Preclinical assessment of Preserflo MicroShunt implantation using an intraocular endoscope-holding robot

Robotic assistance may overcome the limitations of intraocular visualization during glaucoma surgery, particularly in eyes with corneal opacity. This preclinical study investigated the feasibility and surgical utility of a robotic-assisted intraocular endoscope-holding system for real-time visualization during Preserflo MicroShunt implantation. An endoscope-holding robot (OQrimo) enabled stable, hands-free intraocular imaging throughout the procedure. Porcine eyes were used, and corneal opacity was simulated with a black-painted contact lens. Surgical feasibility, tube-endothelium (TE) distance, and intraoperative complications were evaluated. Continuous endoscopic visualization using the robotic system enabled successful MicroShunt implantation in all eyes without complications, including intraoperative mechanical trauma to the cornea, iris, or lens. The TE distance was significantly greater in the robotic group than in the conventional group under both normal visualization conditions (1.96 ± 0.27 mm vs. 1.13 ± 0.40 mm, p = 0.009) and simulated corneal opacity (1.85 ± 0.32 mm vs. 1.12 ± 0.28 mm, p = 0.015), indicating more favorable tube positioning. These results demonstrate that robotic-assisted intraocular endoscopic visualization provides stable and precise guidance for MicroShunt implantation independent of corneal clarity. This technology has the potential to enhance surgical accuracy and expand the feasibility of minimally invasive glaucoma surgery in eyes with compromised anterior segment visualization.