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M. Ali Nasseri, Abouzar Eslami, Daniel M Zapp, Sabrina Bohnacker, Mingchuan Zhou, Chris Lohmann, Mathias M Maier; Intraoperative OCT Guided Robotic Sub-retinal Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5003.
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In this study we integrated an intra-operative Optical Coherence Tomography (OCT) feedback into our robotic platform to improve the subretinal localization of the surgical tooltip. The goal is to precisely access the desired targets for administration of substances including pharmaceuticals, genetic cargo and stemcells to treat retinal pathologies such as Submacular hemorrhage and Aged-related Macular Degeneration (AMD).
Our previously presented robotic platform consists of a micromanipulator; a head fixation system; an eye fixation ring and a dual surgeon control panel. With this setup surgeons are able to intuitively localize the surgical tool with the precision of 5 micron. Conventionally, the surgeon is using stereopsis through an operating microscope and the shadow of the tool to detect and guide the tool. In this study, instead, we use real-time 3D OCT (4D OCT) with heads up display to robotically localize the tool inside the eye. This method has two major benefits: a) OCT visualizes micro-structural anatomy that is vital for sub-retinal interventions; b) 4D-OCT is providing significantly higher precision specifically intra-ocular depth perception for tool localization.
We combined with our robotic platform an iOCT integrated ophthalmic microscope from Carl Zeiss Meditec AG (OPMI LUMERA 700 and RESCAN 700) with heads up display. In mock surgery trials on pig eyes in wet lab environment we show that iOCT guidance, even without en face images, improves the intuitiveness and accuracy of robot assisted sub-retinal interventions. Mean 3D accuracy of 10 micron was observed.
In an on going study we bring together high-resolution real-time visualization of microstructures (4D OCT) with micron-scale high precision micromanipulation techniques (Robotic micro-surgery) to improve the current procedures and to introduce new classes of ophthalmic interventions. Our first clinical indication is Subretinal tPA Injection for Submacular Hemorrhage which will be followed by sub-retinal drug and stem-cell injection for AMD patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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