Intraocular Robotic Interventional and Surgical System for Automated Cataract Surgery

项目摘要/摘要 本研究的长期目标是改善手术结果，降低手术风险。 白内障手术的并发症。我们的中心假设是术中眼球稳定 通过机器人对人工晶状体植入物的结构、完整晶状体取出和精确定位 操作和光学相干断层扫描(OCT)反馈将显著提高关键 白内障手术中的手术步骤。通过可视化和工具控制方面的改进，我们推测 继发性白内障、后囊破裂、屈光不正和其他手术并发症的风险可能是 取消，以提高安全性和减少与白内障手术和后续程序相关的成本。 我们的主要目标是开发必要的技术来实现围手术期的稳定和成像 眼部结构、完整的晶状体摘除和人工晶状体植入物的准确定位。 我们团队开发了眼内机器人介入和手术系统(IRIS)，以执行半 通过内部资助和最近的一项研究相结合，对体外猪眼进行自动化白内障手术[1-7] R21赠款(NIH/R21EY024065)。通过经瞳孔OCT引导的自动化，IRIS已经实现了 在半自动白内障摘除术方面取得了显著的成功。 有三个独立的具体目标。第一，控制手术环境，改善眼内环境 成像质量，集成的对接设备将限制眼球运动和限制运动 通过眼内压控制眼内组织，同时允许使用工具进行眼内操作。 其次，眼内OCT成像探头将实现完整的晶状体提取；精确的反馈 对由虹膜安装和驱动的工具的控制；以及虹膜、角膜和 整个晶状体(包括后囊和赤道)。第三，术中感知和控制的能力 人工晶状体的六自由度位置和方向将通过一个新的定制工具实现 在经瞳孔和眼内OCT反馈的指导下。值得注意的是，虽然最终目标是 将所有这三个目标集成到一个自动化系统中，它们的开发保持独立和 一件事的成功或失败不会影响另一件事的结果。 提议的贡献意义重大，因为它消除了以下几个常见的复杂情况 白内障手术包括后囊破裂、继发性白内障和屈光不正。建议数 研究是创新的，因为它开发了(1)稳定的压力调节对接设备 眼内组织，同时允许使用眼内工具并提高术中成像质量， (2)通过眼内OCT探头和实时图像引导机器人对晶状体赤道进行可视化 用于完成晶状体取出和晶状体囊清洗的仪器控制，以及(3)机器人控制 人工晶状体植入及人工晶状体定位。

PROJECT SUMMARY/ABSTRACT The long-term goals of the present study are to improve surgical outcomes and reduce the risk of surgical complications of cataract surgery. It is our central hypothesis that intraoperative stabilization of the ocular structures, complete lens extraction, and accurate positioning of the intraocular lens implant through robotic manipulations and optical coherence tomography (OCT) feedback will significantly improve the safety of critical surgical steps in cataract surgery. Through improvements in visualization and tool control, we theorize that the risk of secondary cataracts, posterior capsule rupture, ametropia, and other surgical complications can be eliminated to improve safety and abate the costs associated with cataract surgery and follow-up procedures. Our main objective is to develop the technology necessary to realize per-operative stabilization and imaging of ocular structures, complete lens extraction, and accurate positioning of the intraocular lens implant. Our group has developed the Intraocular Robotic Intervention and Surgical System (IRISS) to perform semi- automated cataract surgery on ex-vivo pig eyes [1–7] through a combination of internal funding and a recent R21 grant (NIH/R21EY024065). Through transpupillary OCT-guided automation, the IRISS has achieved notable success in semi-automated cataract extraction. There are three independent specific aims. First, to control the surgical environment and improve intraocular imaging quality, an integrated docking apparatus will constrain the eyeball motion and limit the motion of intraocular tissues through intraocular pressure control while allowing tool access for intraocular manipulations. Second, complete lens extraction will be enabled by an intraocular OCT imaging probe; precise feedback control of the tool mounted and driven by the IRISS; and the real-time visualization of the iris, cornea, and entire lens (including its posterior capsule and equator). Third, the ability to intraoperatively sense and control the intraocular lens six degrees-of-freedom position and orientation will be realized through a new custom tool guided by the transpupillary and intraocular OCT feedback. It is important to note that while the ultimate goal is the integration of all three aims into an automated system, their development remains independent and success or failure in one does not affect the outcome of another. The proposed contribution is significant because it offers to eliminate several common complications of cataract surgery including posterior capsule rupture, secondary cataracts, and ametropia. The proposed research is innovative because of its development of (1) a pressure-regulated docking device that stabilizes intraocular tissue while allowing the access of intraocular tool and improved quality of per-operative imaging, (2) visualization of the lens equator through an intraocular OCT probe and real-time image guided robotic instrument control for complete lens extraction and capsule cleaning, and (3) robotic control over the intraocular lens implantation and positioning of the intraocular lens.