A Robotic Tele-Laser System for Remote Visualization and Nd:YAG Laser Triggering: A Preclinical Feasibility Study

Purpose: To evaluate the technical feasibility and short-term procedural safety of a remotely operated robotic tele-laser platform for anterior-segment neodymium-doped yttrium aluminum garnet (Nd:YAG) laser delivery in rabbit models. Methods: A remotely operated, robotic tele-laser platform integrating a customizable finger robot, stereoscopic visualization, and a Nd:YAG laser device was developed to enable ophthalmologists to remotely perform laser treatments. Twenty-four rabbits were allocated into two predefined experimental cohorts: a posterior capsular opacification (PCO) cohort (n = 12) and a laser peripheral iridotomy (LPI) cohort (n = 12). Within each cohort, animals were assigned into remotely operated and on-site subgroups. Outcome measures included technical completion, laser-delivery duration, laser parameters, engineering performance, and postoperative findings. Results: All 24 procedures were technically completed. For capsulotomy, median laser-delivery duration was 285.0 seconds (interquartile range [IQR], 161.5-793.5) in the remotely operated group and 214.0 seconds (IQR, 173.25-441.0) in the on-site group (P = 0.589). Intraocular lens (IOL) pitting within the central 3-mm optical zone occurred in four of six eyes and in three of six eyes, respectively. For LPI, no statistically significant between-group differences were detected in laser-delivery duration, laser parameters, or change from baseline at postoperative day 1 in intraocular pressure (IOP). Mean targeting errors were 0.0380 ± 0.0174 mm in the remotely operated procedure and 0.0341 ± 0.0230 mm on site (P = 0.053). Mean glass-to-glass video latency and button-to-laser activation latency were 258.6 ± 10.2 ms and 522.7 ± 29.3 ms, respectively. Conclusions: This controlled preclinical study demonstrates the feasibility of a remotely operated robotic tele-laser platform for anterior-segment laser delivery. The platform enabled remote completion of capsulotomy and LPI workflows under controlled experimental conditions and provides a foundation for further engineering and translational validation. Translational Relevance: This study demonstrates the preliminary feasibility of a remotely operated robotic tele-laser platform in a preclinical animal model. This platform enables remote expert participation in laser treatment workflows and provides a foundation for future tele-laser applications. Further engineering optimization, safety validation, and clinical studies are required before translation into human ophthalmic practice.