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Lussi J, Mattmann M, Sevim S, Grigis F, De Marco C, Chautems C, Pané S, Puigmartí‐Luis J, Boehler Q, Nelson BJ. A Submillimeter Continuous Variable Stiffness Catheter for Compliance Control. Adv Sci (Weinh) 2021; 8:e2101290. [PMID: 34272935 PMCID: PMC8456283 DOI: 10.1002/advs.202101290] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/10/2021] [Indexed: 05/02/2023]
Abstract
Minimally invasive robotic surgery often requires functional tools that can change their compliance to adapt to the environment and surgical needs. This paper proposes a submillimeter continuous variable stiffness catheter equipped with a phase-change alloy that has a high stiffness variation in its different states, allowing for rapid compliance control. Variable stiffness is achieved through a variable phase boundary in the alloy due to a controlled radial temperature gradient. This catheter can be safely navigated in its soft state and rigidified to the required stiffness during operation to apply a desired force at the tip. The maximal contact force that the catheter applies to tissue can be continuously modified by a factor of 400 (≈20 mN-8 N). The catheter is equipped with a magnet and a micro-gripper to perform a fully robotic ophthalmic minimally invasive surgery on an eye phantom by means of an electromagnetic navigation system.
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Affiliation(s)
- Jonas Lussi
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Michael Mattmann
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Semih Sevim
- Institute of Chemical and BioengineeringETH ZurichVladimir Prelog Weg 1ZurichCH‐8093Switzerland
| | - Fabian Grigis
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Carmela De Marco
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Christophe Chautems
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Salvador Pané
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Josep Puigmartí‐Luis
- Departament de Ciència dels Materials i Química FísicaInstitut de Química Teòrica i ComputacionalBarcelona08028Spain
- ICREACatalan Institution for Research and Advanced StudiesPg. Lluís Companys 23Barcelona08010Spain
| | - Quentin Boehler
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Bradley J. Nelson
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
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Torii H, Noma H, Miike S. OMNIDIRECTIONAL ILLUMINATION LIGHT SOURCE DEVICE: LED ORB Light System. Retina 2021; 41:886-889. [PMID: 33332809 PMCID: PMC7989609 DOI: 10.1097/iae.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text.
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Affiliation(s)
- Hideo Torii
- Department of Ophthalmology, Ukinojo Ophthalmology Clinic, Miyazaki, Japan;
| | - Hidetaka Noma
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan; and
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Abstract
A murine model of corneal epithelial wounding can be performed using simple injury and imaging methods. Here, we describe the creation of a central corneal epithelial defect using mechanical debridement under ophthalmic microscopic visualization. Subsequent monitoring with vital dye application and slit-lamp bio microscopy (slit-lamp) is described in detail.
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Affiliation(s)
- Dhara Shah
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Vinay Kumar Aakalu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
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Abstract
To evaluate the safety and efficacy [intraocular pressure (IOP)-lowering effect and medication use] of a single trabecular microbypass stent (iStent; Glaukos Corp, San Clemente, CA) for medically controlled open-angle glaucoma.This retrospective case series included 42 eyes of 34 patients with medically controlled open-angle glaucoma with IOP less than 21 mm Hg. Clinical outcomes analyzed were IOP, medication use, corrected distance visual acuity (CDVA), and surgical complications. Surgical success was defined according to 4 criteria: IOP < 21 mm Hg without medication; IOP < 18 mm Hg without medication; IOP < 15 mm Hg without medications; and IOP < 18 mm Hg with or without medication. Patients were followed for a minimum of 6 months postoperatively.Mean IOP was reduced from 15.8 ± 2.8 mm Hg to 14.5 ± 2.8 mm Hg (P < .001), while mean number of medications decreased from 2.2 ± 1.2 to 0.8 ± 1.1 at final visit (P < .001). Surgical success rates were 78.6%, 61.9%, 57.1%, and 97.6% at 6 months and 78.6%, 59.5%, 52.4%, and 95.2% at final visits according to criteria A, B, C, and D. Meanwhile, 59.5% of patients were medication-free at their final visit. The relative risk of surgical failure by Criteria B and C was 4.337 (95% confidence interval: 1.799-10.454) and 3.717 (95% confidence interval: 1.516-9.116) times greater in the higher-medication group (3 or more preoperative medications), respectively. CDVA was significantly improved from 0.41 ± 0.10 to 0.09 ± 0.07 LogMAR in the combined phacoemulsification and iStent implantation group (P < .001). There was no case whose vision was threatened (vision loss of 2 or more lines) or who showed severe complications after surgery.Single trabecular microbypass stent implantation was effective in reducing IOP and medication usage in patients with open-angle glaucoma with a low preoperative IOP. Our results imply that it is more difficult to achieve low target IOP control in eyes with higher numbers of preoperative medications.
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Affiliation(s)
- Hee Jun Kim
- Good Doctors Eye Hospital, Ulsan
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu
| | - Su-Ho Lim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu
- Department of Ophthalmology, Daegu Veterans Health Service Medical Center, Daegu, Republic of Korea
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Fang W, Li Q, Fan J, Tang N, Yu J, Xu H, Zong Y, Jiang C, Shi G, Sun X. Microscope-integrated Intraoperative Optical Coherence Tomography for Anterior Segment Surgical Maneuvers. Transl Vis Sci Technol 2020; 9:18. [PMID: 32832225 PMCID: PMC7414702 DOI: 10.1167/tvst.9.7.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/21/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose To evaluate the potential value of microscope-integrated optical coherence tomography (MI-OCT) in anterior segment surgical maneuvers. Methods Twenty-four ophthalmology residents, who were randomly and evenly divided into two groups, performed four anterior segment surgical maneuvers (corneal tunnel, scleral tunnel, simple corneal suture, and corneal laceration repair) on porcine eyes with (group B) or without (group A) real-time MI-OCT feedback. All residents performed the maneuvers again without MI-OCT. Results Compared with group A, group B (with MI-OCT) showed better accuracy in the length/depth of the corneal tunnel and the length of the scleral tunnel. However, both groups showed similar performances in the depth of both the simple corneal suture and the corneal laceration suture. When both groups performed the maneuvers again without MI-OCT, group B still showed better results than group A for the length of both the corneal and scleral tunnels. Conclusions Primary results suggest that real-time MI-OCT images are valuable for some anterior segment surgical maneuvers and could be helpful in surgical training. Translational Relevance MI-OCT systems can be valuable in improving accuracy and decision making during anterior segment surgery and will be useful in surgical training.
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Affiliation(s)
- Wangyi Fang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Qingchen Li
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Jinyu Fan
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Ning Tang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Huan Xu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
| | - Guohua Shi
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Xinghuai Sun
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, People's Republic of China
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Poor HA, Zhou M, Lohmann CP, Cerveri P, Nasseri MA. Reducing the Number of Degrees of Freedom to Control an Eye Surgical Robot through Classification of Surgical Phases. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5403-5406. [PMID: 31947077 DOI: 10.1109/embc.2019.8857360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper introduces an optimized input device workflow to control an eye surgical robot in a simulated vitreoretinal environment. The input device is a joystick with four Degrees of Freedom (DOF) that controls a six DOFs robot. This aim is achieved through a segmentation plan for an eye surgeon. In this study, the different surgical phases are defined while each phase includes their specific number of DOFs. The segmentation plan is divided into four surgical phases: Phase I: Approach with three DOFs; Phase II: Introduction with three DOFs; Phase III: Aim with 3+1 DOFs; and Phase IV: Injection with one DOF. Taking these phases into consideration, an eye surgical robot with six DOFs could be controlled through a joystick with only four DOFs intuitively. In this work we show that reducing the number of DOFs will decrease the complexity of the surgery with a robotic platform.
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Affiliation(s)
- Daniel Palanker
- From the Department of Ophthalmology and Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA
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Weiss J, Rieke N, Nasseri MA, Maier M, Eslami A, Navab N. Fast 5DOF needle tracking in iOCT. Int J Comput Assist Radiol Surg 2018; 13:787-796. [PMID: 29603065 DOI: 10.1007/s11548-018-1751-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/22/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Intraoperative optical coherence tomography (iOCT) is an increasingly available imaging technique for ophthalmic microsurgery that provides high-resolution cross-sectional information of the surgical scene. We propose to build on its desirable qualities and present a method for tracking the orientation and location of a surgical needle. Thereby, we enable the direct analysis of instrument-tissue interaction directly in OCT space without complex multimodal calibration that would be required with traditional instrument tracking methods. METHOD The intersection of the needle with the iOCT scan is detected by a peculiar multistep ellipse fitting that takes advantage of the directionality of the modality. The geometric modeling allows us to use the ellipse parameters and provide them into a latency-aware estimator to infer the 5DOF pose during needle movement. RESULTS Experiments on phantom data and ex vivo porcine eyes indicate that the algorithm retains angular precision especially during lateral needle movement and provides a more robust and consistent estimation than baseline methods. CONCLUSION Using solely cross-sectional iOCT information, we are able to successfully and robustly estimate a 5DOF pose of the instrument in less than 5.4 ms on a CPU.
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Affiliation(s)
- Jakob Weiss
- Computer Aided Medical Procedures, Technische Universität München, Boltzmannstr. 3, 85748, Garching, Germany.
| | - Nicola Rieke
- Computer Aided Medical Procedures, Technische Universität München, Boltzmannstr. 3, 85748, Garching, Germany
| | - Mohammad Ali Nasseri
- Augenklinik und Poliklinik, Klinikum rechts der Isar der Technische Universit München, 81675, Munich, Germany
| | - Mathias Maier
- Augenklinik und Poliklinik, Klinikum rechts der Isar der Technische Universit München, 81675, Munich, Germany
| | | | - Nassir Navab
- Computer Aided Medical Procedures, Technische Universität München, Boltzmannstr. 3, 85748, Garching, Germany
- Johns Hopkins University, Baltimore, MD, USA
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Zhao F, Li L, Zhou W, Shi D, Fan Y, Ma L. Correlative factors' analysis of postural-related ocular cyclotorsion with image-guided system. Jpn J Ophthalmol 2017; 62:237-242. [PMID: 29134322 DOI: 10.1007/s10384-017-0544-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 10/08/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the correlation between ocular cyclotorsion induced by sitting and supine positions as well as other selected factors, validated by an image-guided system. STUDY DESIGN A cross-sectional study conducted in 73 inpatients (85 eyes) who received intraocular operations in China Medical University. METHODS The ocular cyclotorsion degree was recorded using an image-guided system (Verion Reference Unit, Alcon) by comparing images captured in sitting position, as well as pre- and post-different anesthesia methods in the supine position. Possible correlative factors including age, gender, eye axial length, best corrected visual acuity (BCVA), astigmatism degree, astigmatism axis, anesthesia, and comparison in laterality of eyes on ocular cyclotorsion were analyzed. RESULTS The total cyclotorsion rate was 88.24% and the cyclotorsion degree ranged from - 14.0° to + 12.0° with an average of 4.6° ± 3.4°. Excyclotorsion was predominant OD whereas incyclotorsion was predominant OS (p < 0.05). The effect of eye axial length, BCVA, astigmatism degree, astigmatism axis, anesthesia method, age and gender on cyclotorsion orientation was not statistically significant, neither did these factors show any significant differences in the ocular cyclotorsion degree (p > 0.05). Pre- and post-anesthesia, and different anesthetic methods, did not show any significant influence on the ocular cyclotorsion degree (p > 0.05). CONCLUSIONS Cyclotorsion orientation seems to be correlated only with eye laterality. None of the other investigated factors, including age, gender, eye axial length, BCVA, astigmatism degree, astigmatism axis and anesthesia seems to affect cyclotorsion orientation or degree.
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Affiliation(s)
- Fangkun Zhao
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Ling Li
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
- Beijing AIER-Intech Eye Hospital, Beijing, China
| | - Wenkai Zhou
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Dong Shi
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Yu Fan
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Liwei Ma
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China.
- The Key Lens Research Laboratory of Liaoning Province, Shenyang, China.
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Rachitskaya AV, Yuan A, Marino MJ, Reese J, Ehlers JP. Intraoperative OCT Imaging of the Argus II Retinal Prosthesis System. Ophthalmic Surg Lasers Imaging Retina 2017; 47:999-1003. [PMID: 27842194 DOI: 10.3928/23258160-20161031-03] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Optimal placement of the Argus II Retinal Prosthesis System (Second Sight Medical Products, Sylmar, CA) is critical. Intraoperative optical coherence tomography (OCT) allows for intrasurgical visualization and confirmation of array placement. In this study, two different OCT systems were evaluated to assess the feasibility and utility of this technology during Argus II surgery. PATIENTS AND METHODS Intraoperative OCT was performed on five patients undergoing Argus II implantation at Cole Eye Institute from June 2015 to July 2016. The EnVisu portable OCT (Bioptigen, Morrisville, NC) and microscope-integrated RESCAN 700 (Zeiss, Oberkochen, Germany) intraoperative OCT systems were utilized. The EnVisu was used in three patients and the RESCAN 700 in three of the five patients. Following array tacking, intraoperative OCT was performed over the entire array including the edges and tack. RESULTS Intraoperative OCT allowed for visualization of the array/retina interface. Microscope integration of the OCT system facilitated ease of focusing, real-time feedback, surgeon-directed OCT scanning to the areas of interest, and enhanced image quality at points of interest. CONCLUSIONS Intraoperative imaging of the Argus II electrode array is feasible and provides information about electrode array-retina interface and distance to help guide a surgeon. Microscope integration of OCT appears to provide an optimal and efficient approach to intraoperative OCT during Argus II array placement. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:999-1003.].
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Barthel A, Trematerra D, Nasseri MA, Zapp D, Lohmann CP, Knoll A, Maier M. Haptic interface for robot-assisted ophthalmic surgery. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2015:4906-9. [PMID: 26737392 DOI: 10.1109/embc.2015.7319492] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vitreo-retinal surgery is challenging, as delicate structures have to be manipulated. Eliminating tremor caused by human motions when doing micromanipulation can therefore improve the outcome of such an intervention. An eye surgery robot has been built to overcome this problem. The contribution of this paper is the design of a telemanipulation setup for the robotic system. A telemanipulation setup using a haptic device featuring force feedback as a user interface for controlling a hybrid parallel-serial micromanipulator is designed and developed. The position error control scheme is chosen and different control modes are provided. The output forces of the haptic device are analyzed. The system allows the surgeon to perform precise and comfortable micromanipulation. Nevertheless a way to provide more meaningful force feedback still has to be found.
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12
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Ikuno Y. [Understanding the Pathology and Current Treatment Strategy of Highly Myopic Complications]. Nippon Ganka Gakkai Zasshi 2017; 121:292-313. [PMID: 30088703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The population of high myopia in Japan is large and increasing. It is a high risk factor not only for its specific macular complications but also as a precursor for cataracts and glaucoma. Myopic foveoschisis and the consequent macular hole with retinal detachment (MHRD) are caused by inner retinal traction which may include the vitreous cortex, epiretinal membrane, internal limiting membrane and posterior staphyloma formation. Vitrectomy is the 1st choice of treatment, and releasing the retina from traction is the goal. MHRD has poor anatomical success rates, and, therefore, inverted internal limiting membrane is a common treatment procedure to enhance MH closure. Myopic choroidal neovascularization occurs predominantly in highly myopic eyes, and anti-vascular endothelial growth factor therapy is the 1st line treatment. Normally the patient's eyes respond well, however, recurrence is an important issue. Conventional optical coherence tomography (OCT) and fluorescein angiography are the major diagnostic tools. At the same time, advanced technologies such as OCT-angiography and Polarization-sensitive OCT may enable an early and more accurate diagnosis. High myopia is a high risk factor for glaucoma and its mechanism is still uncertain. Studies using OCT thus far have shown variety of abnormalities occurring in highly myopic eyes inside and around the optic nerve head. High myopia has uncommon progression patterns such as preceding the papillo-macular bundle damage, especially in younger patients. Future studies are needed.
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Kelman JC, McPherson ZE, Sim BW. Projectile fly larvae: A potentially under-reported cause of ocular foreign body sensation and inflammation in Australia. Aust Fam Physician 2017; 46:129-130. [PMID: 28260275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Veselovskaya NM, Veselovskaya ZF, Zherebko IB. [EFFICACY OF COMBINED MICROSURGICAL TECHNIQUE IN SEVERE TRAUMATIC INJURY OF EYEBALL]. Klin Khir 2017:48-51. [PMID: 30272916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Analysis of clinical and functional results of microsurgical restoration of eyeball in remote terms after primary surgical processing for traumatic injury of eyes, using combined one-stage operative intervention on anterior and posterior segments, was presented. Satisfactory result was achieved in 56.4% injured persons, in 43.6% - functional outcome after the operation, concerning perspectives of further restoration of optic functions, have appeared unsatisfactory.
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Li H, Hitchins VM, Wickramasekara S. Rapid detection of bacterial endotoxins in ophthalmic viscosurgical device materials by direct analysis in real time mass spectrometry. Anal Chim Acta 2016; 943:98-105. [PMID: 27769383 PMCID: PMC5500980 DOI: 10.1016/j.aca.2016.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/23/2016] [Accepted: 09/24/2016] [Indexed: 01/17/2023]
Abstract
Bacterial endotoxins are lipopolysaccharides bound to the bacterial cell wall and released when bacteria rupture or disintegrate. Possible contamination of endotoxin in ophthalmic devices can cause a painful eye inflammation or result in toxic anterior segment syndrome after cataract surgery. Measurement of bacterial endotoxin in medical device materials is difficult since endotoxin binds with polymer matrix and some of the materials are very viscous and non-water soluble, where traditional enzyme-based Limulus amebocyte lysate (LAL) assay cannot be applied. Here we propose a rapid and high throughput ambient ionization mass spectrometric (MS) method using direct analysis in real time (DART) for the evaluation of endotoxin contamination in medical device materials. Large and structurally complex endotoxin instantaneously breaks down into low-mass characteristic fragment ions using DART and is detected by MS in both positive and negative ion modes. This method enables the identification and separation of endotoxin from medical materials with a detection limit of 0.03 ng mL-1 endotoxins in aqueous solution. Ophthalmic viscosurgical device materials including sodium hyaluronate (NaHA), non-water soluble perfluoro-n-octane (PFO) and silicone oil (SO) were spiked with different known concentrations of endotoxin and analyzed by DART MS, where the presence of endotoxin was successfully detected and featured small mass fragment ions were generated for NaHA, PFO and SO as well. Current findings showed the feasibility of measuring endotoxin contamination in medical device materials using DART-MS, which can lead to a one-step analysis of endotoxins in different matrices, avoiding any potential contamination during sample pre-treatment steps.
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Affiliation(s)
- Hongli Li
- Division of Biology, Chemistry, and Materials Science, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, 20993, United States; Jiangsu Collaborative Innovation Center of Biomedical Functional Materials, Jiangsu Key Laboratory of Biomedical Materials, College of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Victoria M Hitchins
- Division of Biology, Chemistry, and Materials Science, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, 20993, United States
| | - Samanthi Wickramasekara
- Division of Biology, Chemistry, and Materials Science, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, 20993, United States.
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Alsheakhali M, Eslami A, Roodaki H, Navab N. CRF-Based Model for Instrument Detection and Pose Estimation in Retinal Microsurgery. Comput Math Methods Med 2016; 2016:1067509. [PMID: 27867418 PMCID: PMC5102876 DOI: 10.1155/2016/1067509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/25/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
Abstract
Detection of instrument tip in retinal microsurgery videos is extremely challenging due to rapid motion, illumination changes, the cluttered background, and the deformable shape of the instrument. For the same reason, frequent failures in tracking add the overhead of reinitialization of the tracking. In this work, a new method is proposed to localize not only the instrument center point but also its tips and orientation without the need of manual reinitialization. Our approach models the instrument as a Conditional Random Field (CRF) where each part of the instrument is detected separately. The relations between these parts are modeled to capture the translation, rotation, and the scale changes of the instrument. The tracking is done via separate detection of instrument parts and evaluation of confidence via the modeled dependence functions. In case of low confidence feedback an automatic recovery process is performed. The algorithm is evaluated on in vivo ophthalmic surgery datasets and its performance is comparable to the state-of-the-art methods with the advantage that no manual reinitialization is needed.
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Horise Y, He X, Gehlbach P, Taylor R, Iordachita I. FBG-based sensorized light pipe for robotic intraocular illumination facilitates bimanual retinal microsurgery. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:13-6. [PMID: 26736189 DOI: 10.1109/embc.2015.7318249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In retinal surgery, microsurgical instruments such as micro forceps, scissors and picks are inserted through the eye wall via sclerotomies. A handheld intraocular light source is typically used to visualize the tools during the procedure. Retinal surgery requires precise and stable tool maneuvers as the surgical targets are micro scale, fragile and critical to function. Retinal surgeons typically control an active surgical tool with one hand and an illumination source with the other. In this paper, we present a "smart" light pipe that enables true bimanual surgery via utilization of an active, robot-assisted source of targeted illumination. The novel sensorized smart light pipe measures the contact force between the sclerotomy and its own shaft, thereby accommodating the motion of the patient's eye. Forces at the point of contact with the sclera are detected by fiber Bragg grating (FBG) sensors on the light pipe. Our calibration and validation results demonstrate reliable measurement of the contact force as well as location of the sclerotomy. Preliminary experiments have been conducted to functionally evaluate robotic intraocular illumination.
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Pacella E, Mipatrini D, Pacella F, Amorelli G, Bottone A, Smaldone G, Turchetti P, La Torre G. Suspensory Materials for Surgery of Blepharoptosis: A Systematic Review of Observational Studies. PLoS One 2016; 11:e0160827. [PMID: 27631781 PMCID: PMC5025102 DOI: 10.1371/journal.pone.0160827] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. OBJECTIVES The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. DATA SOURCE AND METHODS Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. RESULTS The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. CONCLUSIONS Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results.
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Affiliation(s)
- Elena Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Daniele Mipatrini
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza, University of Rome, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Giulia Amorelli
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Andrea Bottone
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Gianpaolo Smaldone
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Paolo Turchetti
- National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza, University of Rome, Rome, Italy
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Leung EH, Flynn HW, Rosenfeld PJ. Crescent-Shaped Retinal Defects Associated With Membrane Peeling With a Diamond-Dusted Membrane Scraper. Ophthalmic Surg Lasers Imaging Retina 2016; 47:90-3. [PMID: 26731218 DOI: 10.3928/23258160-20151214-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/06/2015] [Indexed: 11/20/2022]
Abstract
Membrane peeling is a common procedure for treating diseases of the vitreoretinal interface, such as macular holes and epiretinal membranes; however, potential complications include inner retinal dimples and inner retinal optic neuropathy. The current case series describes five patients who developed large, crescentic inner retinal defects after membrane peeling with diamond-dusted membrane scrapers. The changes visualized by en face optical coherence tomography were outside the fovea and followed the expected contours of membrane scrapers being used intraoperatively. The visual acuities at the last follow-up were 20/40 or better in all five patients.
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Branchini LA, Gurley K, Duker JS, Reichel E. Use of Handheld Intraoperative Spectral-Domain Optical Coherence Tomography in a Variety of Vitreoretinal Diseases. Ophthalmic Surg Lasers Imaging Retina 2016; 47:49-54. [PMID: 26731209 DOI: 10.3928/23258160-20151214-07] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/06/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The use of intraoperative optical coherence tomography (iOCT) has been described with a variety of imaging devices and techniques. The purpose of this investigation is to examine the role of iVue (Optovue, Fremont, CA), a commercially available, handheld spectral-domain iOCT system, in vitreoretinal surgery. PATIENTS AND METHODS For this retrospective, observational case series, patients who underwent a vitreoretinal surgical procedure and were imaged with the iVue were identified. Images were qualitatively assessed. RESULTS Five cases were identified, including an examination under anesthesia, epiretinal membrane, macular hole, retinal detachment, and non-clearing vitreous hemorrhage in the setting of proliferative diabetic retinopathy. CONCLUSION Clinically useful images were obtained in all cases, though it was difficult to center the scan on the area of interest in the retina. Further work is necessary to improve system design and investigate the ways in which iOCT can aid in vitreoretinal surgery.
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Abstract
Sir Harold Ridley is well known for his pioneering intraocular lens implantation surgery. He also had a significant commitment to the televising and filming of surgery. In his 1950 Television in Ophthalmology paper, Ridley describes the techniques he used to capture his surgery in monochrome and later in full colour for audiences at St Thomas' Hospital.
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22
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Langenbucher A, Eppig T. Optics as an enabling technique in medicine. Z Med Phys 2016; 26:115-6. [PMID: 27066762 DOI: 10.1016/j.zemedi.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pashtaev NP, Pozdeeva NA, Sinitsyn MV, Zotov VV, Gagloev BV. [Comparative evaluation of different corneal cross-linking techniques with respect to biomechanical stability of the cornea]. Vestn Oftalmol 2016; 132:38-46. [PMID: 27213796 DOI: 10.17116/oftalma2016132238-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To perform a comparative analysis of the following cross-linking techniques: standard cross-linking (SCXL), local transepithelial femto cross-linking (LTF) and transepithelial intrastromal femto cross-linking with MyoRing implantation (TIF+MyoRing) in experimental animals and patients with progressive stage II--III keratoconus (KC), paying particular attention to the changes in biomechanical stability of the cornea. MATERIAL AND METHODS The experimental series was performed on 20 eyes of 10 rabbits. The animals were divided into 4 groups of 5. Group 1 served as the control, group 2 consisted of animals that underwent SCXL, group 3 -- of those after LTF, and group 4 -- of those after TIF+MyoRing. Femto step was performed using the IntraLase FS 60 kHz femtosecond laser, cross-linking - with the Evolution machine. The follow-up period was 1 month. Clinical study enrolled 48 patients (45 eyes) with stage II-III KC. Depending on the surgical technique all the patients were divided into 3 groups. In group I (14 eyes, 9 patients), TIF+MyoRing was performed, in group II (16 eyes, 20 patients) --SCXL, in group III (15 eyes, 19 patients) -- LTF. The follow-up period was 6 months. RESULTS The experiment showed a significant increase in rupture resistance of the cornea in all three groups. Six months after surgery, patients from group I demonstrated a 1.0±0.22 mmHg higher corneal resistance factor (CRF) and a 1.0±0.12 mmHg higher corneal hysteresis (CH). In group II, the said parameters increased by 0.8±0.10 mmHg and 0.6±0.16 mmHg, respectively; in group III -- by 0.8±0.25 mmHg and 0.6±0.26 mmHg, respectively. In neither group the density of endothelial cells has reduced significantly over the follow-up period. C-ONCLUSION: All three methods (LTF, TIF and SCXL) equally increase the biomechanical strength of the cornea and are safe. In patients with progressive stage II-III KC, TIF+MyoRing surgery has yielded an even higher improvement of biomechanical parameters in a 6-month follow-up period, which is due to the combination of mechanical and chemical mechanisms of corneal reinforcement.
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Affiliation(s)
- N P Pashtaev
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028; Postgraduate Doctors' Training Institute, Ministry of Healthcare and Social Development of the Chuvash Republic, 3 Krasnaya Sq., Cheboksary, Chuvash Republic, Russian Federation, 428003; The Chuvash State University named after I.N. Ulyanov, 15 Moskovskiy pr., Cheboksary, Chuvash Republic, Russian Federation, 428010
| | - N A Pozdeeva
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028; Postgraduate Doctors' Training Institute, Ministry of Healthcare and Social Development of the Chuvash Republic, 3 Krasnaya Sq., Cheboksary, Chuvash Republic, Russian Federation, 428003
| | - M V Sinitsyn
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028
| | - V V Zotov
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028
| | - B V Gagloev
- Postgraduate Doctors' Training Institute, Ministry of Healthcare and Social Development of the Chuvash Republic, 3 Krasnaya Sq., Cheboksary, Chuvash Republic, Russian Federation, 428003
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Ovchinsky A, Cranford JP. Medial orbital wall reconstruction with a porous polyethylene titan barrier implant. Ear Nose Throat J 2016; 95:102-103. [PMID: 26991217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Alexander Ovchinsky
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
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25
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Siebelmann S, Steven P, Hos D, Hüttmann G, Lankenau E, Bachmann B, Cursiefen C. Advantages of microscope-integrated intraoperative online optical coherence tomography: usage in Boston keratoprosthesis type I surgery. J Biomed Opt 2016; 21:16005. [PMID: 26780223 DOI: 10.1117/1.jbo.21.1.016005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/14/2015] [Indexed: 05/22/2023]
Affiliation(s)
- Sebastian Siebelmann
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, GermanybUniversity of Cologne, Cluster of Excellence: Cellular Stress Responses in Aging-associated Diseases, Joseph-Stelzmann-Straße 26, Cologne 50931, Germany
| | - Philipp Steven
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, GermanybUniversity of Cologne, Cluster of Excellence: Cellular Stress Responses in Aging-associated Diseases, Joseph-Stelzmann-Straße 26, Cologne 50931, Germany
| | - Deniz Hos
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, Germany
| | | | - Eva Lankenau
- OptoMedical Technologies GmbH (OPmedT), Maria-Goeppert-Straße 1, Luebeck 23562, Germany
| | - Björn Bachmann
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, Germany
| | - Claus Cursiefen
- University of Cologne, Department of Ophthalmology, Kerpener Strasse 62, Cologne 50924, Germany
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Nasseri MA, Eder M, Nair S, Dean EC, Maier M, Zapp D, Lohmann CP, Knoll A. The introduction of a new robot for assistance in ophthalmic surgery. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:5682-5. [PMID: 24111027 DOI: 10.1109/embc.2013.6610840] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper introduces the design and development of a new robotic system to assist surgeons performing ophthalmic surgeries. The robot itself is very compact and similar to an average human hand in size. Its primary application is intraocular micromanipulation in order to overcome the existing challenges in treatment of diseases like Retinal Vein Occlusion (RVO). The novel hybrid mechanism designed for this robot allows microscale motions and is stable in the presence of vibrations common in operation room (OR). The robotic system can be easily integrated into standard operation rooms and does not require modification of conventional surgical tools. This compact microsurgical system is suitable for mounting on the patient's head and thereby, solves the problem of patient motion. The compatibility of the robotic system with a real world surgical setup was evaluated and confirmed in this work.
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27
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Zhang H, Wang L, Cai Y, Ye R, Lin J, Jiang D. Application of a Quality Control Circle to Reduce the Wait Times between Continuous Surgeries. Eye Sci 2015; 30:60-62. [PMID: 26902062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To investigate how to shorten patient wait times between continuous ocular operations and to evaluate the influence of a quality control circle (QCC) on operating room management. METHODS QCC management was established to conduct activities. Clinical data were collected to analyze the causes of long wait times between continuous surgeries. Effective measures were undertaken correspondingly. RESULTS The staff from QCC actively undertook measures that would significantly shorten patient wait times between continuous ocular surgeries (P < 0.05). CONCLUSION Multiple measures, such as setting up a QCC, enhancing the arrangement of surgical procedures, establishing effective communication channels, optimizing human resources, and integrating the use of instruments, can effectively shorten patient wait times between continuous vitreous or retinal surgeries.
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Kotomin I, Valtink M, Hofmann K, Frenzel A, Morawietz H, Werner C, Funk RHW, Engelmann K. Sutureless fixation of amniotic membrane for therapy of ocular surface disorders. PLoS One 2015; 10:e0125035. [PMID: 25955359 PMCID: PMC4425509 DOI: 10.1371/journal.pone.0125035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/17/2015] [Indexed: 11/18/2022] Open
Abstract
Amniotic membrane is applied to the diseased ocular surface to stimulate wound healing and tissue repair, because it releases supportive growth factors and cytokines. These effects fade within about a week after application, necessitating repeated application. Generally, amniotic membrane is fixed with sutures to the ocular surface, but surgical intervention at the inflamed or diseased site can be detrimental. Therefore, we have developed a system for the mounting of amniotic membrane between two rings for application to a diseased ocular surface without surgical intervention (sutureless amniotic membrane transplantation). With this system, AmnioClip, amniotic membrane can be applied like a large contact lens. First prototypes were tested in an experiment on oneself for wearing comfort. The final system was tested on 7 patients in a pilot study. A possible influence of the ring system on the biological effects of amniotic membrane was analyzed by histochemistry and by analyzing the expression of vascular endothelial growth factor-A (VEGF-A), hepatocyte growth factor (HGF), fibroblast growth factor 2 (FGF 2) and pigment epithelium-derived factor (PEDF) from amniotic membranes before and after therapeutic application. The final product, AmnioClip, showed good tolerance and did not impair the biological effects of amniotic membrane. VEGF-A and PEDF mRNA was expressed in amniotic membrane after storage and mounting before transplantation, but was undetectable after a 7-day application period. Consequently, transplantation of amniotic membranes with AmnioClip provides a sutureless and hence improved therapeutic strategy for corneal surface disorders.
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Affiliation(s)
- Ilya Kotomin
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Monika Valtink
- Institute of Anatomy, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Kai Hofmann
- Deutsche Gesellschaft für Gewebetransplantation, DGFG, Hannover, Germany
| | - Annika Frenzel
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, TU Dresden, Dresden, Germany
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, TU Dresden, Dresden, Germany
- CRTD / DFG-Center for Regenerative Therapies Dresden—Cluster of Excellence, Dresden, Germany
| | - Carsten Werner
- CRTD / DFG-Center for Regenerative Therapies Dresden—Cluster of Excellence, Dresden, Germany
- Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Richard H. W. Funk
- Institute of Anatomy, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- CRTD / DFG-Center for Regenerative Therapies Dresden—Cluster of Excellence, Dresden, Germany
| | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
- Deutsche Gesellschaft für Gewebetransplantation, DGFG, Hannover, Germany
- CRTD / DFG-Center for Regenerative Therapies Dresden—Cluster of Excellence, Dresden, Germany
- * E-mail:
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Gupta A, Gonenc B, Balicki M, Olds K, Handa J, Gehlbach P, Taylor RH, Iordachita I. Human eye phantom for developing computer and robot-assisted epiretinal membrane peeling. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:6864-7. [PMID: 25571573 DOI: 10.1109/embc.2014.6945205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A number of technologies are being developed to facilitate key intraoperative actions in vitreoretinal microsurgery. There is a need for cost-effective, reusable benchtop eye phantoms to enable frequent evaluation of these developments. In this study, we describe an artificial eye phantom for developing intraocular imaging and force-sensing tools. We test four candidate materials for simulating epiretinal membranes using a handheld tremor-canceling micromanipulator with force-sensing micro-forceps tip and demonstrate peeling forces comparable to those encountered in clinical practice.
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Ayton LN, Blamey PJ, Guymer RH, Luu CD, Nayagam DAX, Sinclair NC, Shivdasani MN, Yeoh J, McCombe MF, Briggs RJ, Opie NL, Villalobos J, Dimitrov PN, Varsamidis M, Petoe MA, McCarthy CD, Walker JG, Barnes N, Burkitt AN, Williams CE, Shepherd RK, Allen PJ. First-in-human trial of a novel suprachoroidal retinal prosthesis. PLoS One 2014; 9:e115239. [PMID: 25521292 PMCID: PMC4270734 DOI: 10.1371/journal.pone.0115239] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022] Open
Abstract
Retinal visual prostheses (“bionic eyes”) have the potential to restore vision to blind or profoundly vision-impaired patients. The medical bionic technology used to design, manufacture and implant such prostheses is still in its relative infancy, with various technologies and surgical approaches being evaluated. We hypothesised that a suprachoroidal implant location (between the sclera and choroid of the eye) would provide significant surgical and safety benefits for patients, allowing them to maintain preoperative residual vision as well as gaining prosthetic vision input from the device. This report details the first-in-human Phase 1 trial to investigate the use of retinal implants in the suprachoroidal space in three human subjects with end-stage retinitis pigmentosa. The success of the suprachoroidal surgical approach and its associated safety benefits, coupled with twelve-month post-operative efficacy data, holds promise for the field of vision restoration. Trial Registration Clinicaltrials.gov NCT01603576
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Affiliation(s)
- Lauren N. Ayton
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- * E-mail:
| | - Peter J. Blamey
- Bionics Institute, East Melbourne, Australia
- Department of Medical Bionics, University of Melbourne, East Melbourne, Australia
| | - Robyn H. Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Chi D. Luu
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - David A. X. Nayagam
- Bionics Institute, East Melbourne, Australia
- Department of Pathology, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | | | - Mohit N. Shivdasani
- Bionics Institute, East Melbourne, Australia
- Department of Medical Bionics, University of Melbourne, East Melbourne, Australia
| | - Jonathan Yeoh
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Mark F. McCombe
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Robert J. Briggs
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Nicholas L. Opie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | - Peter N. Dimitrov
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Mary Varsamidis
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | - Chris D. McCarthy
- NICTA, Computer Vision Research Group, Canberra, Australia
- National Institute for Mental Health Research, Australian National University, Canberra, Australia
| | - Janine G. Walker
- NICTA, Computer Vision Research Group, Canberra, Australia
- National Institute for Mental Health Research, Australian National University, Canberra, Australia
| | - Nick Barnes
- NICTA, Computer Vision Research Group, Canberra, Australia
- National Institute for Mental Health Research, Australian National University, Canberra, Australia
| | - Anthony N. Burkitt
- Bionics Institute, East Melbourne, Australia
- Centre for Neural Engineering, University of Melbourne, National Information and Communications Technology Australia (NICTA), Ltd., Melbourne, Australia
| | | | - Robert K. Shepherd
- Bionics Institute, East Melbourne, Australia
- Department of Medical Bionics, University of Melbourne, East Melbourne, Australia
| | - Penelope J. Allen
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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Cheung N, Wong D. Graefe's archive for clinical and experimental ophthalmology-instant glue for retinal detachment surgery? Graefes Arch Clin Exp Ophthalmol 2014; 252:1695-6. [PMID: 25283771 DOI: 10.1007/s00417-014-2788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ning Cheung
- The Eye Institute, Department of Ophthalmology, University of Hong Kong, Pokfulam, Hong Kong, China
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Mandelcorn ED, Kitchens JW, Fijalkowski N, Moshfeghi DM. Active aspiration of suprachoroidal hemorrhage using a guarded needle. Ophthalmic Surg Lasers Imaging Retina 2014; 45:150-2. [PMID: 24635157 DOI: 10.3928/23258160-20140306-09] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 11/22/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe a novel technique using a guarded needle to drain suprachoroidal hemorrhage. PATIENTS AND METHODS A guarded needle is used to drain suprachoroidal hemorrhage under direct microscope visualization. A scleral buckling sleeve is used to create a guarded 26-gauge needle to avoid over-penetration of the needle beyond the suprachoroidal space. Active extrusion can be used to drain suprachoroidal blood. RESULTS The authors report two cases in which active aspiration using a guarded needle was successful in draining suprachoroidal hemorrhage without complications. In both cases, the vitreous cavity could be restored, allowing for subsequent pars plana vitrectomy. CONCLUSION The technique of active aspiration using a guarded needle optimizes surgeon control of suprachoroidal hemorrhage drainage and also has the added benefit of easy transition to secondary vitrectomy after drainage has been completed.
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Horvath S, Galeotti J, Siegel M, Stetten G. Refocusing a scanned laser projector for small and bright images: simultaneously controlling the profile of the laser beam and the boundary of the image. Appl Opt 2014; 53:5421-5424. [PMID: 25321114 PMCID: PMC4476398 DOI: 10.1364/ao.53.005421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/20/2014] [Indexed: 06/04/2023]
Abstract
This paper describes a projection system for augmenting a scanned laser projector to create very small, very bright images for use in a microsurgical augmented reality system. Normal optical design approaches are insufficient because the laser beam profile differs optically from the aggregate image. We propose a novel arrangement of two lens groups working together to simultaneously adjust both the laser beam of the projector (individual pixels) and the spatial envelope containing them (the entire image) to the desired sizes. The present work models such a system using paraxial beam equations and ideal lenses to demonstrate that there is an "in-focus" range, or depth of field, defined by the intersection of the resulting beam-waist radius curve and the ideal pixel radius for a given image size. Images within this depth of field are in focus and can be adjusted to the desired size by manipulating the lenses.
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Affiliation(s)
- Samantha Horvath
- Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue Pittsburgh, PA 15213
| | - John Galeotti
- Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue Pittsburgh, PA 15213
- Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219
| | - Mel Siegel
- Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue Pittsburgh, PA 15213
| | - George Stetten
- Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue Pittsburgh, PA 15213
- Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219
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Liang S, Wan G, Li X, Liu X, Zhu Y. Removal of a giant nonmagnetic intraocular foreign body using micro alligator forceps. Ophthalmic Surg Lasers Imaging Retina 2014; 45:228-30. [PMID: 24716803 DOI: 10.3928/23258160-20140407-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/30/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To introduce a new method for removal of a giant nonmagnetic intraocular foreign body using micro alligator forceps. PATIENTS AND METHODS Eleven patients underwent pars plana vitrectomy and lensectomy. The micro alligator forceps were used to grasp and extract the giant nonmagnetic intraocular foreign body through a sclerocorneal tunnel. RESULTS All patients underwent surgical removal of the intraocular foreign body successfully without any intraoperative complications. The alligator forceps were operational in the intraocular environment and effective in surgical maneuvers. There was no accidental slippage during the procedures. CONCLUSION Micro alligator forceps are a feasible option for removal of giant nonmagnetic intraocular foreign body during vitreoretinal surgery and offer advances in terms of operating stability and surgical safety.
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Keeler R, Singh AD, Dua HS. The instrumental Nathaniel Bishop Harman (1869-1945). Br J Ophthalmol 2014; 98:152-3. [PMID: 24571004 DOI: 10.1136/bjophthalmol-2013-304773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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36
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Ryan G, Lee GA, Maccheron L. Epithelial debridement with diamond burr superficial keratectomy for the treatment of recurrent corneal erosion. Clin Exp Ophthalmol 2014; 41:621-2. [PMID: 23230823 DOI: 10.1111/ceo.12052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 11/07/2012] [Indexed: 11/30/2022]
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Sakai T, Harada K, Tanaka S, Ueta T, Noda Y, Sugita N, Mitsuishi M. Design and development of miniature parallel robot for eye surgery. Annu Int Conf IEEE Eng Med Biol Soc 2014; 2014:371-374. [PMID: 25569974 DOI: 10.1109/embc.2014.6943606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A five degree-of-freedom (DOF) miniature parallel robot has been developed to precisely and safely remove the thin internal limiting membrane in the eye ground during vitreoretinal surgery. A simulator has been developed to determine the design parameters of this robot. The developed robot's size is 85 mm × 100 mm × 240 mm, and its weight is 770 g. This robot incorporates an emergency instrument retraction function to quickly remove the instrument from the eye in case of sudden intraoperative complications such as bleeding. Experiments were conducted to evaluate the robot's performance in the master-slave configuration, and the results demonstrated that it had a tracing accuracy of 40.0 μm.
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Hutchens TC, Darafsheh A, Fardad A, Antoszyk AN, Ying HS, Astratov VN, Fried NM. Detachable microsphere scalpel tips for potential use in ophthalmic surgery with the erbium:YAG laser. J Biomed Opt 2014; 19:18003. [PMID: 24441945 DOI: 10.1117/1.jbo.19.1.018003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/18/2013] [Indexed: 05/03/2023]
Abstract
Vitreoretinal surgery is performed using mechanical dissection that sometimes results in iatrogenic complications, including vitreous hemorrhage, retinal breaks, incomplete membrane delamination, retinal distortion, microscopic damage, etc. An ultraprecise laser probe would be an ideal tool for cutting away pathologic membranes; however, the depth of surgery should be precisely controlled to protect the sensitive underlying retina. The ultraprecise surgical microprobe formed by chains of dielectric spheres for use with the erbium:YAG laser source (λ=2940 nm), with extremely short optical penetration depth in tissue, was optimized. Numerical modeling demonstrated a potential advantage of five-sphere focusing chains of sapphire spheres with index n=1.71 for ablating the tissue with self-limited depth around 10 to 20 μm. Novel detachable microsphere scalpel tips formed by chains of 300 μm sapphire (or ruby) spheres were tested on ophthalmic tissues, ex vivo. Detachable scalpel tips could allow for reusability of expensive mid-infrared trunk fibers between procedures, and offer more surgical customization by interchanging various scalpel tip configurations. An innovative method for aiming beam integration into the microsphere scalpel to improve the illumination of the surgical site was also shown. Single Er:YAG pulses of 0.2 mJ and 75-μs duration produced ablation craters in cornea epithelium for one, three, and five sphere structures with the latter generating the smallest crater depth (10 μm) with the least amount of thermal damage depth (30 μm). Detachable microsphere laser scalpel tips may allow surgeons better precision and safety compared to mechanical scalpels when operating on delicate or sensitive areas like the retina.
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Affiliation(s)
- Thomas C Hutchens
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina
| | - Arash Darafsheh
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina
| | | | - Andrew N Antoszyk
- Retina Service, Charlotte Eye Ear Nose and Throat Associates, Charlotte, North Carolina
| | - Howard S Ying
- Johns Hopkins University, Wilmer Eye Institute, Baltimore, Maryland
| | - Vasily N Astratov
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina
| | - Nathaniel M Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina
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Bedard J, Moore CD, Shelton W. A survey of healthcare industry representatives' participation in surgery: some new ethical concerns. J Clin Ethics 2014; 25:238-244. [PMID: 25192348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To provide preliminary evidence of the types and amount of involvement by healthcare industry representatives (HCIRs) in surgery, as well as the ethical concerns of those representatives. METHODS A link to an anonymous, web-based survey was posted on several medical device boards of the website http://www. cafepharma.com. Additionally, members of two different medical device groups on LinkedIn were asked to participate. Respondents were self-identified HCIRs in the fields of orthopedics, cardiology, endoscopic devices, lasers, general surgery, ophthalmic surgery, oral surgery, anesthesia products, and urologic surgery. RESULTS A total of 43 HCIRs replied to the survey over a period of one year: 35 men and eight women. Respondents reported attending an average of 184 surgeries in the prior year and had an average of 17 years as an HCIR and six years with their current employer. Of the respondents, 21 percent (nine of 43) had direct physical contact with a surgical team or patient during a surgery, and 88 percent (38 of 43) provided verbal instruction to a surgical team during a surgery. Additionally, 37 percent (16 of 43) had participated in a surgery in which they felt that their involvement was excessive, and 40 percent (17 of 43) had attended a surgery in which they questioned the competence of the surgeon. CONCLUSIONS HCIRs play a significant role in surgery. Involvement that exceeds their defined role, however, can raise serious ethical and legal questions for surgeons and surgical teams. Surgical teams may at times be substituting the knowledge of the HCIR for their own competence with a medical device or instrument. In some cases, contact with the surgical team or patient may violate the guidelines not only of hospitals and medical device companies, but the law as well. Further study is required to determine if the patients involved have any knowledge or understanding of the role that an HCIR played in their surgery.
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Affiliation(s)
- Jeffrey Bedard
- Albany Medical College, MC153, 47 New Scotland, Albany, New York 12208 USA
| | - Crystal Dea Moore
- Skidmore College, Department of Social Work, Sarasota Springs, New York 12866 USA
| | - Wayne Shelton
- Albany Medical College, MC153, 47 New Scotland, Albany, New York 12208 USA.
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40
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Belin MW, Hannush SB. Endothelial keratoplasty: prospective, randomized, masked clinical trial comparing an injector with forceps for tissue insertion. Am J Ophthalmol 2013; 156:1318. [PMID: 24238205 DOI: 10.1016/j.ajo.2013.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 08/14/2013] [Accepted: 08/29/2013] [Indexed: 11/19/2022]
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Liu Z, Sha X, Liang X, Wang Z. Use of silicone tubes to repair canalicular lacerations via a novel method. Eye Sci 2013; 28:195-200. [PMID: 24961092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To develop a novel method to repair canalicular lacerations using silicone tubes. METHODS A total of 47 adult patients (47 eyes) with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012. The age ranged from 16 to 53 years. Among the 47 eyes, 37 had lower canalicular lacerations, 6 had upper canalicular lacerations, and 4 had bicanalicular lacerations. A soft probe was made using a stainless steel acupuncture needle, which was inserted into the lumen of the proximal part of the catheter to increase its rigidity. The probe was then inserted into the lacrimal sac and nasolacrimal duct. After retrieval of the catheters, the two ends of the silicone tube were securely tied (end to end) to the catheters. The silicon tube outside the nostril formed a U-shape. The catheters were then pulled upward until the silicone tube was completely located in the canalicular system. The catheters were cut off of the silicone tube near the site of the connection. The two ends of the silicone tube were cut short, -2mm out of the lacrimal punctum, and tied securely, end to end. The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus, and the suture was removed through the nostril. The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI). RESULTS All cases were anatomically rehabilitated after surgery. The silicone tube was removed after implanted in 3-10 months (mean 4.5 +/- 1.3 months), the average follow-up time was 11.8 months after removal. In total, 45 eyes in all 47 eyes (95.74%) were free from obstruction. Among them, 41 eyes (91.11%) achieved complete success (completely disappearance of epiphora after tube removal), 4 eyes (8.89%) achieved partial success (irritation occurs under stimulation conditions, such as wind or cold conditions), 4 eyes showed postoperative tearing, with three eyes having inferior lacrimal duct laceration, and one eye with superior canalicular laceration. Apart from two cases (4.26%) suffering inferior punctum splitting, no other associated issues occurred with the silicone tube or iatrogenic injury and lacrimal complications. CONCLUSION For adult patients with canalicular laceration, the NCI was an effective, atraumatic surgery, which has fewer complications than traditional canalicular suture.
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Terry MA. Reply: To PMID 23522354. Am J Ophthalmol 2013; 156:1318-9. [PMID: 24238206 DOI: 10.1016/j.ajo.2013.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
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Belay ED, Blase J, Sehulster LM, Maddox RA, Schonberger LB. Management of neurosurgical instruments and patients exposed to Creutzfeldt-Jakob disease. Infect Control Hosp Epidemiol 2013; 34:1272-80. [PMID: 24225612 PMCID: PMC4748700 DOI: 10.1086/673986] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the approaches used to manage exposure of patients to inadequately sterilized neurosurgical instruments contaminated as a result of Creutzfeldt-Jakob disease (CJD). METHODS Information on past CJD exposure incidents reported to the Centers for Disease Control and Prevention (CDC) was aggregated and summarized. In addition, inactivation studies were reviewed, and data from selected publications were provided for reference. RESULTS Nineteen incidents of patient exposure to potentially CJD-contaminated instruments were reported to the CDC, including 17 that involved intracranial procedures and 2 that involved ophthalmologic procedures. In more than 50% of incidents, the neurosurgical procedures were performed for diagnostic work up of the index patients. At least 12 of the hospitals had multiple neurosurgical sets, and the CJD-contaminated instruments could not be identified in 11 of 19 hospitals. In 12 of 15 hospitals with neurosurgical incidents, a decision was made to notify patients of their potential exposure. CONCLUSIONS Neurosurgical instruments used for treatment of patients with suspected or diagnosed CJD or patients whose diagnosis is unclear should be promptly identified and sterilized using recommended CJD decontamination protocols. Inability to trace instruments complicates appropriate management of exposure incidents. The feasibility of instituting instrument tracking procedures should be considered.
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Affiliation(s)
- Ermias D Belay
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Food and Drug Administration, HHS. Medical devices; ophthalmic devices; classification of the scleral plug. Final rule. Fed Regist 2013; 78:68714-5. [PMID: 24236336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Food and Drug Administration (FDA or Agency) is classifying the scleral plug into class II (special controls), and exempting the scleral plugs composed of surgical grade stainless steel (with or without coating in gold, silver, or titanium) from premarket notification (510(k)) and continuing to require premarket notification (510(k)) for all other scleral plugs in order to provide a reasonable assurance of safety and effectiveness of the device. The scleral plug is a prescription device used to provide temporary closure of a scleral incision during an ophthalmic surgical procedure.
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Sasaki T, Nishijima M. [Preservation of visual function by intraoperative VEP monitoring: consideration from surgical procedures caused VEP changes]. No Shinkei Geka 2013; 41:961-976. [PMID: 24190622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Tatsuya Sasaki
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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Yang S, Wells TS, Maclachlan RA, Riviere CN. Performance of a 6-degree-of-freedom active microsurgical manipulator in handheld tasks. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:5670-3. [PMID: 24111024 DOI: 10.1109/embc.2013.6610837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents the first experimental results from human users of a new 6-degree-of-freedom handheld micromanipulator. This is the latest prototype of a fully-handheld system, known as "Micron," which performs active compensation of hand tremor for microsurgery. The manipulator is a miniature Gough-Stewart platform incorporating linear ultrasonic motors that provide a cylindrical workspace 4 mm long and 4 mm wide. In addition, the platform allows the possibility of imposing a remote center of motion for controlling motion not only at the tip but also at the entry point in the sclera of the eye. We demonstrate hand tremor reduction in both static and dynamic micromanipulation tasks on a rubber pad. The handheld performance is also evaluated in an artificial eye model while imposing a remote center of motion. In all cases, hand tremor is significantly reduced.
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Tamashiro NSM, Souza RQ, Gonçalves CR, Ikeda TI, Luz RA, Cruz AS, Padoveze MC, Graziano KU. Cytotoxicity of cannulas for ophthalmic surgery after cleaning and sterilization: evaluation of the use of enzymatic detergent to remove residual ophthalmic viscosurgical device material. J Cataract Refract Surg 2013; 39:937-41. [PMID: 23688881 DOI: 10.1016/j.jcrs.2012.12.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/22/2012] [Accepted: 12/31/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the cytotoxicity of reusable cannulas for ophthalmic surgery after the cannulas were filled with an ophthalmic viscosurgical device (OVD) and cleaned with an enzymatic detergent. SETTING Microbiological Testing Laboratory, Department of Medical-Surgical Nursing, University of São Paulo School of Nursing, and Cell Culture Section, Adolfo Lutz Institute, São Paulo, Brazil. DESIGN Experimental study. METHODS The sample consisted of 30 reusable 25-gauge injection cannulas, 20.0 mm in length, whose lumens were filled with an OVD solution for 50 minutes. The following steps were used to process the cannulas: (1) presoaking, (2) washing the lumen using a high-pressure water jet, (3) backwashing with enzymatic detergent in ultrasonic cleaner, (4) preliminary rinsing with tap water, (5) final rinsing with sterile distilled water, (6) drying with compressed filtered air, (7) wrapping in surgical-grade paper, and (8) steam sterilization at 134°C for 4 minutes. The cannulas were then tested for cytotoxicity according to the United States Pharmacopeia 32. RESULTS The cleaning protocol used in this study removed residues of OVD solution and enzymatic detergent as shown by the lack of cytotoxicity of all sample extracts. CONCLUSION This cleaning protocol has the potential to minimize the occurrence of toxic anterior segment syndrome associated with residues of OVD solutions and enzymatic detergents. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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48
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Sznitman R, Richa R, Taylor RH, Jedynak B, Hager GD. Unified detection and tracking of instruments during retinal microsurgery. IEEE Trans Pattern Anal Mach Intell 2013; 35:1263-1273. [PMID: 23520263 DOI: 10.1109/tpami.2012.209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Methods for tracking an object have generally fallen into two groups: tracking by detection and tracking through local optimization. The advantage of detection-based tracking is its ability to deal with target appearance and disappearance, but it does not naturally take advantage of target motion continuity during detection. The advantage of local optimization is efficiency and accuracy, but it requires additional algorithms to initialize tracking when the target is lost. To bridge these two approaches, we propose a framework for unified detection and tracking as a time-series Bayesian estimation problem. The basis of our approach is to treat both detection and tracking as a sequential entropy minimization problem, where the goal is to determine the parameters describing a target in each frame. To do this we integrate the Active Testing (AT) paradigm with Bayesian filtering, and this results in a framework capable of both detecting and tracking robustly in situations where the target object enters and leaves the field of view regularly. We demonstrate our approach on a retinal tool tracking problem and show through extensive experiments that our method provides an efficient and robust tracking solution.
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Affiliation(s)
- Raphael Sznitman
- EPFL IC ISIM CVLAB, BC 309 (Batiment BC), Station 14, Lausanne, Switzerland.
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49
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Xie LX, Gao H. [Understanding the advantages and disadvantages of femtosecond laser comprehensive applications in ophthalmology]. Zhonghua Yan Ke Za Zhi 2013; 49:289-291. [PMID: 23900085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The femtosecond (FS) laser is a novel laser technology, and is approved clinical application by FDA in 2000. FS laser initially mainly used in corneal refractive surgery to replace the mechanical microkeratome. Since the accuracy and controllability of the FS laser is very high, it shows superiority in the field of corneal refractive surgery. And with the development of the relative hard and software, FS laser is began to used in other fields of ophthalmology, such as corneal transplants, cataract surgery, as well as assisted diagnosis et al., although still have some limitations, the preliminary clinical results have been shown a very good prospects in the ophthalmology fields. Therefore, we reviewed the alternative applications, challenges and limitations, research direction in the future of FS laser, so that provide a reference and revelations for the peers.
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Hamard P, El Maftouhi A, Baudouin C. [Molteno implant and the vicryl tie technique: role of Visante anterior segment OCT]. J Fr Ophtalmol 2013; 36:469-71. [PMID: 23433525 DOI: 10.1016/j.jfo.2012.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 09/24/2012] [Indexed: 11/18/2022]
Affiliation(s)
- P Hamard
- CHNO des XV XX, 28, rue de Charenton, 75012 Paris, France.
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