Robotic surgery in ophthalmology: revolutionary diagnostic and therapeutic techniques of the main ocular pathologies available at the Center of Excellence in Eye Research of Chieti-Pescara. The clinical facility has been recognized as a National High-Technology Center (NHTC) and is directed by Prof. Leonardo Mastropasqua.
A centre that pioneered the use of technology for diagnostic, therapeutic and surgical purposes. The Ophthalmology Clinic of the “G. d’Annunzio” University of Chieti-Pescara has been recognized as the National High- Technology Center (NHTC) and as a Center of Excellence in Ophthalmology, playing an important role in the national and international healthcare system. Directed by Prof. Leonardo Mastropasqua, the NHTC was acknowledged in 2013 by the Italian Society of Ophthalmology as the only Italian School of Robotic Surgery in Ophthalmology. The International Agency for the Prevention of Blindness awarded the high level of professionalism and quality care by identifying the Clinic as a reference for prevention of blindness, low vision and visual rehabilitation in the region of Abruzzo. Therefore the regional governance has promoted the local Excellence in Ophthalmological Healthcare within the country, by creating a project called “Abruzzo The Region of Vision.” NHTC will act as the Coordinating Structure of the entire region in order to guarantee a high national standard of the scientific work and of the prevention and treatment of ocular diseases.
Therefore, a cutting edge Clinic, backed by its achievements, turns an eye to the international scene, thanks also to the foresight and the preparation of its founder and to his team of specialists in every field of ophthalmology, assisted by a highly qualified healthcare and administrative staff.
For quite some time NHTC places technological innovation in ophthalmic surgery at the centre of its activities. In 2006 NHTC pioneered the use of robotic surgery in transplantation, performing the first corneal transplant in Italy with a femtosecond laser robotic system. Today, it is the only public health centre offering the possibility of undergoing surgery of the lens (cataract), correction of myopia and astigmatism, laser navigated treatment of diabetic and macular retinopathy and of corneal diseases with the most advanced robotic systems.
Myopia and astigmatism have always been two of the most widespread ocular problems, which in NHTC are definitively treated using an innovative surgical technique called SMILE, which represents the latest technological development in the field of refractive surgery.
Today, patients have become more demanding in terms of quality and quantity of visual outcome and when possible patients demand spectacle independence while reducing to a minimum the risk of post-operative complications. The SMILE technique uses a robotic system with a femtosecond laser (an ultra fast pulse laser with microscopic precision). Thus this new technique represents a significant advance over previous techniques (LASIK and PRK) that use an excimer laser. The advantage for the patient is that this is an even less invasive procedure, in that it does not damage the epithelium nor the innervation of the cornea. The cuts do not weaken the cornea because of both the precision of the robotic laser system that produces a thin lenticule of tissue the shape of which is designed to correct the myopic (up to -10 diopters) and astigmatic (up to -5 diopters) visual defect, and the very small corneal incision (about 3 mm) required for the removal of the lenticule. Therefore, this is a technique performed deep in the corneal tissue without using an excimer laser. It has been proven to be safe and painless but able to treat high myopia and astigmatism even in thin corneas, with a faster recovery time. Thus, patients can become spectacle independent with excellent night vision and can continue to practice contact sports. Robot systems also be used for other diseases, such as cataracts, with several advantages for the patient. Extreme precision and safety are just two of the characteristics that allow the use of the femtosecond laser for other eye pathologies. For example, in the surgical treatment of cataracts, a progressive opacification of the natural lens of the eye located behind the pupil. It may be the result of other conditions besides aging. The only therapy currently available is surgical. The latest evolution in surgical techniques is based on nano laser used in conjunction with robotic systems utilising femtosecond laser that, although similar to that utilised in corneal surgery, uses extremely short infrared light pulses that produce cuts on the order of a few microns (1/1000th of a millimetre). These cuts can be positioned at different depths within the intact eye (for example within the lens and its capsule coating). It is considered a robotic surgical technique because the laser is controlled by a computer that first creates a three-dimensional map of patient’s ocular structures and then suggests the positions of the various cut planes. The surgeon must then manually correct the positions on the system monitors and give the final approval to initiate the laser procedures. The cuts, the most delicate part of the procedure, are computer controlled, thus providing a degree of precision not possible with the human hand, not even by the most experienced surgeons. The result is perfect centering of the artificial lens, enhancing the quality of vision and permitting the use of most advanced artificial lenses, which allow the correction of astigmatism and presbyopia. Thus the objective is to allow the patient to see well over the greatest range of distances without glasses. This ensures a very good recovery not only in terms of quantity but also in quality of vision. The patients can resume their daily activities, including sports and work, after a very short time.
Robotic surgical techniques have also brought about excellent results in the treatment of retinal and macular pathologies.
The retina is the membrane of nerve cells located in the eye that is directly connected to the visual structures of the brain. Basically, it has the function of a roll of film or light sensor of a camera. The macula is the structure with the highest density of nerve cells and is responsible for central vision. Age and diabetes are conditions that most frequently affect the macula, causing age-related and diabetic macular degeneration. Today, a new generation of laser systems and anti-VEGF drugs that are administered by intra-ocular injection are the main innovative therapies for these pathologies. The newest generation of computer-guided target-tracking robotic laser systems, “the NAVILAS system”, yield highly precise results, in terms of spot placement on damaged tissue while sparing healthy retina, that have not been possible with manual treatment. Thus, the outcome in terms of quality of vision has improved, while the pain associated with traditional treatment has been reduced, and the risk of errors has been eliminated.
Robotic surgery has therefore brought about a new era in ophthalmology. Today, high technology is indispensable for the diagnosis and for the treatment of ocular diseases. The planning and execution in robotic surgery helps the surgeon. Replacing the classical scalpels with computer-guided laser systems (light scalpel) yields a degree of precision that is impossible even for the most experienced surgeon. The advantages for the patients derive from the reduction in the invasiveness and increase in the repeatability of the surgical procedures, reducing the variability due to the surgeon and patient. The future course has already been set, with high technology gaining ground as a fundamental pillar in routine ophthalmological procedures. But a high level of experience of the physician and surgeon will always be required for the correct use of this technology.
A centre that pioneered the use of technology for diagnostic, therapeutic and surgical purposes. The Ophthalmology Clinic of the “G. d’Annunzio” University of Chieti-Pescara has been recognized as the National High- Technology Center (NHTC) and as a Center of Excellence in Ophthalmology, playing an important role in the national and international healthcare system. Directed by Prof. Leonardo Mastropasqua, the NHTC was acknowledged in 2013 by the Italian Society of Ophthalmology as the only Italian School of Robotic Surgery in Ophthalmology. The International Agency for the Prevention of Blindness awarded the high level of professionalism and quality care by identifying the Clinic as a reference for prevention of blindness, low vision and visual rehabilitation in the region of Abruzzo. Therefore the regional governance has promoted the local Excellence in Ophthalmological Healthcare within the country, by creating a project called “Abruzzo The Region of Vision.” NHTC will act as the Coordinating Structure of the entire region in order to guarantee a high national standard of the scientific work and of the prevention and treatment of ocular diseases.
Therefore, a cutting edge Clinic, backed by its achievements, turns an eye to the international scene, thanks also to the foresight and the preparation of its founder and to his team of specialists in every field of ophthalmology, assisted by a highly qualified healthcare and administrative staff.
For quite some time NHTC places technological innovation in ophthalmic surgery at the centre of its activities. In 2006 NHTC pioneered the use of robotic surgery in transplantation, performing the first corneal transplant in Italy with a femtosecond laser robotic system. Today, it is the only public health centre offering the possibility of undergoing surgery of the lens (cataract), correction of myopia and astigmatism, laser navigated treatment of diabetic and macular retinopathy and of corneal diseases with the most advanced robotic systems.
Myopia and astigmatism have always been two of the most widespread ocular problems, which in NHTC are definitively treated using an innovative surgical technique called SMILE, which represents the latest technological development in the field of refractive surgery.
Today, patients have become more demanding in terms of quality and quantity of visual outcome and when possible patients demand spectacle independence while reducing to a minimum the risk of post-operative complications. The SMILE technique uses a robotic system with a femtosecond laser (an ultra fast pulse laser with microscopic precision). Thus this new technique represents a significant advance over previous techniques (LASIK and PRK) that use an excimer laser. The advantage for the patient is that this is an even less invasive procedure, in that it does not damage the epithelium nor the innervation of the cornea. The cuts do not weaken the cornea because of both the precision of the robotic laser system that produces a thin lenticule of tissue the shape of which is designed to correct the myopic (up to -10 diopters) and astigmatic (up to -5 diopters) visual defect, and the very small corneal incision (about 3 mm) required for the removal of the lenticule. Therefore, this is a technique performed deep in the corneal tissue without using an excimer laser. It has been proven to be safe and painless but able to treat high myopia and astigmatism even in thin corneas, with a faster recovery time. Thus, patients can become spectacle independent with excellent night vision and can continue to practice contact sports. Robot systems also be used for other diseases, such as cataracts, with several advantages for the patient. Extreme precision and safety are just two of the characteristics that allow the use of the femtosecond laser for other eye pathologies. For example, in the surgical treatment of cataracts, a progressive opacification of the natural lens of the eye located behind the pupil. It may be the result of other conditions besides aging. The only therapy currently available is surgical. The latest evolution in surgical techniques is based on nano laser used in conjunction with robotic systems utilising femtosecond laser that, although similar to that utilised in corneal surgery, uses extremely short infrared light pulses that produce cuts on the order of a few microns (1/1000th of a millimetre). These cuts can be positioned at different depths within the intact eye (for example within the lens and its capsule coating). It is considered a robotic surgical technique because the laser is controlled by a computer that first creates a three-dimensional map of patient’s ocular structures and then suggests the positions of the various cut planes. The surgeon must then manually correct the positions on the system monitors and give the final approval to initiate the laser procedures. The cuts, the most delicate part of the procedure, are computer controlled, thus providing a degree of precision not possible with the human hand, not even by the most experienced surgeons. The result is perfect centering of the artificial lens, enhancing the quality of vision and permitting the use of most advanced artificial lenses, which allow the correction of astigmatism and presbyopia. Thus the objective is to allow the patient to see well over the greatest range of distances without glasses. This ensures a very good recovery not only in terms of quantity but also in quality of vision. The patients can resume their daily activities, including sports and work, after a very short time.
Robotic surgical techniques have also brought about excellent results in the treatment of retinal and macular pathologies.
The retina is the membrane of nerve cells located in the eye that is directly connected to the visual structures of the brain. Basically, it has the function of a roll of film or light sensor of a camera. The macula is the structure with the highest density of nerve cells and is responsible for central vision. Age and diabetes are conditions that most frequently affect the macula, causing age-related and diabetic macular degeneration. Today, a new generation of laser systems and anti-VEGF drugs that are administered by intra-ocular injection are the main innovative therapies for these pathologies. The newest generation of computer-guided target-tracking robotic laser systems, “the NAVILAS system”, yield highly precise results, in terms of spot placement on damaged tissue while sparing healthy retina, that have not been possible with manual treatment. Thus, the outcome in terms of quality of vision has improved, while the pain associated with traditional treatment has been reduced, and the risk of errors has been eliminated.
Robotic surgery has therefore brought about a new era in ophthalmology. Today, high technology is indispensable for the diagnosis and for the treatment of ocular diseases. The planning and execution in robotic surgery helps the surgeon. Replacing the classical scalpels with computer-guided laser systems (light scalpel) yields a degree of precision that is impossible even for the most experienced surgeon. The advantages for the patients derive from the reduction in the invasiveness and increase in the repeatability of the surgical procedures, reducing the variability due to the surgeon and patient. The future course has already been set, with high technology gaining ground as a fundamental pillar in routine ophthalmological procedures. But a high level of experience of the physician and surgeon will always be required for the correct use of this technology.