It was a seemingly impossible challenge. The aim was to treat the cause of a condition that has plunged 16.4 million people globally into a dark and blurry world.
But in order to do this, surgeons needed to inject a needle into a vessel the size of a human hair and hold it completely still for seven minutes. Any unwanted movement risked doing serious damage to the vein or retina.
After seven years, many hurdles and a collaboration between Belgium engineers and ophthalmologists, a surgical team has managed to achieve this delicate task using a robot as an assistant.
University Hospitals Leuven eye surgeon, Professor Peter Stalmans, worked in tandem with the robot during the surgery on 12 January.
He explained to OT that the patient had a 10-fold recovery in visual acuity.
“When we saw the patient again yesterday after the surgery, everybody was almost crying. It was a fantastic feeling, absolutely,” Professor Stalmans added.
As well as an improvement in visual acuity, swelling in the retina, which was normally five-fold, had gone back to normal.
“I couldn't believe it at first - I checked the OCT and thought ‘Am I looking at the right eyes of the right patient?' It was amazing. We did not know what to expect because it has never been done. We had no idea if we could dissolve the blood clot and whether it would improve the patient's condition,” he outlined.
Central retinal vein occlusion (CRVO) obscures or completely robs a patient of their sight after a clot forms in the large vessel of the retina.
At present, the only treatment that exists for the condition is to ameliorate the side effects. This can be a costly endeavour, with a price tag of €32,000 (£27,289) per eye for injection treatments.
Professor Stalmans explained that CRVO had a “devastating impact” on visual acuity.
“The eye goes legally blind. That's what also makes it very exciting that we are treating an eye disease that is relatively prevalent and results in very severe impacts,” he added.
Using the robot involves the surgeon guiding the needle into the vein while the robot eliminates any vibration.
After locking the robot, the needle and the eye are automatically stabilised. The surgeon can then inject a product to dissolve the blood clot into the vein in a controlled way.
“It gives the surgeon the feeling that they are manipulating the instrument in a very thick gel which dampens any tremors,” Professor Stalmans explained.
At the moment, there are no commercial robots that are used during eye surgery.
There is a surgical robot used during urology surgery, the da Vinci surgical system, but this robot has an accuracy of one millimetre, compared to the Belgium robot’s accuracy of one micrometre.
“We are talking about 1000 times more accuracy,” Professor Stalmans explained.
A phase one clinical trial involving six patients will test feasibility of the technology, with the research team hoping to attract an investor if the trial is successful.
The technology has exciting implications for other procedures: “Any eye surgery that is delicate could be aided by this robot because it eliminates the unwanted movement of your hand,” Professor Stalmans highlighted.
“For example – membrane peeling. If you have any scar tissue on the retina it has to be peeled off, which is now done by forceps, but you could have the robot hold the forceps as well to dampen any unwanted movement,” he added.
Image credit: KU Leuven