Artificial intelligence applications in ophthalmic surgery.

Purpose Of Review: Technologies in healthcare incorporating artificial intelligence tools are experiencing rapid growth in static-image-based applications such as diagnostic imaging. Given the proliferation of artificial intelligence (AI)-technologies created for video-based imaging, ophthalmic microsurgery is likely to experience significant benefits from the application of emerging technologies to multiple facets of the care of the surgical patient.

Recent Findings: Proof-of-concept research and early phase clinical trials are in progress for AI-based surgical technologies that aim to provide preoperative planning and decision support, intraoperative image enhancement, surgical guidance, surgical decision-making support, tactical assistive technologies, enhanced surgical training and assessment of trainee progress, and semi-autonomous tool control or autonomous elements of surgical procedures.

Ultrasonic Vitrectomy Performance Assessment Using Micro-Extensional Rheology.

Purpose: The purpose of this study was to assess the performance of ultrasonic (US) vitrectomy devices by quantifying and comparing its impact on extracted vitreous properties to conventional pneumatic blade (PB) cutters using micro-extensional rheology. US vitrectomy is a new technology that offers an alternative to PB cutters used in vitreo-retinal surgeries.

Methods: Thirty-six porcine vitreous samples were extracted using US and PB cutters.

Automated Retinal Vein Cannulation on Silicone Phantoms Using Optical-Coherence-Tomography-Guided Robotic Manipulations.

Retinal vein occlusion is one of the most common causes of vision loss, occurring when a blood clot or other obstruction occludes a retinal vein. A potential remedy for retinal vein occlusion is retinal vein cannulation, a surgical procedure that involves infusing the occluded vein with a fibrinolytic drug to restore blood flow through the vascular lumen. This work presents an image-guided robotic system capable of performing automated cannulation on silicone retinal vein phantoms.

Development and validation of an offline deep learning algorithm to detect vitreoretinal abnormalities on ocular ultrasound.

Purpose: We describe our offline deep learning algorithm (DLA) and validation of its diagnostic ability to identify vitreoretinal abnormalities (VRA) on ocular ultrasound (OUS).

Methods: Enrolled participants underwent OUS. All images were classified as normal or abnormal by two masked vitreoretinal specialists (AS, AM).

RETINAL DETACHMENT IN EYES WITH BOSTON TYPE 1 KERATOPROSTHESIS: Surgical Techniques and Mid-Term Outcomes.

Purpose: To evaluate the mid-term outcomes of pars plana vitrectomy performed for retinal detachment (RD) repair after Boston Type 1 keratoprosthesis (KPro) implantation.

Methods: Retrospective review of medical records of KPro implanted at the Stein Eye Institute presenting with RD and treated by pars plana vitrectomy. Functional success was defined as a postoperative visual acuity maintained within 2 Snellen lines of the corrected distance visual acuity measured before the development of the RD (baseline) and anatomical success as an attached retina after the pars plana vitrectomy.

Epiretinal proliferation after rhegmatogenous retinal detachment.

Purpose: To determine the characteristics and appearance rate of epiretinal proliferation (ERP) on SD-OCT after surgery for rhegmatogenous retinal detachment (RRD) repair.

Methods: One hundred eight eyes of 108 patients who underwent one or more surgeries for RRD were enrolled. The eyes with other maculopathies that were directly related to RRD were excluded.

Risk factors for microcystic macular oedema in glaucoma.

Background/aims: To identify clinical characteristics and factors associated with microcystic macular edema (MME) in patients with primary open-angle glaucoma (POAG).

Methods: We included 315 POAG eyes between 2010 and 2019 with good-quality macular volume scans that had reliable visual fields (VF) available within 6 months in this observational retrospective cohort study. Eyes with retinal pathologies except for epiretinal membrane (ERM) were excluded.

Semi-Automated Extraction of Lens Fragments via a Surgical Robot Using Semantic Segmentation of OCT Images with Deep Learning - Experimental Results in Animal Model.

The overarching goal of this work is to demonstrate the feasibility of using optical coherence tomography (OCT) to guide a robotic system to extract lens fragments from pig eyes. A convolutional neural network (CNN) was developed to semantically segment four intraocular structures (lens material, capsule, cornea, and iris) from OCT images. The neural network was trained on images from ten pig eyes, validated on images from eight different eyes, and tested on images from another ten eyes.

A Novel Tissue Identification Framework in Cataract Surgery Using an Integrated Bioimpedance-Based Probe and Machine Learning Algorithms.

Objective: The objective of this work was to develop and experimentally validate a bioimpedance-based framework to identify tissues in contact with the surgical instrument during cataract surgery.

Methods: This work introduces an integrated hardware and software solution based on the unique bioimpedance of different intraocular tissues. The developed hardware can be readily integrated with commonly used surgical instruments.

Evaluation of non-exudative microcystoid macular abnormalities secondary to retinal vein occlusion.

Purpose: We aimed to investigate non-exudative microcystoid macular abnormalities for visual and anatomical outcome in patients with retinal vein occlusion (RVO) with and without glaucomatous optic neuropathy (GON).

Methods: Medical records of 124 eyes (105 patients) with RVO were reviewed and analyzed. Eyes demonstrating microcystoid macular abnormalities were divided into 2 groups, those with evidence of glaucoma (group A) and those without glaucoma (group B).

POSTOPERATIVE POSTERIOR SEGMENT COMPLICATIONS AFTER BOSTON TYPE 1 KERATOPROSTHESIS: Incidence, Risk Factors, and Intermediate-Term Outcomes.

Purpose: To identify the incidence of, risk factors for, and outcomes of posterior segment complications (PSC) after Boston Type 1 keratoprosthesis (KPro) implantation.

Methods: Retrospective, consecutive case series of KPro procedures at the Stein Eye Institute. Data regarding ocular history, intraoperative details, postoperative management, and outcomes were collected.

Clinical Update on Metamorphopsia: Epidemiology, Diagnosis and Imaging.

: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function.: A literature search of electronic databases was performed: Metamorphopsia has commonly been associated with vitreomacular interface disorders (such as epiretinal membrane) and has also regularly been noted in diseases of the retina and choroid, particularly age-related macular degeneration and central serous chorioretinopathy. Developments in optical coherence tomography retinal imaging have enabled improved imaging of the foveal microstructure and have led to the localisation of the pathophysiology of metamorphopsia within the retinal layers of the macula.

[Optical coherence tomography biomarkers in epimacular membranes and vitreomacular traction syndrome].

Using high-resolution imaging, such as optical coherence tomography (OCT), the different layers of the retina as well as the vitreoretinal interface and its alterations can be very clearly differentiated. This includes the morphological characteristics of tractive maculopathies, such as epiretinal gliosis and vitreomacular traction syndrome. Additionally, structural alterations of the various layers of the neurosensory retina as a result of traction due to these pathologies can be demarcated.

Robotic posterior capsule polishing by optical coherence tomography image guidance.

Background: In cataract surgery, polishing of the posterior capsule (PC) can lead to improved surgical outcomes but is currently avoided due to its high-risk nature. This work developed a robotic system capable of performing PC polishing on ex vivo pig eyes using optical coherence tomography (OCT) guidance.

Methods: The lenses of five ex vivo pig eyes were extracted and a thin layer of glue deposited onto the PC.

Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses.

Purpose: To investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair.

Methods: Consecutive, retrospective case-control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared.

Spontaneous Conversion of Lamellar Macular Holes to Full-Thickness Macular Holes: Clinical Features and Surgical Outcomes.

Purpose: To describe the clinical features and surgical outcomes of patients experiencing a spontaneous conversion of a lamellar macular hole (LMH) to a full-thickness macular hole (FTMH).

Design: Retrospective, multicenter, observational case series.

Participants: Patients with LMH who experienced a spontaneous conversion to FTMH and underwent FTMH surgery.

Traumatic Retinal Detachment in Patients with Self-Injurious Behavior: An International Multicenter Study.

Purpose: To describe the clinical characteristics, surgical outcomes, and management recommendations in patients with traumatic rhegmatogenous retinal detachment (RRD) resulting from self-injurious behavior (SIB).

Design: International, multicenter, retrospective, interventional case series.

Participants: Patients with SIB from 23 centers with RRD in at least 1 eye.

Idiopathic Vitritis after Boston Type 1 Keratoprosthesis Implantation: Incidence, Risk Factors and Outcomes in a Multicentric Cohort.

Purpose: To determine incidence, risks factors for, and outcomes of idiopathic vitritis (IV) after Boston type 1 keratoprosthesis (KPro) implantation.

Methods: Retrospective, consecutive case series. Risk factors were analyzed between IV group and No IV group.

SPONTANEOUS LAMELLAR MACULAR HOLES CLOSURE.

Purpose: To report two cases of spontaneous closure of lamellar macular holes with epiretinal proliferation (ERP).

Methods: Observational cases report.

Results: Two patients affected with lamellar macular hole showed progressive and spontaneous closure of the hole associated with ERP development.