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Open AccessArticle

Demonstration of Optical Coherence Tomography Guided Big Bubble Technique for Deep Anterior Lamellar Keratoplasty (DALK)

1
Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
2
Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
3
Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
*
Author to whom correspondence should be addressed.
Current address: Barton Hall, 3400N Charles St., Baltimore, MD 21218, USA.
Sensors 2020, 20(2), 428; https://doi.org/10.3390/s20020428
Received: 30 November 2019 / Revised: 7 January 2020 / Accepted: 8 January 2020 / Published: 12 January 2020
(This article belongs to the Special Issue Multisensor Intelligent Medical Robotics)
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. View Full-Text
Keywords: common-path optical coherence tomography; distal sensor integrated needle; AUTO-DALK; deep anterior lamellar keratoplasty; big bubble technique; Descemet’s membrane common-path optical coherence tomography; distal sensor integrated needle; AUTO-DALK; deep anterior lamellar keratoplasty; big bubble technique; Descemet’s membrane
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Guo, S.; Sarfaraz, N.R.; Gensheimer, W.G.; Krieger, A.; Kang, J.U. Demonstration of Optical Coherence Tomography Guided Big Bubble Technique for Deep Anterior Lamellar Keratoplasty (DALK). Sensors 2020, 20, 428.

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