Surgical outcomes have been dramatically improved in the last 2 decades through the integration of new technologies including among other innovative visualization systems and robotic assistance. We think that cataract surgery can also benefit from these advancements and we envision that cataract surgery will possibly be entirely performed in fifteen years from now by an automated robotic surgical platform. The goal of the present proposal is to develop automated capabilities of the Intraocular Robotic Interventional Surgical System (IRISS) based on its new abilities to reconstruct in real time the anatomical structures of the anterior segment of the eye. This 3D real time reconstruction of the anterior segment of the eye is made possible by the joint use of Computer Vision techniques and Optical Coherence Tomography (OCT) acquisition and analysis. Cataracts are the number one cause of blindness in the world and cataract surgery is the most frequently performed operation totaling 3 million operations every year in the United States. The procedure accounts for the single largest expenditure for any Part B procedure in the Medicare Program. The modern cataract surgical procedure involves several steps each with significant potential for complicated inadvertent tissue manipulation possibly resulting in intraocular trauma. Previous studies have shown that undesired tissue manipulation can be significantly decreased using robotic systems that attenuate undesirable movement, and possibly collision, of surgical tools both intraocularly and at the site of incision. Thus, we have developed IRISS, the first dual arm, intraocular robotic surgical system designed for performing intraocular surgeries with a primary focus on cataract surgery. Preliminary results have shown an optimization of vibration reduction, a controlled remote center of motion (RCM) for both robotic arms and the ability to mount multiple surgical instruments to either arm with automated surgical instrument replacement. The system has been used to perform successfully Ex Vivo cataract surgeries on pig eyes by teleoperation, completing capsulorhexis, lens aspiration, as well as maneuvers even more technically challenging than cataract removal such as vitrectomy and retinal vein cannulation To achieve automated cataract surgery, the present study will develop new vision- based object tracking system utilizing real time local gradient orientation analysis algorithms and develop an OCT guided 3D real-time reconstruction of the anterior segment of the eye to offer feedback to the robotic system. We hypothesize that an improved anatomical detection system will decrease the incidence of undesirable trauma to ocular tissues by creating restrictions on the proximity of surgical tools to ocular structures. By performing Ex Vivo testing of cataract extraction surgeries on harvested pig eyes, the efficacy and accuracy of the system will be assessed by the evaluation of the corneal endothelial cell, the iris and the capsular bag integrity and of the complete removal of the lens material.
This project will develop new capabilities of the robotic manipulated platform to perform an automated cataract extraction surgical procedure. Automated lens extraction will be achieved using real-time tracking and 3D reconstruction of the ocular structures. In automating the surgical procedure we believe that the incidence of inadvertent tissue manipulation, and the associated intraocular tissue trauma, will decline.