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Glover K, Mishra D, Gade S, Vora LK, Wu Y, Paredes AJ, Donnelly RF, Singh TRR. Microneedles for advanced ocular drug delivery. Adv Drug Deliv Rev 2023; 201:115082. [PMID: 37678648 DOI: 10.1016/j.addr.2023.115082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
In the field of ocular drug delivery, topical delivery remains the most common treatment option for managing anterior segment diseases, whileintraocular injectionsare the current gold standard treatment option for treating posterior segment diseases. Nonetheless, topical eye drops are associated with low bioavailability (<5%), and theintravitreal administration procedure is highly invasive, yielding poor patient acceptability. In both cases, frequent administration is currently required. As a result, there is a clear unmet need for sustained drug delivery to the eye, particularly in a manner that can be localised. Microneedles, which are patches containing an array of micron-scale needles (<1 mm), have the potential to meet this need. These platforms can enable localised drug delivery to the eye while enhancing penetration of drug molecules through key ocular barriers, thereby improving overall therapeutic outcomes. Moreover, the minimally invasive manner in which microneedles are applied could provide significant advantages over traditional intravitreal injections regarding patient acceptability. Considering the benefitsofthis novel ocular delivery system, this review provides an in-depth overviewofthe microneedle systems for ocular drug delivery, including the types of microneedles used and therapeutics delivered. Notably, we outline and discuss the current challenges associated with the clinical translation of these platforms and offer opinions on factors which should be considered to improve such transition from lab to clinic.
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Affiliation(s)
- Katie Glover
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Deepakkumar Mishra
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Shilpkala Gade
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Yu Wu
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Alejandro J Paredes
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
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2
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Posselli NR, Bernstein PS, Abbott JJ. Eye-mounting goggles to bridge the gap between benchtop experiments and in vivo robotic eye surgery. Sci Rep 2023; 13:15503. [PMID: 37726336 PMCID: PMC10509142 DOI: 10.1038/s41598-023-42561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
A variety of robot-assisted surgical systems have been proposed to improve the precision of eye surgery. Evaluation of these systems has typically relied on benchtop experiments with artificial or enucleated eyes. However, this does not properly account for the types of head motion that are common among patients undergoing eye surgery, which a clinical robotic system will encounter. In vivo experiments are clinically realistic, but they are risky and thus require the robotic system to be at a sufficiently mature state of development. In this paper, we describe a low-cost device that enables an artificial or enucleated eye to be mounted to standard swim goggles worn by a human volunteer to enable more realistic evaluation of eye-surgery robots after benchtop studies and prior to in vivo studies. The mounted eye can rotate about its center, with a rotational stiffness matching that of an anesthetized patient's eye. We describe surgeon feedback and technical analyses to verify that various aspects of the design are sufficient for simulating a patient's eye during surgery.
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Affiliation(s)
- Nicholas R Posselli
- Robotics Center and Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Paul S Bernstein
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Jake J Abbott
- Robotics Center and Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
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Pan-Doh N, Sikder S, Woreta FA, Handa JT. Using the language of surgery to enhance ophthalmology surgical education. Surg Open Sci 2023; 14:52-59. [PMID: 37528917 PMCID: PMC10387608 DOI: 10.1016/j.sopen.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
Background Currently, surgical education utilizes a combination of the apprentice model, wet-lab training, and simulation, but due to reliance on subjective data, the quality of teaching and assessment can be variable. The "language of surgery," an established concept in engineering literature whose incorporation into surgical education has been limited, is defined as the description of each surgical maneuver using quantifiable metrics. This concept is different from the traditional notion of surgical language, generally thought of as the qualitative definitions and terminology used by surgeons. Methods A literature search was conducted through April 2023 using MEDLINE/PubMed using search terms to investigate wet-lab, virtual simulators, and robotics in ophthalmology, along with the language of surgery and surgical education. Articles published before 2005 were mostly excluded, although a few were included on a case-by-case basis. Results Surgical maneuvers can be quantified by leveraging technological advances in virtual simulators, video recordings, and surgical robots to create a language of surgery. By measuring and describing maneuver metrics, the learning surgeon can adjust surgical movements in an appropriately graded fashion that is based on objective and standardized data. The main contribution is outlining a structured education framework that details how surgical education could be improved by incorporating the language of surgery, using ophthalmology surgical education as an example. Conclusion By describing each surgical maneuver in quantifiable, objective, and standardized terminology, a language of surgery can be created that can be used to learn, teach, and assess surgical technical skill with an approach that minimizes bias. Key message The "language of surgery," defined as the quantification of each surgical movement's characteristics, is an established concept in the engineering literature. Using ophthalmology surgical education as an example, we describe a structured education framework based on the language of surgery to improve surgical education. Classifications Surgical education, robotic surgery, ophthalmology, education standardization, computerized assessment, simulations in teaching. Competencies Practice-Based Learning and Improvement.
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Affiliation(s)
- Nathan Pan-Doh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika A. Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James T. Handa
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Alafaleq M. Robotics and cybersurgery in ophthalmology: a current perspective. J Robot Surg 2023:10.1007/s11701-023-01532-y. [PMID: 36637738 PMCID: PMC9838251 DOI: 10.1007/s11701-023-01532-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
Ophthalmology is one of the most enriched fields, allowing the domain of artificial intelligence to be part of its point of interest in scientific research. The requirement of specialized microscopes and visualization systems presents a challenge to adapting robotics in ocular surgery. Cyber-surgery has been used in other surgical specialties aided by Da Vinci robotic system. This study focuses on the current perspective of using robotics and cyber-surgery in ophthalmology and highlights factors limiting their progression. A review of literature was performed with the aid of Google Scholar, Pubmed, CINAHL, MEDLINE (N.H.S. Evidence), Cochrane, AMed, EMBASE, PsychINFO, SCOPUS, and Web of Science. Keywords: Cybersurgery, Telesurgery, ophthalmology robotics, Da Vinci robotic system, artificial intelligence in ophthalmology, training on robotic surgery, ethics of the use of robots in medicine, legal aspects, and economics of cybersurgery and robotics. 150 abstracts were reviewed for inclusion, and 68 articles focusing on ophthalmology were included for full-text review. Da Vinci Surgical System has been used to perform a pterygium repair in humans and was successful in ex vivo corneal, strabismus, amniotic membrane, and cataract surgery. Gamma Knife enabled effective treatment of uveal melanoma. Robotics used in ophthalmology were: Da Vinci Surgical System, Intraocular Robotic Interventional Surgical System (IRISS), Johns Hopkins Steady-Hand Eye Robot and smart instruments, and Preceyes' B.V. Cybersurgery is an alternative to overcome distance and the shortage of surgeons. However, cost, availability, legislation, and ethics are factors limiting the progression of these fields. Robotic and cybersurgery in ophthalmology are still in their niche. Cost-effective studies are needed to overcome the delay. Technologies, such as 5G and Tactile Internet, are required to help reduce resource scheduling problems in cybersurgery. In addition, prototype development and the integration of artificial intelligence applications could further enhance the safety and precision of ocular surgery.
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Affiliation(s)
- Munirah Alafaleq
- grid.411975.f0000 0004 0607 035XOphthalmology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia ,Artificial Intelligence and Business School, 18 Rue du Dôme, 92100 Boulogne Billancourt, France ,grid.412134.10000 0004 0593 9113Ophthalmology Department and Centre for Rare Ophthalmological Diseases OPHTARA, Necker Enfants-Malades University Hospital, AP-HP, University Paris Cité, Paris, France
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A Review of Recent Advances in Vitreoretinal Surgical Visualization and Tissue Manipulation. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bourcier T, Dormegny L, Sauer A, Nardin M, Becmeur PH, Chammas J, Gaucher D, Ballonzoli L, Speeg C, Liverneaux P, Vix M, Marescaux J, Mutter D. State of the Art in Robot-Assisted Eye Surgery. Klin Monbl Augenheilkd 2021; 238:1290-1293. [PMID: 34571552 DOI: 10.1055/a-1562-2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite the advantages that robot-assisted surgery can offer to patient care, its use in ophthalmic surgery has not yet progressed to the extent seen in other fields. As such, its use remains limited to research environments, both basic and clinical. The technical specifications for such ophthalmic surgical robots are highly challenging, but rapid progress has been made in recent years, and recent developments in this field ensure that the use of this technology in operating theatres will soon be a real possibility. Fully automated ocular microsurgery, carried out by a robot under the supervision of a surgeon, is likely to become our new reality. This review discusses the use of robot-assisted ophthalmic surgery, the recent progress in the field, and the necessary future developments which must occur before its use in operating theatres becomes routine.
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Affiliation(s)
- Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Léa Dormegny
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Mathieu Nardin
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Pierre-Henri Becmeur
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Laurent Ballonzoli
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Claude Speeg
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Hautepierre Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Michel Vix
- IRCAD, European Institute of Telesurgery, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | | | - Didier Mutter
- IRCAD, European Institute of Telesurgery, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
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Yang UJ, Kim D, Hwang M, Kong D, Kim J, Nho YH, Lee W, Kwon DS. A novel microsurgery robot mechanism with mechanical motion scalability for intraocular and reconstructive surgery. Int J Med Robot 2021; 17:e2240. [PMID: 33599377 DOI: 10.1002/rcs.2240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Intraocular surgery and reconstructive surgery are challenging microsurgery procedures that require two types of motion: precise motion and larger motion. To effectively perform the requisite motion using a robot, it is necessary to develop a manipulator that can adjust the scale of motion between precise motion and less precise, yet larger motion. AIMS In this paper, we propose a novel microsurgery robot using the dual delta structure (DDS) to mechanically scale the motion to seamlessly adjust between precise and larger motion. MATERIALS & METHODS: The DDS forms a lever mechanism that enables the motion scaling at the end-effector using two delta platforms. Seamless scale adjustment enables the robot to effectively perform various surgical moves. RESULTS A prototype robot system was developed to validate the effectiveness of the DDS. The experiment results in various scale settings validated the scaling mechanism of the DDS. CONCLUSION Through a graphical simulation and measurement experiment, the robot's precision level and attainable workspace has been confirmed adequate for intraocular and reconstructive surgery.
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Affiliation(s)
- Un-Je Yang
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.,EasyEndo Surgical Inc., Daejeon, Republic of Korea
| | - Duksang Kim
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.,EasyEndo Surgical Inc., Daejeon, Republic of Korea
| | - Minho Hwang
- Department of Electrical Engineering and Computer Sciences, University of California Berkeley, Berkeley, California, USA
| | - Dukyoo Kong
- EasyEndo Surgical Inc., Daejeon, Republic of Korea.,Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - JoonHwan Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | | | - WonKi Lee
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Republic of Korea
| | - Dong-Soo Kwon
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.,EasyEndo Surgical Inc., Daejeon, Republic of Korea.,Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
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