Optical Coherence Tomography Guided Robotic Needle Insertion for Deep Anterior Lamellar Keratoplasty
Optical Coherence Tomography Guided Robotic Needle Insertion for Deep Anterior Lamellar Keratoplasty
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DOI：
10.1109/tbme.2019.2954505
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发表时间：
2020-07-01
影响因子：
4.6
通讯作者：
Izatt, Joseph A.
中科院分区：
文献类型：
--
作者：
Draelos, Mark;Tang, Gao;Izatt, Joseph A.
目的：深前板层角膜移植术（DALK）显着降低适合部分厚度角膜移植的患者的移植后发病率。然而，流行的 DALK“大气泡”技术非常具有挑战性，对于没有丰富 DALK 特定经验的外科医生来说，即使有上一代横截面光学相干断层扫描 (OCT) 引导，很大一部分角膜气剥离尝试也会失败。我们寻求开发机器人体积 OCT 引导技术，能够促进或自动化 DALK 中困难的针插入步骤。方法：我们的系统提供实时体积角膜成像、分割和针插入跟踪，以便为外科医生显示反馈并生成供机器人执行的针插入计划。我们包括用于协作针控制以实现稳定和震颤衰减的非自动模式，以及基于 OCT 跟踪结果生成针插入计划并在机器人臂的外科医生保持运行控制下执行的自动模式。我们在离体人角膜模型中评估并比较了徒手、体积 OCT 引导、协作和自动进针方法的穿孔率和最终进针深度。结果：体积 OCT 可视化减少了角膜穿孔，并有益地将手动插入中的最终针深度增加了临床显着量。我们的自动机器人进针技术在进针位置和穿孔率方面均达到或超过了外科医生的表现。结论：虽然机器人技术可以可靠地复制其性能，但体积 OCT 是外科医生的关键推动因素。意义：机器人针控制和体积 OCT 有望改善 DALK 的治疗结果。
Objective: Deep anterior lamellar keratoplasty (DALK) significantly reduces the post-transplantation morbidity in patients eligible for partial-thickness cornea grafts. The popular "big bubble" technique for DALK is so challenging, however, that a significant fraction of corneal pneumodissection attempts fail for surgeons without extensive DALK-specific experience, even with previous-generation cross-sectional optical coherence tomography (OCT) guidance. We seek to develop robotic, volumetric OCT-guided technology capable of facilitating or automating the difficult needle insertion step in DALK. Methods: Our system provides for real-time volumetric corneal imaging, segmentation, and tracking of the needle insertion to display feedback for surgeons and to generate needle insertion plans for robotic execution. We include a non-automatic mode for cooperative needle control for stabilization and tremor attenuation, and an automatic mode in which needle insertion plans are generated based on OCT tracking results and executed under surgeon hold-to-run control by the robot arm. We evaluated and compared freehand, volumetric OCT-guided, cooperative, and automatic needle insertion approaches in terms of perforation rate and final needle depth in an ex vivo human cornea model. Results: Volumetric OCT visualization reduces cornea perforations and beneficially increases final needle depth in manual insertions by clinically significant amounts. Our automatic robotic needle insertion techniques meet or exceed surgeon performance in both needle placement and perforation rate. Conclusion: Volumetric OCT is a key enabler for surgeons, although robotic techniques can reliably replicate their performance. Significance: Robotic needle control and volumetric OCT promise to improve outcomes in DALK.