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.

Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in patients over the age of 65 years in industrialized countries. Epidemiologic studies suggest that high dietary fat intake is a risk factor for the development and progression of both vascular and retinal disease. These, and other associations, suggest a hypothesis linking elevated cholesterol and AMD progression. It follows, therefore, that cholesterol-lowering medications, such as statins, may influence the onset and progression of AMD. However, the findings have been inconclusive as to whether statins play a role in AMD. Due to the significant public health implications of a potential inhibitory effect of statins on the onset and progression of AMD, it is important to continually evaluate emerging findings germane to this question.

Vitreoretinal surgery is one of the most technically challenging microsurgical procedures,¹ derived in part from inherent human physiologic limits including tremor, precision, visual resolution, ability to sense microforces on underlying tissue, and fatigue. The level of surgical difficulty is also associated with innate properties of the target retinal tissues, which are delicate, transparent, nonregenerative, and critical to visual function.^2-4

Background/aims: Fetal haemoglobin (HbF) has an oxyhaemoglobin dissociation curve that may affect systemic oxygenation and the development of retinopathy of prematurity (ROP). The study aim is to characterise the effects of HbF levels on systemic oxygenation and ROP development.Methods: Prospective study conducted from 1 September 2017 through 31 December 2018 at the Johns Hopkins NICU. Preterm infants with HbF measured at birth, 31, 34 and 37 weeks post-menstrual age (PMA), complete blood gas and SpO₂recorded up to 42 weeks PMA, and at least one ROP exam were included.Results: Sixty-four preterm infants were enrolled. Higher HbF was associated with significantly higher SpO₂, lower PCO₂, lower FiO₂from birth to 31 weeks PMA and 31 to 34 weeks PMA (r_s=0.51, r_s=−0.62 and r_s=−0.63; p<0.0001 and r_s=0.71, r_s=−0.58 and r_s=−0.79; p<0.0001, respectively). To maintain oxygen saturation goals set by the neonatal intensive care unit, higher median FiO₂was required for HbF in the lowest tercile from birth compared with HbF in the highest tercile to 31 weeks and 31 to 34 weeks PMA; FiO₂=35 (21–100) versus 21 (21–30) p<0.006 and FiO₂=30 (28–100) versus 21 (21–30) p<0.001, respectively. Preterm infants with ROP had poorer indices of systemic oxygenation, as measured by median levels of SpO2 and PCO₂, and lower levels of HbF (p<0.039 and p<0.0001, respectively) up to 34 weeks PMA.Conclusion: Low HbF levels correlated with poor oxygenation indices and increased risk for ROP. O₂saturation goals to prevent ROP may need to incorporate relative amount of HbF.