Intraocular Robotic Interventional and Surgical System for Automated Cataract Surgery

项目总结/摘要 本研究的长期目标是改善手术效果，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稳定眼球 结构、完整的透镜摘除和通过机器人精确定位眼内透镜植入物 操作和光学相干断层扫描（OCT）反馈将显着提高安全的关键 白内障手术的步骤通过可视化和工具控制方面的改进，我们认为 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 取消了白内障手术，以提高安全性，降低与白内障手术和后续手术相关的费用。 我们的主要目标是开发必要的技术，以实现术前稳定和成像， 眼结构、完整的透镜摘除和眼内透镜植入物的精确定位。 我们的团队开发了眼内机器人介入和手术系统（IRISS）， 在离体猪眼上进行自动化白内障手术[1-7]， R21赠款（NIH/R21 EY 024065）。通过经瞳孔OCT引导的自动化，IRISS实现了 在半自动白内障摘除术中取得了显著的成功。 有三个独立的具体目标。一是控制手术环境，改善眼内环境， 成像质量，集成对接装置将约束眼球运动并限制眼球的运动。 通过眼内压控制来控制眼内组织，同时允许用于眼内操作的工具进入。 其次，通过眼内OCT成像探头实现透镜的完全摘除;精确反馈 由IRISS安装和驱动的工具的控制;以及虹膜、角膜和角膜的实时可视化。 整个透镜（包括后囊和赤道）。第三，术中感知和控制的能力 眼内透镜六自由度定位和定向将通过新定制工具来实现 由经瞳孔和眼内OCT反馈引导。值得注意的是，虽然最终目标是 将所有三个目标集成到一个自动化系统中，它们的开发仍然是独立的， 一个项目的成功或失败并不影响另一个项目的结果。 拟议的贡献是重要的，因为它提供了消除几个常见的并发症， 白内障手术包括后囊破裂、继发性白内障和屈光不正。拟议 这项研究是创新的，因为它开发了（1）一种压力调节对接装置， 眼内组织，同时允许进入眼内工具并提高术前成像的质量， (2)通过眼内OCT探头和实时图像引导机器人观察透镜赤道 用于完全透镜提取和胶囊清洁的仪器控制，以及（3）对 眼内透镜植入和眼内透镜的定位。

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.