Remote Topography-Guided Transepithelial Photorefractive Combined Phototherapeutic Keratectomy Telesurgery
Published 2024 - 42nd Congress of the ESCRS
Reference: PO122 | Type: Case Report | DOI: 10.82333/k6t2-6b90
Authors: Francesco D'oria 1 , Pasquale Puzo* 1 , Camilla Di Pardo 1 , Alessandra Sborgia 1 , Giovanni Alessio 1
1Biomedicina Traslazionale e Neuroscienze,University of Bari,Bari,Italy
Purpose
To report the first remote topography-guided transepithelial photorefractive combined with phototherapeutic keratectomy (PRK-PTK) telesurgery in a case of epithelial basement membrane dystrophy (EBMD).
Setting
A.O.U Policlinico of Bari (Italy), section of Ophthalmology
Report of case
A 58-year-old Caucasian man presented to our Ophthalmology unit complaining of severe recurrent corneal erosions, more frequent in the right eye (RE). His visual acuity was 20/20 in both eyes (RE: +0.75 +0.75@170, LE -0.25 +3.00@180), and slit-lamp examination showed paracentral stromal opacities that spared the peripheral cornea and did not involve the limbus and were confirmed by AS-OCT. A transepithelial topography-guided combined PRK-PTK of the RE was performed on September 19, 2023, using the iRes®2 excimer laser platform (iVIS Technologies, Taranto, Italy). The iRes®2 laser has been designed to allow, in 5G connection, through the Remote Control Station, the execution of surgery with remote control, ensuring latency of less than 50 milliseconds. After customized surface ablation – by a ray-tracing process determined with the Corneal Interactive Programmed Topographic Ablation software (CIPTA, iVIS Technologies, Taranto, Italy)- performed with the surgeon (G.A.) sitting in his room and controlling the excimer laser in remote through the Remote Control Station and the patient in the operating room, PTK was performed using masking agents (1% hydroxy-methylcellulose) to smooth the ablated surface with the same remote modalities. Subsequently, 0.02% Mitomycin C was applied over the ablated surface for 20 seconds .The early post-operative follow-up was uneventful with a clear cornea and plano refraction.
Conclusion/Take home message
The automated management and remote control eliminate the need for high-specificity skills at the service delivery site, thus introducing the revolutionary opportunity to offer equal chances of success to every patient, wherever they live, regardless of race, age or sex, eliminating the root causes of health migration. Our surgery open the era of telesurgery in the corneal panorama