Robot-assisted corneal transplants: a world first

Since the first corneal transplants (penetrating keratoplasties) were performed in the early 20th century, significant progress has been made in tissue selection, such as deep anterior lamellar and endothelial keratoplasties, as well as in corneal cutting, which is sometimes assisted by a femtosecond laser. In contrast, techniques for suturing the graft to the recipient have evolved little, even though they determine immediate postoperative safety, the risk of rejection, and the final visual outcome. Recently, the Symani surgical system (MMI, Pisa, Italy), a robot dedicated to microsurgery, was developed and certified for performing nerve and vascular anastomoses. To our knowledge, this is the first report of using a microsurgery robot in ophthalmology to perform penetrating keratoplasties as part of the GRACE (Graft Robot-Assisted Corneal Enhancement) pilot study. Results from the first patients demonstrate the feasibility and safety of robot-assisted corneal transplantation and confirm the anatomical and visual recovery achieved by this new procedure. In the future, our study's final results will clarify this innovative technology's modalities, risks, and potential benefits and subsequently define its role in tomorrow's ophthalmic surgery.