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Iovieno A, Fontana L, Coassin M, Bovio D, Salito C. Ex Vivo Evaluation of a Pressure-Sensitive Device to Aid Big Bubble Intrastromal Dissection in Deep Anterior Lamellar Keratoplasty. Transl Vis Sci Technol 2022; 11:17. [PMID: 36580320 PMCID: PMC9804022 DOI: 10.1167/tvst.11.12.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To develop and perform ex vivo testing for a device designed for semiquantitative determination of intracorneal dissection depth during big bubble (BB) deep anterior lamellar keratoplasty. Methods A prototype device connected to a syringe and cannula was designed to determine depth of intrastromal placement based on air rebound pressure emitted by a software controlled generator. Ex vivo testing of the device was conducted on human corneas mounted on an artificial anterior chamber in three experiments: (1) cannula purposely introduced at different depths measured with anterior segment optical coherence tomography, (2) cannula introduced as per the BB technique, and (3) simulation of the BB technique guided by the device. Results A positive pressure differential and successful BB were observed only when the cannula was positioned within 150 microns from the endothelial plane. In all successful BB cases (21/40), a repeatable increase in tissue rebound pressure was detected, which was not recorded in unsuccessful cases. The device was able to signal to the surgeon correct placement of the cannula (successful BB) in 16 of 17 cases and incorrect placement of the cannula (unsuccessful BB) in 8 of 8 cases (94.1% sensitivity, 100% specificity). Conclusions In our ex vivo model, this novel medical device could reliably signal cannula positioning in the deep stroma for effective pneumatic dissection and possibly aid technical execution of BB deep anterior lamellar keratoplasty. Translational Relevance A medical device that standardizes big bubble deep anterior lamellar keratoplasty could increase the overall success rate of the surgical procedure and aid popularization of deep anterior lamellar keratoplasty.
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Affiliation(s)
- Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Luigi Fontana
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Marco Coassin
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy,Department of Ophthalmology, University Campus Bio-medico, Rome, Italy
| | - Dario Bovio
- Biocubica Biomedical Engineering, Milan, Italy
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2
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Otuya DO, Dechene NM, Poshtupaka D, Judson S, Carlson CJ, Zemlok SK, Sevieri E, Choy P, Shore RE, De León-Peralta E, Cirio AA, Rihm TW, Krall AA, Gavgiotaki E, Dong J, Silva SL, Baillargeon A, Baldwin G, Gao AH, Jansa Z, Barrios A, Ryan E, Bhat NGM, Balmasheva I, Chung A, Grant CN, Bablouzian AL, Beatty M, Ahsen OO, Zheng H, Tearney GJ. Passively scanned, single-fiber optical coherence tomography probes for gastrointestinal devices. Lasers Surg Med 2022; 54:935-944. [PMID: 35708124 PMCID: PMC9541095 DOI: 10.1002/lsm.23576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND/OBJECTIVES Optical coherence tomography (OCT) uses low coherence interferometry to obtain depth-resolved tissue reflectivity profiles (M-mode) and transverse beam scanning to create images of two-dimensional tissue morphology (B-mode). Endoscopic OCT imaging probes typically employ proximal or distal mechanical beam scanning mechanisms that increase cost, complexity, and size. Here, we demonstrate in the gastrointestinal (GI) tracts of unsedated human patients, that a passive, single-fiber probe can be used to guide device placement, conduct device-tissue physical contact sensing, and obtain two-dimensional OCT images via M-to-B-mode conversion. MATERIALS AND METHODS We designed and developed ultrasmall, manually scannable, side- and forward-viewing single fiber-optic probes that can capture M-mode OCT data. Side-viewing M-mode OCT probes were incorporated into brush biopsy devices designed to harvest the microbiome and forward-viewing M-mode OCT probes were integrated into devices that measure intestinal potential difference (IPD). The M-mode OCT probe-coupled devices were utilized in the GI tract in six unsedated patients in vivo. M-mode data were converted into B-mode images using an M-to-B-mode conversion algorithm. The effectiveness of physical contact sensing by the M-mode OCT probes was assessed by comparing the variances of the IPD values when the probe was in physical contact with the tissue versus when it was not. The capacity of forward- and side-viewing M-mode OCT probes to produce high-quality B-mode images was compared by computing the percentages of the M-to-B-mode images that showed close contact between the probe and the luminal surface. Passively scanned M-to-B-mode images were qualitatively compared to B-mode images obtained by mechanical scanning OCT tethered capsule endomicroscopy (TCE) imaging devices. RESULTS The incorporation of M-mode OCT probes in these nonendoscopic GI devices safely and effectively enabled M-mode OCT imaging, facilitating real-time device placement guidance and contact sensing in vivo. Results showed that M-mode OCT contact sensing improved the variance of IPD measurements threefold and side-viewing probes increased M-to-B-mode image visibility by 10%. Images of the esophagus, stomach, and duodenum generated by the passively scanned probes and M-to-B-mode conversion were qualitatively superior to B-mode images obtained by mechanically scanning OCT TCE devices. CONCLUSION These results show that passive, single optical fiber OCT probes can be effectively utilized for nonendoscopic device placement guidance, device contact sensing, and two-dimensional morphologic imaging in the human GI tract in vivo. Due to their small size, lower cost, and reduced complexity, these M-mode OCT probes may provide an easier avenue for the incorporation of OCT functionality into endoscopic/nonendoscopic devices.
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Affiliation(s)
- David O Otuya
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas M Dechene
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Darina Poshtupaka
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Seth Judson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Camella J Carlson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah K Zemlok
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evan Sevieri
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Choy
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel E Shore
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Alissa A Cirio
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tyler W Rihm
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexander A Krall
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evangelia Gavgiotaki
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jing Dong
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah L Silva
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron Baillargeon
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grace Baldwin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anna H Gao
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary Jansa
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amilcar Barrios
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily Ryan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nitasha G M Bhat
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Indira Balmasheva
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anita Chung
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catriona N Grant
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ara L Bablouzian
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew Beatty
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Osman O Ahsen
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hui Zheng
- Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General Hospital Biostatistics, Boston, Massachusetts, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard-MIT Division of Health Sciences and Technology (HST), Boston, Massachusetts, USA
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Guo S, Sarfaraz NR, Gensheimer WG, Krieger A, Kang JU. Demonstration of Optical Coherence Tomography Guided Big Bubble Technique for Deep Anterior Lamellar Keratoplasty (DALK). SENSORS 2020; 20:s20020428. [PMID: 31940877 PMCID: PMC7013995 DOI: 10.3390/s20020428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/03/2022]
Abstract
Deep anterior lamellar keratoplasty (DALK) is a highly challenging procedure for cornea transplant that involves removing the corneal layers above Descemet’s membrane (DM). This is achieved by a “big bubble” technique where a needle is inserted into the stroma of the cornea down to DM and the injection of either air or liquid. DALK has important advantages over penetrating keratoplasty (PK) including lower rejection rate, less endothelial cell loss, and increased graft survival. In this paper, we successfully designed and evaluated the optical coherence tomography (OCT) distal sensor integrated needle for a precise big bubble technique. We successfully used this sensor for micro-control of a robotic DALK device termed AUTO-DALK for autonomous big bubble needle insertion. The OCT distal sensor was integrated inside a 25-gauge needle, which was used for pneumo-dissection. The AUTO-DALK device is built on a manual trephine platform which includes a vacuum ring to fix the device on the eye and add a needle driver at an angle of 60 degrees from vertical. During the test on five porcine eyes with a target depth of 90%, the measured insertion depth as a percentage of cornea thickness for the AUTO-DALK device was 90.05%±2.33% without any perforation compared to 79.16%±5.68% for unassisted free-hand insertion and 86.20%±5.31% for assisted free-hand insertion. The result showed a higher precision and consistency of the needle placement with AUTO-DALK, which could lead to better visual outcomes and fewer complications.
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Affiliation(s)
- Shoujing Guo
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
- Correspondence: ; Tel.: +1-443-858-6100
| | - Nicolas R. Sarfaraz
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA; (N.R.S.); (A.K.)
| | - William G. Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA;
| | - Axel Krieger
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA; (N.R.S.); (A.K.)
| | - Jin U. Kang
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
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Wei S, Guo S, Kang JU. Analysis and evaluation of BC-mode OCT image visualization for microsurgery guidance. BIOMEDICAL OPTICS EXPRESS 2019; 10:5268-5290. [PMID: 31646046 PMCID: PMC6788622 DOI: 10.1364/boe.10.005268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/27/2019] [Accepted: 09/13/2019] [Indexed: 05/09/2023]
Abstract
Optical coherence tomography (OCT) has been gaining acceptance in image-guided microsurgery as a noninvasive imaging technique. However, when using B-mode OCT imaging, it is difficult to continuously keep the surgical tool in the imaging field, and the image of the tissue beneath the tool is corrupted by shadow effects. The alternative using C-mode OCT imaging is either too slow in imaging speed when operating in a high-resolution mode, or provides a poor image resolution in a high-speed mode, with the sweep rate less than one million hertz. Moreover, the 3-dimensional rendering of C-mode OCT image makes it difficult to visualize the tissue structure and track the surgical tool beneath the tissue surface. To solve these problems, we propose a BC-mode OCT image visualization method. This method uses a sparse C-scanning scheme, which provides a set of high-resolution B-mode OCT images at sparsely spaced cross sections. The final BC-mode OCT image is obtained by averaging the image set, with inter frame variance processing to enhance the signal of the surgical tool and tissue layers. The performance of BC-mode OCT images, such as image resolution, signal to noise ratio (SNR), imaging speed, and surgical tool tracking accuracy, is analyzed theoretically and verified experimentally. The feasibility of the proposed method is evaluated by guiding the insertion of a 30-gauge needle into the cornea of an ex-vivo human eye freehand. The results show that this provides better visualization of both the surgical tool and the tissue structure than the conventional B- or C- mode OCT image.
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Yoo YS, Whang WJ, Kang MJ, Hwang JH, Byun YS, Yoon G, Shin S, Jung W, Moon S, Joo CK. Effect of Air Injection Depth on Big-bubble Formation in Lamellar Keratoplasty: an Ex Vivo Study. Sci Rep 2019; 9:3785. [PMID: 30846714 PMCID: PMC6405887 DOI: 10.1038/s41598-018-36522-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/19/2018] [Indexed: 11/09/2022] Open
Abstract
This study evaluated the effect of air injection depth in the big-bubble (BB) technique, which is used for corneal tissue preparation in lamellar keratoplasty. The BB technique was performed on ex vivo human corneoscleral buttons using a depth-sensing needle, based on optical coherence tomography (OCT) imaging technology. The needle tip, equipped with a miniaturized OCT depth-sensing probe, was inserted for air injection at a specified depth. Inside the corneal tissue, our needle obtained OCT line profiles, from which residual thickness below the needle tip was measured. Subjects were classified into Groups I, II, III, and IV based on injection depths of 75-80%, 80-85%, 85-90%, and >90% of the full corneal thickness, respectively. Both Type I and II BBs were produced when the mean residual thicknesses of air injection were 109.7 ± 38.0 µm and 52.4 ± 19.2 µm, respectively. Type II BB (4/5) was dominant in group IV. Bubble burst occurred in 1/16 cases of type I BB and 3/16 cases of type II BB, respectively. Injection depth was an important factor in determining the types of BBs produced. Deeper air injection could facilitate formation of Type II BBs, with an increased risk of bubble bursts.
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Affiliation(s)
- Young-Sik Yoo
- Department of Convergence Medical Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woong-Joo Whang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Min-Ji Kang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Je-Hyung Hwang
- Department of Ophthalmology, Sang-gye Paik Hospital, Inje University, Seoul, South Korea
| | - Yong-Soo Byun
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Geunyoung Yoon
- Flaum Eye Institute, The Institute of Optics, Center for Visual Science, University of Rochester, Rochester, New York, USA
| | - Sungwon Shin
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Woonggyu Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Sucbei Moon
- Department of Physics, Kookmin University, Seoul, South Korea.
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Keller B, Draelos M, Tang G, Farsiu S, Kuo AN, Hauser K, Izatt JA. Real-time corneal segmentation and 3D needle tracking in intrasurgical OCT. BIOMEDICAL OPTICS EXPRESS 2018; 9:2716-2732. [PMID: 30258685 PMCID: PMC6154196 DOI: 10.1364/boe.9.002716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 05/09/2023]
Abstract
Ophthalmic procedures demand precise surgical instrument control in depth, yet standard operating microscopes supply limited depth perception. Current commercial microscope-integrated optical coherence tomography partially meets this need with manually-positioned cross-sectional images that offer qualitative estimates of depth. In this work, we present methods for automatic quantitative depth measurement using real-time, two-surface corneal segmentation and needle tracking in OCT volumes. We then demonstrate these methods for guidance of ex vivo deep anterior lamellar keratoplasty (DALK) needle insertions. Surgeons using the output of these methods improved their ability to reach a target depth, and decreased their incidence of corneal perforations, both with statistical significance. We believe these methods could increase the success rate of DALK and thereby improve patient outcomes.
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Affiliation(s)
- Brenton Keller
- Department of Biomedical Engineering, Duke University, Durham, NC 27708,
USA
| | - Mark Draelos
- Department of Biomedical Engineering, Duke University, Durham, NC 27708,
USA
| | - Gao Tang
- Department of Mechanical Engineering, Duke University, Durham, NC 27708,
USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708,
USA
- Department of Ophthalmology, Duke University Medical Center, Durham NC 27710,
USA
| | - Anthony N. Kuo
- Department of Biomedical Engineering, Duke University, Durham, NC 27708,
USA
- Department of Ophthalmology, Duke University Medical Center, Durham NC 27710,
USA
| | - Kris Hauser
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27701,
USA
| | - Joseph A. Izatt
- Department of Ophthalmology, Duke University Medical Center, Durham NC 27710,
USA
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