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September 12, 2016

Robot helps in delicate eye operation – a world’s first!

For the first time ever, surgeons have used a robot to operate inside the eye and restore sight. A team at Oxford’s John Radcliffe Hospital used the device, controlled by joystick, to remove a membrane one hundredth of a millimetre thick.

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The patient, 70 year old Bill Beaver, talks about a fairy tale now he can see again.” I’m just fortunate that I’m the first to have it,”said the Oxford based curate. Surgeons say they hope the procedure will pave the way for more complex eye surgery than is currently possible with the human hand, according to the BBC.

Prof Robert MacLaren from University of Oxford, led the procedure. He underlines that operating at the back of the eye needs great precision. The challenge has been to get a robot system to do that through a tiny hole in the wall of the eye without causing damage as it moves around. The Preceyes surgical robot used in the procedure was developed by the Dutch company Preceyes, a spin-out of Eindhoven University of Technology.

The surgeon uses a joystick and touch-screen to guide a thin needle into the eye, while monitoring its progress through a microscope. The robot acts like a mechanical hand. It has seven motors and is able to filter out hand tremors from the surgeon. Large movements of the joystick result in tiny movements of the robot, and if the surgeon releases their grip any movement is frozen. Normally during the procedure by hand the retina is touched and there is some haemorrhage, but while using the robot the membrane was lifted cleanly away.

The patient was officiating chaplain to the Household Cavalry Mounted Regiment until last year.
In July his optician spotted a membrane growing at the back of his right eye. The pressure had created a hole in his retina which was destroying his central vision. He could only see mush in the centre of his eye. Any vision was restricted to the periphery. The result of the pioneering procedure is that Dr Beaver’s central vision in his right eye has been restored.

Twelve patients will undergo surgical procedures using the robot, in a trial funded by the NIHR Oxford Biomedical Research Centre. Additional funding is being provided by Zizoz, a Dutch charity for patients with choroideremia, a genetic form of blindness which might be a future target for treatment using the robot.

The trial is designed as a proof of principle, to establish whether the robot can do what an eye surgeon does, but with greater accuracy. The ultimate goal is for robotics to take eye surgery to another level, not just improving on current procedures. Prof MacLaren: “I hope the robot will allow us to do new more complex and delicate operations that are impossible with the human hand."

Oxford is among several centres around the world which are trialling retinal gene therapy – a new treatment to prevent blindness. Currently this treatment is done by hand. Further interventions involving stem cell injections are planned which require cells to be slowly infused into the eye. The robot should allow surgeons to inject cells under the retina over a period of 10 minutes, something which would be impossible with the human hand.

The Dutch company which developed the robot believes that it could eventually be used outside the operating theatre, e.g. in an office based setting where only the robot would touch the eye. Maarten Beelen from Preceyes said: “It would be fully automated, which would improve efficiency and reduce costs."

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