To assess the feasibility and safety of remotely performed, robot-assisted subretinal rt-PA injection for submacular hemorrhage (SMH).
Approach:
Design and setting: Single-case report involving a surgeon in Guangzhou and a patient in Urumqi, China, approximately 4,000 km apart.
Procedure: Under general anesthesia, the local team performed pars plana vitrectomy and introduced the robotic instrument. The remote surgeon used a teleoperated platform over a 5G connection to inject 0.056 mL of rt-PA at 0.5 mg/mL into the subretinal space.
Assessment: Reported outcomes included adverse events, completion without conversion to manual surgery, visual acuity, and OCT-based hemorrhage resolution.
Key Findings:
The procedure was completed without conversion to manual surgery, instrument malfunction, visualization loss, procedural interruption, or intraoperative complication.
Mean network latency was 77.9 milliseconds; mean robotic-system latency was 100.8 milliseconds.
No serious adverse events were documented during 3 months of follow-up.
SMH was nearly completely absorbed by postoperative day 30; no residual SMH or pigment epithelial detachment was evident on day 86.
At 3 months, best-corrected visual acuity remained 0.6 logMAR (20/80), unchanged from before surgery.
Interpretation:
The authors report successful completion of a remotely performed, robot-assisted subretinal rt-PA injection over approximately 4,000 km in this case, with no serious adverse events during follow-up.
Limitations:
This was a single-case report, so the findings do not establish safety or effectiveness across patients or settings.
Conclusion:
The case demonstrates the reported feasibility of ultra-long-distance teleoperated robotic subretinal injection for SMH.
by Andi Xu, Bo Yang, Bingqian Liu, Lin Lu, Zhangkai Lian, Wenben Chen, Rihui Song, Wang Guo, Subinuer Alimu, Zhenzhen Liu, Dong Liu, Yanlin Li, Wei Xiao, Mohammad Ali Nasseri, Kai Huang, Haotian Lin
Aqueous humor sampling confirmed iris metastasis in a patient with refractory secondary glaucoma and lung adenocarcinoma, avoiding iris tissue sampling.
