodsProspective experimental study performed in in vivo porcine eyes. A standard three port pars plana vitrectomy was followed by laser induced branch retinal vein occlusion. Consequently, a retinal vein cannulation with the help of a surgical robot and a micro‐needle was performed. Complete success was defined as a stable intravenous position of the needle tip confirmed by blood washout for at least 3 min. Secondary outcomes were the occurrence of intraoperative complications and technical failures.ResultsCannulation was successful in 15 out of 18 eyes with a complete success rate (duration of infusion of more than 3 min) of 73.3% after exclusion of 2 eyes from analysis due to failure in establishing a blood clot. There were no technical failures regarding the robotic device. The intravessel injections of ocriplasmin in 2 out of 2 eyes led to a clot dissolution. In a subset of 5 eyes, a second cannulation attempt at the border of the optic disc resulted in a stable intravessel position and infusion during 361.8 (±138.5) seconds.ConclusionsRobot assisted retinal vein cannulation with prolonged infusion time is technically feasible. Human experiments are required to analyze the clinical benefit of this new therapy.

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Retinal Vein Occlusion is a common retinal vascular disorder which can cause severe loss of vision. Retinal vein cannulation followed by injection of an anti-coagulant into the affected vein is a promising treatment. However, given the scale and fragility of the surgical workfield, this procedure is considered too high-risk to perform manually. A first successful robot-assisted procedure has been demonstrated. Even though successful, the procedure remains extremely challenging. This paper aims at providing a solution for the limited perception of instrument-tissue interaction forces as well as depth estimation during retinal vein cannulation. The development of a novel combined force and distance sensing cannulation needle relying on Fiber Bragg grating (FBG) and Optical Coherence Tomography (OCT) A-scan technology is reported. The design, the manufacturing process, the calibration method, and the experimental characterization of the produced sensor are discussed. The functionality of the combined sensing modalities and the real-time distance estimation algorithm are validated respectively on in-vitro and ex-vivo models.

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The results demonstrate the feasibility of deploying a combined sensing instrument in an in vivo setting. The performed study provides a foundation for further work on real-time local modelling of the surgical scene. This paper provides initial insights; however, additional processing remains necessary.

Retinal surgery is one of the most challenging types of surgery because of the scale and the fragility of the human eye anatomy. The surgeon suffers from limited positioning accuracy, tremor and poor force feedback directly affecting the quality of the surgical procedures. To tackle these issues, we developed a teleoperation system to assist surgeons during retinal surgery. The system offers features like motion scaling, tremor compensation and scaled force feedback. This paper reports on the design of the slave and the master.