Enabling technology for image-guided robot-assisted sub-retinal injections

图像引导机器人辅助视网膜下注射的实现技术

• 批准号: 10019539
• 负责人: IULIAN IOAN IORDACHITA
• 金额: $ 50.4万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10019539
• 关键词: 3-Dimensional; 4D Imaging; Age related macular degeneration; Anatomy; Animals; Area; Atrophic; Back; Biological; Biological Products; Biological Response Modifier Therapy; Blindness; Cell Therapy; Cell physiology; Cells; Choroidal Neovascularization; Clinical; Complex; Computers; Consumption; Dangerousness; Data; Development; Disease; Drusen; Educational process of instructing; Elderly; Ensure; Environment; Eye; Eye diseases; Foundations; Functional disorder; Future; Gene Transduction Agent; Genes; Genetic; Goals; Growth; Hand; Healthcare Systems; Image; Imaging technology; Injections; Institutional Review Boards; Intuition; Location; Macular degeneration; Methods; Motion; Movement; Natural regeneration; Needles; Nonexudative age-related macular degeneration; Operative Surgical Procedures; Ophthalmologist; Optical Coherence Tomography; Patients; Performance; Pharmacology; Photoreceptors; Physicians; Physiological; Physiology; Preparation; Prevalence; Procedures; Reproducibility; Research; Retina; Retinal Detachment; Retinal Diseases; Risk; Robot; Robotics; Safety; Savings; Scheme; Shapes; Signal Transduction; Specialist; Structure of retinal pigment epithelium; Surgeon; Surgical Instruments; System; Systems Integration; Techniques; Technology; Testing; Therapeutic; Therapeutic Agents; Time; Tissues; Translations; Treatment Efficacy; Tremor; Vision; Visualization; base; bevacizumab; care costs; clinical care; cost; design; design and construction; effective therapy; gene therapy; high resolution imaging; human disease; image guided; in vivo; innovation; instrument; interest; man; minimally invasive; nanoparticle; new technology; novel; novel therapeutics; preclinical evaluation; prevent; prototype; retinal damage; retinal imaging; robot assistance; robotic system; sensor; standard of care; stem cell therapy; stem cells; subretinal injection; success; symptom treatment; targeted delivery; tool; virtual; visual information

Project Summary The goal of this proposal is to design, develop and evaluate a novel clinically compatible surgical platform for enhancing the retina surgeon's ability to provide therapy to the subretinal domain. Efficient, safe, reproducible delivery methods would enable safe and precise delivery of stem cell, nanoparticle and gene therapies for prevalent ocular diseases including but not limited to Age-related Macular Degeneration (AMD). The proposed cooperative surgical robot utilizes force-sensing instruments that are guided by 4D intraoperative Optical Coherence Tomography (4D-iOCT) imaging for intuitive surgeon-robot-patient interfaces. It is recognized that precise surgical access to the subretinal and intraretinal spaces would provide novel treatment options for a number of prevalent ocular diseases; the fact that AMD remains the leading cause of blindness in the elderly as well as its extraordinary cost of care makes it a strategic prototype condition for advances in therapy. During the last decade, stem cells and gene therapy have been extensively explored as treatments for AMD. Preliminary results indicate a promising safety profile, and suggest potential efficacy for both. However, translation of these methods into a clinical standard of care has in part, been limited by lack of a method to easily, safely, reproducibly and effectively deliver fully viable agents to the subretinal space. By advancing robotic technology, we seek to safely and reliably enhance access to the subretinal space to allow for the targeted delivery of novel therapeutic agents in the setting of prevalent retinal diseases, such as AMD. Our aims are: (1) Develop and evaluate a clinically compatible cooperative-controlled robotic assistant to enable precise tool manipulation. The enhanced functionality will allow for precise targeted delivery, proper orientation of cells and genetic cargo in the subretinal space, and enhanced survival of therapeutic biological agents; (2) Develop and integrate a novel path planning function to the workstation that will facilitate robot- assisted subretinal injections: utilizing real-time intraoperative 3D OCT images we will detect and track previously invisible subretinal microstructure, optimize approach trajectories to achieve safe, controlled and precise subretinal injections into the target space. Virtual fixtures will be incorporated into the design to avoid dangerous motions; (3) System integration and preclinical evaluation: we will develop assistive control schemes and workflow that fuse the tool-tissue interactions captured by the force-sensing instruments and the visual information provided by the OCT system. In addition, comparison of the new technology against current surgical techniques, in vivo, will be conducted to demonstrate the feasibility of our approach. This highly innovative system will enable surgeons to perform complex maneuvers in a tremor free environment with a higher level of precision than previously possible and with the ability to sense tool-to-tissue interactions that have been previously imperceptible. We envision this development as a logical next step in the integration of man, machine and computer for the performance of unprecedented microsurgical maneuvers.

项目概要 该提案的目标是设计、开发和评估一种新型的临床兼容手术平台 用于增强视网膜外科医生为视网膜下区域提供治疗的能力。高效、安全、可重复 递送方法将能够安全、精确地递送干细胞、纳米粒子和基因疗法 常见的眼部疾病，包括但不限于年龄相关性黄斑变性（AMD）。拟议的 协作手术机器人利用由 4D 术中光学引导的力传感仪器 相干断层扫描 (4D-iOCT) 成像，实现直观的外科医生-机器人-患者界面。 人们认识到，精确的手术进入视网膜下和视网膜内空间将提供新的方法。 多种常见眼部疾病的治疗方案； AMD 仍然是导致这一问题的主要原因 老年人失明及其高昂的护理费用使其成为一种战略原型条件 治疗方面的进步。在过去的十年中，干细胞和基因疗法得到了广泛的探索 AMD 的治疗。初步结果显示了良好的安全性，并表明了潜在的功效 两个都。然而，将这些方法转化为临床护理标准在一定程度上受到缺乏 一种简单、安全、可重复且有效地将完全可行的药物递送至视网膜下腔的方法。 通过推进机器人技术，我们寻求安全可靠地增强进入视网膜下空间的机会 允许在流行的视网膜疾病中靶向输送新型治疗剂，例如 AMD。我们的目标是：（1）开发和评估临床兼容的协作控制机器人助手 实现精确的工具操作。增强的功能将允许精确的目标交付、正确的 视网膜下空间中细胞和遗传货物的定向，并提高治疗性生物的存活率 代理； (2) 开发一种新颖的路径规划功能并将其集成到工作站中，以促进机器人 辅助视网膜下注射：利用实时术中 3D OCT 图像，我们将事先检测和跟踪 隐形视网膜下微结构，优化接近轨迹，实现安全、可控、精准 视网膜下注射到目标空间。虚拟灯具将纳入设计中以避免危险 动议； （3）系统集成和临床前评估：我们将开发辅助控制方案和 融合力传感仪器和视觉捕捉的工具-组织相互作用的工作流程 OCT系统提供的信息。此外，新技术与当前手术的比较 将进行体内技术来证明我们方法的可行性。 这种高度创新的系统将使外科医生能够在无震颤的情况下执行复杂的操作 环境的精度比以前更高，并且能够感知工具到组织 以前无法察觉的相互作用。我们认为这一发展是合乎逻辑的下一步 人、机器和计算机的集成，用于执行前所未有的显微外科手术。