Abstract
Real-time intraocular optical coherence tomography (OCT) visualization of tissues with surgical feedback can enhance retinal surgery. An intraocular 23-gauge B-mode forward-imaging co-planar OCT-forceps, coupling connectors and algorithms were developed to form a unique ophthalmic surgical robotic system. Approach to the surface of a phantom or goat retina by a manual or robotic-controlled forceps, with and without real-time OCT guidance, was performed. Efficiency of lifting phantom membranes was examined. Placing the co-planar OCT imaging probe internal to the surgical tool reduced instrument shadowing and permitted constant tracking. Robotic assistance together with real-time OCT feedback improved depth perception accuracy. The first-generation integrated OCT-forceps was capable of peeling membrane phantoms despite smooth tips.
Highlights
Optical coherence tomography (OCT) has become widely used as an important diagnostic and surgical pre-planning tool in ophthalmology
The gripper tip was slightly embedded into the gelatin, but the plane of the gelatin could not be determined
The distance was converted to microns by using the actual gripper length of 812 μm and its pixel length in each image to calculate the image scaling factor (γ(microns/pixel)) for each trial
Summary
Optical coherence tomography (OCT) has become widely used as an important diagnostic and surgical pre-planning tool in ophthalmology. This system was mathematically modeled for four modes including: movement of the eye using external robotic tools; movement of intraocular robotic instruments within a stabilized eye; maintenance of intraocular instrument positions relative to the retina during controlled eye movements; and simultaneous movements of the eye and intraocular instruments This group demonstrated the feasibility of micro-stent deployment in a chick chorioallantoic membrane vascular model [33], and subsequently demonstrated an algorithm for force sensing and telemanipulation assistance for microvascular stent deployment [34]. The initial design of a forceps integrated into the intraocular forward-imaging B-scan OCT probe is described in this paper with evaluation of manual and robotic-assisted tasks upon a gelatin phantom and ex vivo retinal tissue. Performances of it and a standard retinal forceps without OCT guidance are compared. The evaluation of robot assistance combined with or without B-scan OCT feedback for retinal microsurgery has not been previously published
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