State of the Art in Robot-Assisted Eye Surgery.

Despite the advantages that robot-assisted surgery can offer to patient care, its use in ophthalmic surgery has not yet progressed to the extent seen in other fields. As such, its use remains limited to research environments, both basic and clinical. The technical specifications for such ophthalmic surgical robots are highly challenging, but rapid progress has been made in recent years, and recent developments in this field ensure that the use of this technology in operating theatres will soon be a real possibility. Fully automated ocular microsurgery, carried out by a robot under the supervision of a surgeon, is likely to become our new reality. This review discusses the use of robot-assisted ophthalmic surgery, the recent progress in the field, and the necessary future developments which must occur before its use in operating theatres becomes routine.

Contact Lenses and Infectious Keratitis: From a Case-Control Study to a Computation of the Risk for Wearers.

PURPOSE: Contact lens (CL)-related microbial keratitis (MK) has major public health implications, with about 300 million wearers worldwide, and certain potentially modifiable risk factors. This study aimed to identify the risk factors of CL-related MK. METHODS: A multicenter case-control study was conducted between 2014 and 2017. Cases presenting with CL-related MK were submitted to an anonymous 52-item questionnaire, which was also completed by healthy controls. Univariate followed by multivariate logistic regression analysis was performed. Risk factors for CL-related MK were given as odds ratio (OR) with 95% confidence interval and P-value. RESULTS: The study included a total of 2267 patients (1198 cases and 1069 controls). The MK risk factors for the daily disposable lenses group were exceeding the lens renewal period (OR = 9.16, P = 0.008) and occasionally wearing CL when sleeping (OR = 15.83, P = 0.035). The most important risk factors in the nondaily disposable lenses group were lens cleaning solution distributed by eye care brands (OR = 3.50, P < 0.001) and failure to renew lens cases (OR = 3.39, P = 0.001). Statistically and clinically significant variables were used to establish the MK risk equation for CL wearers, allowing an individual calculation of the risk of MK under lenses. CONCLUSIONS: The MK risk equation is a valuable tool for educating patients about the risks associated with wearing CL. It allows the patient to be informed about their overall risk of infection while detailing the precipitating elements of the infectious risk with the aim of modifying risk behavior.

Robot-assisted simulated cataract surgery.

PURPOSE: To evaluate the feasibility of robot-assisted simulated cataract surgery. SETTING: Institut de Recherche Contre les Cancers de l'Appareil Digestif, European Institute of Telesurgery, and Strasbourg University Hospital, Strasbourg, France. DESIGN: Experimental study. METHODS: Cataract surgeries were performed on a Kitaro cataract wet-lab training system simultaneously using the Da Vinci Xi robotic surgical system and the Whitestar Signature phacoemulsification system. For each procedure, the duration and successful completion of the surgery with or without ocular complications were assessed. RESULTS: Procedures were successfully performed on 25 lens nuclei. The feasibility of robot-assisted simulated cataract surgery was confirmed. The robotic surgical system provided the intraocular dexterity and operative field visualization necessary to perform the main steps of the phacoemulsification procedure; that is, corneal incisions, capsulorhexis, grooving, cracking, quadrant removal, and irrigation/aspiration of the ophthalmic viscosurgical device (OVD). The intervention of a second surgeon was required for the intraocular injections of OVD, balanced salt solution, and intraocular lenses. The mean operative time was 26.44 minutes ± 5.15 (SD). All lens nuclei were removed. Inadvertent enlargement of the main corneal incision caused by the phaco handpiece was observed in 2 cases. CONCLUSION: Experimental robot-assisted cataract surgery was technically feasible using the new robotic surgical system combined with a phacoemulsification machine.

Robotically Assisted Pterygium Surgery: First Human Case.

PURPOSE: Little research has been done on robotic ocular microsurgery. This study aims to demonstrate the feasibility of pterygium surgery using a robotic surgical system. METHODS: Robot-assisted pterygium surgery was performed on a 73-year-old patient with nasal and temporal pterygia using the DaVinci Si HD robotic Surgical System (Intuitive Surgical Inc). The Kenyon technique (excision coupled with a conjunctival autograft) was performed. RESULTS: The DaVinci system provided appropriate dexterity to perform the different steps of surgery. The operative time was 60 minutes 30 seconds. There were no intraoperative complications and no need for conversion to conventional surgery. Postoperative follow-up was unremarkable. CONCLUSIONS: Robot-assisted pterygium removal is technically feasible using the DaVinci Si HD robotic Surgical System. We report the first human case of robot-assisted pterygium surgery.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02116062.