Comparison of vitreoretinal disorders in fellow eyes of lamellar macular holes versus epiretinal membrane foveoschisis.

PURPOSE: To evaluate and compare the rate and characteristics of vitreoretinal disorders in fellow eyes of lamellar macular holes (LMH) versus epiretinal membrane foveoschisis (ERMF). METHODS: Included patients in this retrospective study were divided into two groups based on spectral-domain optical coherence tomography (SD-OCT) features of their primary eye: LMH (group A) and ERMF (group B). RESULTS: Ninety-four patients were enrolled: 59 (62.8%) in group A and 35 (37.2%) in group B. Fellow eyes in group A had a higher rate of retinal detachment (8/59 [13.6%] vs. 0/35 [0%], P = 0.024), and full-thickness macular hole (FTMH) (11/59 [18.6%] vs. 2/35 [5.7%], P = 0.079), compared with fellow eyes in group B. In group A, 4/59 patients (6.8%) showed a bilateral LMH while none from group B had a LMH in their fellow eye (0/35 [0%]), P = 0.293. Additionally, epiretinal proliferation was noted in 30/59 (50.8%) fellow eyes in group A versus 3/35 (8.6%) fellow eyes in group B, P < 0.001. Longitudinal data were available for 80/94 patients. Over a mean follow-up of 37.4 ± 29.9 months, 1/48 (2.1%) fellow eyes from group A developed a FTMH and 2/48 (4.2%) developed a LMH, while no FTMH or LMH occurred in fellow eyes of group B. CONCLUSIONS: Fellow eyes of LMH showed a high rate of macular and peripheral vitreoretinal disorders. In addition, epiretinal proliferation was detected in a higher number of fellow eyes of LMH versus ERMF. These findings suggest a bilateral process in eyes of patients with LMH.

Semiautomated optical coherence tomography-guided robotic surgery for porcine lens removal.

PURPOSE: To evaluate semiautomated surgical lens extraction procedures using the optical coherence tomography (OCT)-integrated Intraocular Robotic Interventional Surgical System. SETTING: Stein Eye Institute and Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, USA. DESIGN: Experimental study. METHODS: Semiautomated lens extraction was performed on postmortem pig eyes using a robotic platform integrated with an OCT imaging system. Lens extraction was performed using a series of automated steps including robot-to-eye alignment, irrigation/aspiration (I/A) handpiece insertion, anatomic modeling, surgical path planning, and I/A handpiece navigation. Intraoperative surgical supervision and human intervention were enabled by real-time OCT image feedback to the surgeon via a graphical user interface. Manual preparation of the pig-eye models, including the corneal incision and capsulorhexis, was performed by a trained cataract surgeon before the semiautomated lens extraction procedures. A scoring system was used to assess surgical complications in a postoperative evaluation. RESULTS: Complete lens extraction was achieved in 25 of 30 eyes. In the remaining 5 eyes, small lens pieces (≤1.0 mm3) were detected near the lens equator, where transpupillary OCT could not image. No posterior capsule rupture or corneal leakage occurred. The mean surgical duration was 277 seconds ± 42 (SD). Based on a 3-point scale (0 = no damage), damage to the iris was 0.33 ± 0.20, damage to the cornea was 1.47 ± 0.20 (due to tissue dehydration), and stress at the incision was 0.97 ± 0.11. CONCLUSIONS: No posterior capsule rupture was reported. Complete lens removal was achieved in 25 trials without significant surgical complications. Refinements to the procedures are required before fully automated lens extraction can be realized.

Intraocular robotic interventional surgical system (IRISS): Semi-automated OCT-guided cataract removal.

BACKGROUND: With the development of laser-assisted platforms, the outcomes of cataract surgery have been improved by automating several procedures. The cataract-extraction step continues to be manually performed, but due to deficiencies in sensing capabilities, surgical complications such as posterior capsule rupture and incomplete cataract removal remain. METHODS: An optical coherence tomography (OCT) system is integrated into our intraocular robotic interventional surgical system (IRISS) robot. The OCT images are used for preoperative planning and intraoperative intervention in a series of automated procedures. Real-time intervention allows surgeons to evaluate the progress and override the operation. RESULTS: The developed system was validated by performing lens extraction on 30 postmortem pig eyes. Complete lens extraction was achieved on 25 eyes, and "almost complete" extraction was achieved on the remainder due to an inability to image small lens particles behind the iris. No capsule rupture was found. CONCLUSION: The IRISS successfully demonstrated semiautomated OCT-guided lens removal with real-time supervision and intervention.