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Robot-assisted tremor control for performance enhancement of retinal microsurgeons
  1. Marina Roizenblatt1,2,3,
  2. Alex Treiger Grupenmacher2,
  3. Rubens Belfort Junior2,3,
  4. Mauricio Maia2,3,
  5. Peter L Gehlbach1
  1. 1 Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
  3. 3 Vision Institute, IPEPO, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
  1. Correspondence to Dr Marina Roizenblatt, Departamento de Oftalmologia – Secretaria Administrativa, Federal University of São Paulo, SP 04023-062, Brazil; maroizenb{at}


Pars plana vitrectomy is a challenging, minimally invasive microsurgical procedure due to its intrinsic manoeuvres and physiological limits that constrain human capability. An important human limitation is physiological hand tremor, which can significantly increase the risk of iatrogenic retinal damage resulting from unintentional manoeuvres that affect anatomical and functional surgical outcomes. The limitations imposed by normal physiological tremor are more evident and challenging during ‘micron-scale’ manoeuvres such as epiretinal membrane and internal limiting membrane peeling, and delicate procedures requiring coordinated bimanual surgery such as tractional retinal detachment repair. Therefore, over the previous three decades, attention has turned to robot-assisted surgical devices to overcome these challenges. Several systems have been developed to improve microsurgical accuracy by cancelling hand tremor and facilitating faster, safer and more effective microsurgeries. By markedly reducing tremor, microsurgical precision is improved to a level beyond present human capabilities. In conclusion, robotics offers potential advantages over free-hand microsurgery as it is currently performed during ophthalmic surgery and opens the door to a new class of revolutionary microsurgical modalities. The skills transfer that is beyond human capabilities to robotic technology is a logical next step in microsurgical evolution.

  • retina
  • vitreous
  • treatment surgery
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  • Contributors All the authors have contributed directly to the literature search process, critical revision of the manuscript and final approval of the version to be published.

  • Funding MR: Lemann Foundation, Instituto de Visão-IPEPO, São Paulo, Brazil. PLG: Research to Prevent Blindness, New York, New York, USA, and gifts from the J Willard and Alice S Marriott Foundation, the Gale Trust, Herb Ehlers, Bill Wilbur and Rajandre Shaw, Helen Nassif, Mary Ellen Keck, Don and Maggie Feiner, and Ronald Stiff. MM and RBJ: CNPq - National Council for Scientific and Technological Development, Brasilia, DF, Brazil.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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