Abstract
Robot-assisted retinal cannulation is an eye surgical procedure which can dissolve the obstruction by using robot to inject anticoagulant into occluded vessel. The current research on the critical parameters of cannulation for human is scarce because of the immature technology. Considering the influence of microneedle, this work investigated the effects of drug concentration, injection velocity, injection position, and size of clot on cannulation by theoretical analysis and finite element analysis. For finite element analysis, the multiphysics continuum model was established to demonstrate species transport and reaction which simulates the entire lytic process of the occlusive clot, and four cell zones were established to describe the generation of plasmin (PLS) with the addition of tissue-type plasminogen activator (tPA) and fibrinolysis of clot by importing subroutines into each cell zone under the conditions of constant clot size and variable size, respectively. The results imply that the most efficient value of tPA concentration is 50 nM, injection velocity is 60 mm/s for clot length of 0.1 mm, and the best position to insert the cannula is 0.5 mm in front of the thrombus. For different clot lengths of 0.1 mm to 0.6 mm, the optimal range of tPA concentration and injection velocity is from 20 nM to 70 nM and from 40 mm/s to 60 mm/s, respectively, and explores the reasonable injection position of 0.3 mm to 0.5 mm in front of clot in a vein of 100 μm. This conclusion can be used to perform robot-assisted cannulation surgery to improve fibrinolytic efficiency.
Highlights
Retinal vein occlusion (RVO) is one of the most common retinal disease where thrombus inside retinal veins distort the delivery of oxygen, resulting in central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) [1,2,3,4,5]
Concentration in drug. e changing trend of nodes is narrow with a sharp peak that rapidly falls off and the profile becomes wider over type plasminogen activator (tPA) concentration
A1, a2, a3, and k1 and other values can be obtained from Table 2, TtPAis fibrinolytic time, ItPA is tPA concentration of injection, and its R-squared is 0.99784 which means fitting well. is curve is presented in Figure 5 showing a decrease in time for lysis when tPA concentration increased from 0 nM to 50 nM
Summary
Retinal vein occlusion (RVO) is one of the most common retinal disease where thrombus inside retinal veins distort the delivery of oxygen, resulting in central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) [1,2,3,4,5]. It impairs the vision of an estimated 16.4 million people in the world [1]. By injecting an anticoagulant directly into the occluded vessel, REVS is focused on thrombolysis to cure RVO completely [10]. Cannulation of the involved vessel and removal of the clot may provide a more permanent solution with a less demanding follow-up [11]
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