Advantages of robotic assistance over a manual approach in simulated subretinal injections and its relevance for gene therapy

Subretinal injection is a method for gene delivery to treat genetic diseases of the photoreceptors and retinal pigment epithelium. A reflux-free subretinal injection is important to allow effective, safe, and cost-effective gene therapy to the retina. We report on a comparison between manual and rob...

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Bibliographic Details
Published in:Gene therapy 2023-04, Vol.30 (3-4), p.264-270
Main Authors: Ladha, Reza, Meenink, Thijs, Smit, Jorrit, de Smet, Marc D.
Format: Article
Language:English
Subjects:
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692/699/375
Biomedical and Life Sciences
Biomedicine
Brief Communication
Cell Biology
Drift
Epithelium
Gene Expression
Gene Therapy
Gene transfer
Genetic disorders
Genetic Therapy
Human Genetics
Humans
Injection
Nanotechnology
Photoreceptors
Retina
Retinal Pigment Epithelium
Robotic Surgical Procedures
Robotics
Tremor
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Summary:Subretinal injection is a method for gene delivery to treat genetic diseases of the photoreceptors and retinal pigment epithelium. A reflux-free subretinal injection is important to allow effective, safe, and cost-effective gene therapy to the retina. We report on a comparison between manual and robotic assistance in simulated subretinal injections using an artificial retina model. Nine surgeons carried out the procedure with and without the Preceyes Surgical System, using an OPMI Lumera 700 Zeiss surgical microscope equipped with intra-operative optical coherence tomography. Success in creating a bleb without reflux, injection duration, drift, tremor, and increase in the diameter of the puncture hole were analyzed. Robotic assistance improved drift (median 16 vs 212 µm), tremor (median 1 vs 18 µm), enlargement of the retinal hole, and allowed for prolonged injection times (median 52 vs 29 sec). Robotic assistance allowed higher rate of bleb formation (8/9 vs 4/9 attempts) with a moderate reduction in reflux (7/9 vs 8/9 attempts) in this artificial model. Robotic assistance can significantly contribute to subretinal injections and provide quantifiable parameters in assessing surgical and clinical success of novel retinal gene therapies.
ISSN:0969-7128
1476-5462
DOI:10.1038/s41434-021-00262-w