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Published on: October 16, 2017
A Robotic Tele-Laser System for Remote Visualization and Nd:YAG Laser Triggering: A Preclinical Feasibility Study
Andi Xu1, Yining Huang1, Zhangkai Lian1
1Zhongshan Ophthalmic Center, Sun Yat-sen University, WHO Collaborating Centre for Eye Care and Vision, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
Purpose:
To evaluate the technical feasibility and short-term procedural safety of a remotely operated robotic tele-laser platform for anterior-segment neodymium-doped yttrium aluminum garnet (Nd:YAG) laser delivery in rabbit models.
Methods:
A remotely operated, robotic tele-laser platform integrating a customizable finger robot, stereoscopic visualization, and a Nd:YAG laser device was developed to enable ophthalmologists to remotely perform laser treatments. Twenty-four rabbits were allocated into two predefined experimental cohorts: a posterior capsular opacification (PCO) cohort (n = 12) and a laser peripheral iridotomy (LPI) cohort (n = 12). Within each cohort, animals were assigned into remotely operated and on-site subgroups. Outcome measures included technical completion, laser-delivery duration, laser parameters, engineering performance, and postoperative findings.
Results:
All 24 procedures were technically completed. For capsulotomy, median laser-delivery duration was 285.0 seconds (interquartile range [IQR], 161.5-793.5) in the remotely operated group and 214.0 seconds (IQR, 173.25-441.0) in the on-site group (P = 0.589). Intraocular lens (IOL) pitting within the central 3-mm optical zone occurred in four of six eyes and in three of six eyes, respectively. For LPI, no statistically significant between-group differences were detected in laser-delivery duration, laser parameters, or change from baseline at postoperative day 1 in intraocular pressure (IOP). Mean targeting errors were 0.0380 ± 0.0174 mm in the remotely operated procedure and 0.0341 ± 0.0230 mm on site (P = 0.053). Mean glass-to-glass video latency and button-to-laser activation latency were 258.6 ± 10.2 ms and 522.7 ± 29.3 ms, respectively.
Conclusions:
This controlled preclinical study demonstrates the feasibility of a remotely operated robotic tele-laser platform for anterior-segment laser delivery. The platform enabled remote completion of capsulotomy and LPI workflows under controlled experimental conditions and provides a foundation for further engineering and translational validation.
Translational Relevance:
This study demonstrates the preliminary feasibility of a remotely operated robotic tele-laser platform in a preclinical animal model. This platform enables remote expert participation in laser treatment workflows and provides a foundation for future tele-laser applications. Further engineering optimization, safety validation, and clinical studies are required before translation into human ophthalmic practice.
