Robotic Systems in Retinal Surgery

Retinal surgery demands sub-millimetre precision within a confined ocular space, where even minimal hand tremor or misalignment can jeopardise delicate neural tissues. Robotic systems have emerged to augment surgeon dexterity, integrating real-time imaging, force sensing and tremor suppression to enhance accuracy and safety. Master–slave platforms and handheld micromanipulators offer active motion scaling and remote centre of motion control, while optical coherence tomography (OCT) guidance provides micrometre-scale visual feedback. These technologies facilitate key interventions such as subretinal injections for gene and cell therapies, retinal vein cannulation to relieve occlusions, and membrane peeling. By reducing procedural variability, robotic assistance supports reproducible outcomes and may accelerate the translation of advanced therapies. Clinical prototypes have demonstrated improved tool stability, reduced tissue trauma and reliable performance in preclinical models, underscoring global efforts to integrate robotic microsurgery into standard ophthalmic practice.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Research from all publishers

Recent studies have advanced deep-learning frameworks for automated needle detection and localisation in robot-assisted subretinal injection, leveraging microscope-integrated OCT to achieve localisation error below 9 µm in ex vivo models. A biomechanical analysis has clarified how anatomical and fluidic variables influence subretinal bleb propagation, underscoring the role of robotic platforms in refining injection trajectories, minimising reflux and preserving retinal integrity. Comparative evaluation of manual versus robotic-assisted subretinal injections using a surgical console revealed a substantial reduction in instrument drift and tremor, higher rates of bleb formation without reflux, and extended injection duration, demonstrating quantifiable improvements pertinent to gene therapy delivery. In retinal vein cannulation, a robotically driven micromanipulator achieved consistent piercings in porcine venules where manual attempts often failed, establishing a robust test bed for therapeutic strategies and highlighting the potential for force- and motion-controlled assistance in vascular interventions.

Robotic Systems in Retinal Surgery publication trend

The graph below shows the total number of articles in robotic systems in retinal surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Optical Coherence Tomography (OCT): Non-invasive imaging modality providing high-resolution, cross-sectional views of retinal architecture.

Master–Slave Robotic System: Configuration in which a surgeon’s input at a master console is mirrored by a remote slave manipulator within the eye.

Micromanipulator: Precision device enabling controlled, fine-scale instrument positioning for microsurgical tasks.

Subretinal Injection: Delivery of fluid or therapeutic agents into the potential space between the neurosensory retina and retinal pigment epithelium.

Retinal Vein Cannulation: Insertion of a micro-catheter into a retinal vein to administer treatments or restore vascular patency.

Tremor Cancellation: Automated suppression of involuntary hand movements to stabilise surgical instruments.

References

1. Needle detection and localisation for robot‐assisted subretinal injection using deep learning. CAAI Transactions on Intelligence Technology (2023).
2. Biomechanical considerations for optimising subretinal injections. Survey of Ophthalmology (2024).
3. Robotic Assisted Cannulation of Occluded Retinal Veins. PLOS ONE (2016).
4. Advantages of robotic assistance over a manual approach in simulated subretinal injections and its relevance for gene therapy. Gene Therapy (2021).