Optical Coherence Tomography Guided Robotic Device for Autonomous Needle Insertion in Cornea Transplant Surgery

This paper reports the design and evaluation of a novel robotic device for cornea transplant surgery. The device enables the OCT-sensor guided Big Bubble hydro-dissection approach for deep anterior lamellar keratoplasty (DALK) cornea transplant surgery. DALK is highly challenging because it requires precise placement of a needle into the stroma of the cornea down to Descemets Membrane (DM) and injects a fluid to separate the remaining stroma from Descemet's membrane. Finally, the stroma is removed and replaced with the donor cornea graft. Compared to traditional penetrating keratoplasty (PK), which involves a full-thickness graft, this method significantly reduces the risk of rejection of the donor cornea by keeping the DM intact. A comparison of autonomous OCT guided needle insertions with expert manual needle insertions showed that the device significantly increased the precision and consistency of the needle placement, which could lead to better visual outcomes and fewer complications. In a study on cadaver porcine eyes, the measured insertion depth as a percentage of cornea thickness for the robotic device was 90.05% +/- 2.33% compared to 79.16% +/- 5.68% for manual insertions.