World's First Remote Robotic Subretinal Injection Surgery Successfully Implemented

Background

China has one of the highest numbers of patients with vision impairment and blindness worldwide. However, quality ophthalmic medical resources remain relatively insufficient and unevenly distributed across the country. Submacular hemorrhage (SMH) is a condition in which blood collects beneath the retina's central macula, threatening central vision. To address challenges in delivering specialized care to remote areas, Professor Lin Haotian's team at Zhongshan Ophthalmic Center collaborated with Professor Huang Kai's team from Sun Yat-sen University's School of Computer Science and Engineering, along with Guangzhou Oculotronics Medical Instrument Co Ltd and partners including China Telecom and Jiaxing Zhitong Technology, to develop a domestically produced 5G ophthalmic surgical robot platform.

In June 2023, the team completed the first domestic remote micron-level intraocular operation in animal experiments spanning the Qiongzhou Strait. The results were accepted for publication in the journal Advanced Science. This work aimed to transition remote high-precision ophthalmic surgery from feasibility to clinical practicality.

What was achieved

On November 2, 2025, at 8 a.m., the world's first remote robotic subretinal injection surgery was successfully implemented, spanning 4,200 kilometers between Guangzhou and Urumqi. Led by Professor Lin Haotian of Zhongshan Ophthalmic Center at Sun Yat-sen University, the procedure was performed in collaboration with Professor Yang Bo of Xinjiang Production and Construction Corps Hospital. Other ZOC team members included Professor Lu Lin and Chief Physician Liu Bingqian.

This single-case report, published in JAMA Ophthalmology, involved one patient with SMH. Following manual pars plana vitrectomy performed under general anesthesia at the patient site, a retinal surgeon in Guangzhou remotely teleoperated the ophthalmic robotic system. A total of 0.056 mL of recombinant tissue plasminogen activator (rt-PA at 0.5 mg/mL) was delivered. Robotic teleoperation lasted 7 minutes within a total surgical time of 46 minutes. Mean network latency was 77.9 milliseconds (range 71-90 ms). There were no intraoperative complications. No serious adverse events occurred during 3 months of follow-up. Optical coherence tomography showed progressive hemorrhage reduction with complete absorption by postoperative day 26. Best-corrected visual acuity remained stable at 0.6 logMAR (Snellen equivalent 20/80) preoperatively and at 3 months postoperatively. The case marks the first transition of remote high-precision ophthalmic surgery to practical clinical application.

How it works

Subretinal injection is a microsurgical technique used to treat conditions such as submacular hemorrhage. Blood accumulating under the macula, the central retina area responsible for detailed vision, can cause severe vision loss. Recombinant tissue plasminogen activator (rt-PA) is injected beneath the retina to dissolve the blood clot, allowing it to be absorbed and potentially limiting damage. The procedure requires extreme precision at the micron level because the retina is only about 0.25 mm thick and any unintended movement can cause further injury.

In this remote approach, the local team in Urumqi first performed pars plana vitrectomy to remove the vitreous gel from the eye. A robotic manipulator then inserted a microneedle into the eye. Using a master console in Guangzhou connected in real time via a 5G network with stable 3D high-definition imaging, the surgeon controlled the robotic arm. The system enabled tremor-free, micron-level movements to guide the needle tip to the targeted retinal surface, advance it to the pre-planned depth, and deliver the precise drug volume. The remote injection phase was completed in under 7 minutes with the needle tip remaining steady despite the distance.

What it means for international patients

This demonstration of ultra-long-distance robotic-assisted intraocular microsurgery indicates that high-precision subretinal injection can be performed safely and feasibly across thousands of kilometers with low latency and high stability. It highlights potential applications for delivering specialized retinal care to geographically underserved regions.

Zhongshan Ophthalmic Center operates a dedicated International Eye Care service launched to serve overseas patients, expatriates, residents from Hong Kong, Macao and Taiwan, and commercially insured individuals. The service includes one-stop diagnostics, private inpatient suites, acceptance of major international credit cards such as Visa, and direct billing with multiple insurers. Patients considering care for complex retinal conditions or interested in advanced technologies should confirm current availability, eligibility and any specific procedural offerings directly with the hospital's International Eye Care department via premiercare@gzzoc.com or hotlines +86 189 2210 6862 / +86 189 2210 2338.

About the hospital

Zhongshan Ophthalmic Center (ZOC) of Sun Yat-sen University is located in Guangzhou, China. It is the largest public ophthalmic hospital in the country and the only ophthalmic specialty hospital directly administered by the National Health Commission. It is China's sole World Health Organization Collaborating Center for Eye Care and Vision and the headquarters location in China for the Asia-Pacific Academy of Ophthalmology (APAO) and Afro-Asian Council of Ophthalmology (AACO) Asia Office.

The center maintains 14 clinical ophthalmology subspecialties and eight specialized diagnostic and treatment centers. It leads in areas including cataract, glaucoma, corneal and ocular surface diseases, fundus diseases, myopia, uveitis, pediatric ophthalmology and genetic eye disorders. It houses the only State Key Laboratory of Ophthalmology in China and has trained more than 6,000 visiting physicians, accounting for approximately one-fifth of China's ophthalmologists. ZOC has been ranked first in China for ophthalmology specialty reputation in consecutive Fudan University hospital rankings and achieved first place globally among ophthalmology institutions in the Nature Index for both Health Sciences and Biological Sciences. It launched dedicated international patient services at its Zhujiang New Town Campus (No. 7 Jinsui Road, Tianhe District) in 2026.