Ultra–long-distance robotic-assisted subretinal injection may be technically feasible in patients with submacular hemorrhage, demonstrating no intraoperative complications or serious adverse events during 3 months of follow-up.
The report involved a 42-year-old male patient with a 2-week history of sudden central scotoma and vision loss in the right eye. The procedure connected Zhongshan Ophthalmic Center in Guangzhou, China, where the surgeon operated the robotic system, with Xinjiang Production and Construction Corps Hospital in Urumqi, China, where the patient underwent surgery. Following manual pars plana vitrectomy by the local surgical team, the remote surgeon used a teleoperated ophthalmic robotic system to deliver recombinant tissue plasminogen activator into the subretinal space.
The primary outcomes were procedural feasibility and safety, defined as successful completion of the robotic subretinal injection without conversion to manual surgery and the absence of intraoperative complications or serious postoperative adverse events. Secondary outcomes included hemorrhage resolution and best-corrected visual acuity (BCVA).
The remote robotic injection was successfully completed without intraoperative complications. Seven of the 46 minutes of surgical time included robotic instrument insertion through injection. The surgeon delivered 0.056 mL of recombinant tissue plasminogen activator. No instrument malfunctions, loss of visualization, or procedural interruptions occurred, and mean network latency was 77.9 milliseconds.
No serious adverse events occurred during 3 months of follow-up. Serial optical coherence tomography showed progressive resolution of the submacular hemorrhage, with complete resolution by postoperative day 23 and no residual hemorrhage or pigment epithelial detachment by postoperative day 86. The patient reported a subjective reduction in the central scotoma area. Angiography subsequently identified underlying polypoidal choroidal vasculopathy, and the patient received 3 intravitreal conbercept injections.
Anatomical resolution was not accompanied by improved visual acuity. BCVA was 0.6 logMAR, equivalent to 20/80, prior to surgery and at 3 months. The researchers noted that the 2-week interval between symptom onset and treatment may have contributed to limited functional recovery despite anatomical improvement because delayed intervention can be associated with irreversible photoreceptor damage.
The local surgical team performed pars plana vitrectomy, introduced the robotic instrument into the vitreous cavity, and completed fluid-air exchange. Teleoperation was intentionally limited to the subretinal injection, which the researchers described as particularly dependent on micron-scale motion control.
The findings were limited by the single-case design and absence of a comparison with conventional surgery. The procedure was performed under general anesthesia, whereas many subretinal injection procedures are routinely performed under local anesthesia. Deployment complexity, infrastructure requirements, communication reliability, availability of trained personnel, and system cost may also limit broader implementation. Larger multicenter studies and controlled comparisons are needed to evaluate safety and efficacy across diverse patient populations and surgical complexities.
“This case study demonstrates that remote robotic subretinal [recombinant tissue plasminogen activator] injection following manual [pars plana vitrectomy] for [submacular hemorrhage] is technically feasible,” wrote lead study author Andi Xu, MD, of Zhongshan Ophthalmic Center, Sun Yat-sen University, and colleagues.
The investigators emphasized that controlled comparisons, substantially larger numbers of cases, and testing in clinical practice are needed to assess the potential risks and benefits of remote robotic treatment.
The study authors reported no conflicts of interest.
Source:JAMA Ophthalmology
