EP3790446A1 - Dispositif et procédé d'imagerie lors de l'implantation d'implants rétiniens - Google Patents

Dispositif et procédé d'imagerie lors de l'implantation d'implants rétiniens

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Publication number
EP3790446A1
EP3790446A1 EP19722113.8A EP19722113A EP3790446A1 EP 3790446 A1 EP3790446 A1 EP 3790446A1 EP 19722113 A EP19722113 A EP 19722113A EP 3790446 A1 EP3790446 A1 EP 3790446A1
Authority
EP
European Patent Office
Prior art keywords
implant
retina
visualizing
oct
image
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
EP19722113.8A
Other languages
German (de)
English (en)
Inventor
Johannes Kindt
Rudolf Murai Von Bünau
Tobias Schmitt-Manderbach
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Carl Zeiss AG
Original Assignee
Carl Zeiss AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Carl Zeiss AG filed Critical Carl Zeiss AG
Publication of EP3790446A1 publication Critical patent/EP3790446A1/fr
Pending legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/0016—Operational features thereof
    • A61B3/0025—Operational features thereof characterised by electronic signal processing, e.g. eye models
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/0016—Operational features thereof
    • A61B3/0041—Operational features thereof characterised by display arrangements
    • A61B3/0058—Operational features thereof characterised by display arrangements for multiple images
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/102—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for optical coherence tomography [OCT]
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    • A61B3/13—Ophthalmic microscopes
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    • A61B3/18—Arrangement of plural eye-testing or -examining apparatus
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    • A61B90/20—Surgical microscopes characterised by non-optical aspects
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    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/0008—Introducing ophthalmic products into the ocular cavity or retaining products therein
    • A61F9/0017—Introducing ophthalmic products into the ocular cavity or retaining products therein implantable in, or in contact with, the eye, e.g. ocular inserts
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
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    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
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    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • A61B2034/104—Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
    • A—HUMAN NECESSITIES
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    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
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    • A61B2034/107—Visualisation of planned trajectories or target regions
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    • A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
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    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0815—Implantable devices for insertion in between organs or other soft tissues
    • A—HUMAN NECESSITIES
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    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • A61B2090/365—Correlation of different images or relation of image positions in respect to the body augmented reality, i.e. correlating a live optical image with another image
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    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/373—Surgical systems with images on a monitor during operation using light, e.g. by using optical scanners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/373—Surgical systems with images on a monitor during operation using light, e.g. by using optical scanners
    • A61B2090/3735—Optical coherence tomography [OCT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/12—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for looking at the eye fundus, e.g. ophthalmoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00863—Retina
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00878—Planning
    • A61F2009/00882—Planning based on topography

Definitions

  • the present application relates to devices and methods for imaging in the implantation of retinal implants, which may in particular serve to prepare for such implantation or to assist during implantation. It should be noted that the implantation itself, i. the surgical procedure is not the subject of the present application.
  • the illustrated devices and methods are non-invasive, i. Imaging takes place from the outside, in particular by means of electromagnetic waves, such as light, which pass through a pupil of an eye.
  • Retinal implants are devices that are implanted into the retina of a patient's eye or attached to the retina to perform a specific therapeutic or prosthetic function to alleviate eye disease.
  • implants may deliver medication, perform a mechanical function such as stabilization or fixation, or deliver electrical stimulation in response to incident light to at least function light-sensitive cells (rods, cones) that normally operate in the retina to convert light into nerve impulses partly to replace.
  • Retinal implant in or on the retina required so that the implant can fulfill the desired function and to avoid damage, for example, to healthy parts of the retina or other parts of the eye.
  • Surgical microscopes are often used to assist a surgeon in the implantation of retinal implants. These also show an image of the inside of the eye during the operation, which is detected through the pupil of the eye to be operated on. Even with the use of stereomicroscopes, essentially only a two-dimensional representation is obtained here, since due to the restriction that the light rays must pass through the pupil of the eye, a stereo base is at most very small. In particular, a height of the implant over the retina can not be detected or measured only with difficulty or only with difficulty.
  • An example of such a surgical microscope is the OPMI Lumera® 700 from Zeiss.
  • Optical coherence tomography is an optical imaging technique that provides depth information for semi-transparent objects.
  • line scans are taken here, which yield depth profiles along the scan line.
  • depth profiles are then displayed along a line, which makes it difficult for a surgeon to perform one in all spatial directions, i. a three-dimensional positional relationship between the implant and the retina.
  • Optical coherence tomography is used to detect anatomical structures such as the various retinal layers, and pathological structures such as lesions, and to detect surgical instruments such as cannulas or tweezers during intra-operative OCT.
  • anatomical structures such as the various retinal layers, and pathological structures such as lesions
  • surgical instruments such as cannulas or tweezers during intra-operative OCT.
  • cannulas or tweezers during intra-operative OCT.
  • a method of visualizing implantation of a retinal implant comprising:
  • an OCT scan i. a scan using optical coherence tomography, the retina and an OCT scan of the implant
  • the taking of the 2D image and the OCT scan of the implant in embodiments serve in particular for determining the position of the implant relative to the retina and / or for determining an inclination of the implant. Therefore, the term "OCT scan of the implant” also does not mean that the entire implant must be scanned. Rather, in many cases, a single scan line across the implant is sufficient to maintain a height of the implant above the retina and / or the inclination of the implant
  • OCT scan of the retina does not mean that the entire retina is scanned. In many cases, it may be sufficient to scan only part of the retina or just a single scan line. This can also be used on previous OCT scans of the retina.
  • the taking of the 2D image can take place in particular during the operation by means of a surgical microscope.
  • the visualization of the implant may include displaying an avatar of the implant.
  • the real shape of the implant which facilitates recognition of the positional relationship between the implant and the retina.
  • Parts of the implant may be hidden or highlighted, or only the outlines of the implant may be displayed.
  • the real form of the implant is - e.g. from manufacturer data - known and therefore need not be determined separately as a rule, even if this basically when needed by means of image acquisition and / or OCT scans in some
  • An avatar is to be understood as a graphical representation of the implant, which corresponds in shape to the shape of the implant or in the case of a multi-part implant of a part thereof.
  • the avatar is displayed in position and orientation within the measurement accuracy according to the real position and orientation of the implant in the eye.
  • the displaying of the avatar may include displaying an avatar of a structural component of the implant and optionally displaying an avatar of a functional component of the implant.
  • the position can also be visualized a functional component of the implant, even if currently only the structural component of the implant is actually implanted in the eye.
  • a structural component of an implant is to be understood as meaning a part of an implant which fulfills structural functions and in particular serves to hold the implant at a desired position on or in the retina, for example
  • the functional component fulfills the actual function of the implant, for example generating electrical pulses in response to incident light or delivery of drugs to the retina.
  • the implant may also have a first configuration and a second configuration.
  • the implant is in the first
  • the second configuration may be a deployed or extended configuration that is achieved by activation of springs or other elastic elements.
  • the avatar may choose between visualizing the first configuration and visualizing the second configuration.
  • the implant can be visualized in the second configuration it occupies after implantation, even if it is still in the first configuration, which is the
  • Positioning can be easier.
  • the method may further include determining a location of the implant in the 2D image of the retina, and determining a scan line of the retinal OCT scan and a scan line of the OCT scan of the implant based on the identifying.
  • the method may thus further include determining a distance between the implant and the retina.
  • the method may then further include displaying the distance on the display.
  • the distance can be displayed, for example, directly as a numerical value. But it is also possible to display by means of a false color representation.
  • the mentioned avatar of the implant at a long distance green at Yellow at a smaller distance and colored red at a distance at or near zero. Displaying the distance is thus not limited to a particular type of display. Thus, quantitative measurements of the positional relationship between the implant and the retina are also possible with the described methods.
  • Visualization of the retina may include visualizing an implanted portion of the retina based on an earlier OCT scan.
  • both the retina and the implant can be visualized, even though a part of the retina lying underneath the implant is currently not visible for image acquisition.
  • the visualization may include visualizing areas of the retina suitable for implantation. This facilitates the selection of a suitable site for implantation.
  • the visualization may include visualizing penetration of fixatives of the implant into the retina.
  • Such visualization of fasteners may better position a retinal implant, particularly in terms of positioning in a direction perpendicular to a local plane of the retinal surface.
  • a local level is a plane that locally approximates the (generally curved) retinal surface. In particular, it can be a tangential plane at a point of the retina.
  • the visualization may further include outputting an indication as to whether or not the depth of penetration is
  • Fastener is correct, include. This facilitates the correct attachment of the
  • Visualization may also include simulating a mechanical response of the retina to the implant and visualizing the simulated mechanical response.
  • the method may further include prior to implantation:
  • the visualization involves displaying the planned implant position. This supports implantation at the planned implant position.
  • further visualization may be performed based on user input for controlling the implant, a 2D image of the retina and an OCT scan of the retina.
  • the method may further comprise:
  • annotations prior to implantation, creating annotations, wherein the visualizing comprises displaying the annotations.
  • Annotations are inputs of an operator, e.g. Surgeons who are made to particular parts of image recordings, OCT scans or the like and then can be visualized in the correct position.
  • the method may further include augmenting the visualization based on pre-implantation data.
  • the data obtained prior to implantation may include a fundus image and / or data from retinal angiography.
  • a displayed image area can be enlarged, or additional information such as from the retina angiography can be displayed. This can be done optionally.
  • an apparatus for visualizing implantation of a retinal implant comprising:
  • the computing device is configured to control the OCT device for performing an OCT scan of the retina and an OCT scan of an implant and to control a display for visualizing the implant and the retina.
  • the apparatus may be arranged to carry out one or more of the methods described above, in particular by appropriate design, e.g. Programming, the computing device.
  • 1 is a block diagram of a device according to an embodiment
  • 2 shows a flow chart for illustrating a method according to an exemplary embodiment
  • Fig. 3 is a schematic view of an eye during an implantation for
  • FIG. 5 shows an example of a two-part implant as used in some embodiments
  • Fig. 6 is a perspective view of an eye during an operation for
  • Fig. 9 is an illustration of various techniques according to various aspects
  • Fig. 10 is an illustration of various techniques according to some embodiments.
  • Fig. 1 1 is an illustration of various techniques of some embodiments during an operation in which previously a planning as in Fig. 10 has taken place.
  • the apparatus 10 comprises a microscope 12 with a camera for providing image recordings of the eye, in particular 2D images, i.
  • the microscope 12 can also be
  • the device 10 comprises an OCT device 11 for optical coherence tomography (OCT).
  • OCT device 11 for optical coherence tomography
  • the OCT device 1 1 can be integrated in the conventional manner in the microscope 12, for example, as in the aforementioned Zeiss microscope.
  • the device 10 further comprises a computing device 13 which controls the OCT device 11 and the microscope 12, for example the camera of the microscope 12, and
  • Image information from the camera of the microscope 12 and the OCT device 11 receives. Based on this information, the computing device 13 creates a
  • Visualization of the eye wherein the visualization of an implant, which at a
  • an avatar is being used.
  • the visualization is then displayed on a display 15.
  • the display can be integrated in the microscope 12, so that a user, like a surgeon, sees the visualization when he looks into the microscope. Additionally or alternatively, a separate display is possible.
  • the computing device 13 may be a computer that includes one or corresponding programmed processors. It may additionally or alternatively be field programmable using other suitable devices, such as application specific integrated circuits (ASICS)
  • ASICS application specific integrated circuits
  • FPGAs Gate arrays
  • digital signal processors and the like can be realized.
  • a structure of a retina of the eye, in which the implant is to be inserted can be detected by the OCT device 11. This can be done in the run-up to the operation for planning purposes.
  • OCT data provide depth information
  • an instantaneous distance of the implant from the retina as well as an inclination of the implant can be detected.
  • an OCT line scan adjacent to the implant and an OCT line scan across the implant can be determined by means of image processing based on images supplied by the camera of the microscope 12.
  • An avatar of the implant can then always be displayed at the detected position during the operation.
  • the inclination of the implant can be continuously measured by the line scan via the implant, which can also be displayed in real time.
  • Fig. 2 shows a Flussidagramm of an embodiment of a corresponding
  • the method can be carried out, for example, with the device 10 of FIG. 1, and the explanations there apply correspondingly for the method.
  • a 2D image is taken of a retina of the eye, optionally with an implant over it.
  • the explanations made for the camera of the microscope 12 also apply here, i.
  • the image does not have to be a pure 2D image, but can also be captured with a stereo camera, for example.
  • an OCT scan is taken of the retina and, optionally, the implant, as explained for the OCT device 1 1 of FIG.
  • the implant is visualized and displayed together with the retina, as shown for the computing device 13 and the display 15 of FIG.
  • FIG. 3 shows a schematic view of an eye when inserting an implant 36.
  • FIG. 3 shows a view of the eye as seen with the camera of the microscope 12 of FIG. 1 or in step 20 of FIG 2D image can be captured.
  • FIG. 3 shows the eye with sclera 32, iris 31, and the retina 35 visible through the pupil.
  • a trocar 37 is used to introduce a surgical instrument 30 into the eye to position an implant 36.
  • the implant 36 is identified by image processing algorithms in the 2D image corresponding to FIG. Based on the position of the implant thus identified, OCT scans are performed. For example, a first OCT scan is taken along a line 33 across the
  • Implant 36 and a second OCT scan 34 adjacent to the implant 36 via the retina 35 performed.
  • the inclination of the implant as well as a position of the implant Implant 36 are determined relative to the retina 35 in a direction perpendicular to the retina 35.
  • This direction perpendicular to the retina is also referred to below as the z-direction, while the image plane of the image of FIG. 3, which approximates (assuming a planar retina) to the plane of the retina 35, is referred to as the xy-plane.
  • FIG. 4 shows an example of a visualization that can be created on the basis of the image recording and the OCT scans of FIG. 3.
  • an avatar 41 of the implant is displayed over a representation 40 of the retina.
  • the representation 40 of the retina is shown partially as an OCT sectional image. From this, the structure of the retina, for example, a point of sharpest vision, can be recognized, and the implant can be positioned accordingly.
  • the position of the avatar 41 is continuously adjusted to the actual position of the implant 36. For example, if the implant 36 is laterally, i. in the xy direction according to the above definition, is moved over the retina 35, the avatar 41 moves accordingly.
  • the implant 36 is laterally, i. in the xy direction according to the above definition
  • the implant As the implant is moved toward the retina or away from the retina, it is detected via the OCT scans along the lines 33, 34 and the position of the avatar 41 is constantly adjusted accordingly.
  • annotations can also be displayed, for which purpose an arrow 42 is shown as an example.
  • Such annotations may in some embodiments be freely pre-created by an operator, e.g. to mark certain areas of the retina. They can then be displayed optionally in the visualization. This will be explained in more detail later with reference to FIG.
  • retinal implants are typically not transparent, the area of the retina directly under the implant can not be detected simultaneously with the implant by optical coherence tomography.
  • OCT scans such as the scan along the line 34, or information from earlier OCT scans when the implant 41 was in a different position, used to fully visualize the retina.
  • FIG. 5 shows an implant which has a structural component 50 and a functional component 50
  • Component 51 comprises.
  • the structural component 50 serves to fix the implant in or on the retina.
  • the functional component 51 serves to provide the actual function of the implant, for example to deliver medication, to stimulate nerves or like.
  • the functional component 51 is held by the structural component 50.
  • FIG. 6 simultaneously shows an example of a 2D image, as can be received by the camera of the microscope 12.
  • a visualization can also be created in this case by a combination of OCT scans and image acquisition.
  • an avatar of the functional component 51 can be represented in this visualization.
  • An example of such visualization is shown in FIG.
  • FIG. 7 shows a visualization in which an avatar of an implant over a representation 40 of the retina is shown.
  • the avatar of the implant in this case consists of two parts, namely an avatar 70 of the structural component and an avatar 71 of the functional component.
  • the avatar 71 of the functional component can be switched on and off, so that optionally the actual situation with a currently running implantation of the structural component or additionally with the avatar 71 the later position of the functional component can be represented. This can be a
  • the functional component fulfills the actual function of the implant, in particular its
  • FIG. 7 Positioning relative to features of the retina (for example, relative to specific parts of the retina or diseased parts of the retina) of importance. This positioning is facilitated by the avatar 71 of the functional component, since here the surgeon can accurately recognize the later position of the functional component.
  • the avatar of the functional component 71 is shown additionally (optionally optionally), the visualization of FIG. 7 corresponds to that already discussed with reference to FIG. 4
  • the interaction of the implant with the retina and the exact position of the implant can be visualized.
  • the interaction of the implant with the tissue of the retina can be visualized, for which purpose simulations can be used.
  • this is a Avatar of the implant (possibly in two parts as in Fig. 7) shown together with the retina.
  • a mathematical model of the biomechanical response of the retinal tissue to the approach of the implant can be used to present an accurate visualization of the interaction between the implant and the retina.
  • an elastic deformation of the retinal tissue and / or the implant, penetration of the implant into the retina, a shift of retinal tissue and the like can be simulated.
  • the structure of the retina obtained by OCT scans can be modified based on such a mathematical model.
  • an interaction of a functional component - such as the functional component 51 of FIG. 5, which is not yet present in the operation at this time - can be taken into account, ie it can be represented, for example, how the retina is deformed by the functional component.
  • a functional component - such as the functional component 51 of FIG. 5, which is not yet present in the operation at this time -
  • it can be represented, for example, how the retina is deformed by the functional component.
  • FIG. 7 not only the avatar 71 of the functional component but also its interaction with the retina 40 can be visualized.
  • a visualization of a first configuration eg a configuration during the implantation
  • a visualization in a second configuration eg a deployed configuration, which is assumed after implantation.
  • FIG. 8 shows another example of an implant and its visualization.
  • FIG. 8 shows a structural component 50 which in this case has attachment legs 80 which may be formed as retinal tacks or the like and by means of which the implant is anchored or held in the retina.
  • the avatar 70 of the structural component is displayed along with the attachment legs.
  • the position of the attachment legs 80 within the retina 40 is also shown.
  • the correct position of the fastening legs 80 can be recognized as indicated by arrows a, and in particular easier to avoid that the fastening legs 80 get into structures of the retina, which should not be injured.
  • an arrow b in FIG. 8 shows a part of the implant which has no attachment leg and therefore does not interact with the retina 40.
  • Additional visualization aids can be provided. For example, based on the position of the implant and the retina, which may be due to image acquisition and / or OCT scans, it can be determined whether a desired penetration depth of the attachment legs 80 into the retina has been achieved. If so, an appropriate indication may be displayed on a display, and / or an audible indication or other form of indication may be given to alert the surgeon. Accordingly, a different type of indication can be given as a warning when a desired penetration depth has already been exceeded. This is particularly helpful when, as in the example of FIG. 8, there are several attachment legs and thus the implant penetrates into the retina at several points, as it makes it easier for the surgeon to position all attachment legs correctly in the retina.
  • the visualization may also output an indication indicating whether, in a position where the implant is just above the retina (ie, position in the xy plane), placement with sufficient depth of penetration for attachment legs such as attachment legs 80 or other fasteners is possible.
  • the retina is not a flat structure of uniform thickness, but may have varying thicknesses and shapes, which may also differ from person to person. Thus, even if the nature of the implant does not require specific positioning, an implant can not be placed anywhere on the retina.
  • the visualization can provide feedback to the surgeon as to whether correct positioning is possible at a position in the xy plane where the implant is currently located is.
  • the retina 40 can be colored in a different color in places where positioning is possible than in places where positioning is not possible, for example due to a too thin retina.
  • FIGS. 9-1 each show a multiplicity of different visualization possibilities and
  • FIG. 9 shows an example of different visualization options during an operation, in which case no planning of the operation specific to the illustrated techniques has taken place in advance. A combination with such prior planning will be explained below with reference to Figs. 10 and 11.
  • FIG. 9 may be applied as a real-time process during the operation.
  • FIG. 9 The illustration in FIG. 9 is subdivided into data acquisition, visualization, analysis and guidance. All of these aspects can occur continuously during an operation.
  • image capture is performed using a camera of a surgical microscope such as the camera of the microscope 12 of FIG. 1.
  • the implant is then identified in the captured images with conventional approaches to image analysis and image processing, and thus the position of the implant in the xy plane certainly. Based on this identification, an OCT scan over the implant (eg, corresponding to line 33 of FIG. 3) is then made at 92 and an OCT scan of the retina adjacent to the implant at 94 (for example, by a scan along line 34 of FIG 3).
  • OCT images are captured by the retina through the pupil, they are typically distorted due to differences between scan and display geometry and the optical properties of the eye (especially refraction when passing through the pupil).
  • Most OCT devices use a biaxial scanning system Galvanometers and free moving mirrors are used to direct the light beam used for optical coherence tomography and to scan it via the retina.
  • Galvanometers and free moving mirrors are used to direct the light beam used for optical coherence tomography and to scan it via the retina.
  • the nodal point, or nodal point is a point on the optical axis of the eye to which the rays of light which enter the system at the same angle to the optical axis as they leave it appear to run.
  • the light beam is then passed over the (curved) posterior segment of the eye and thus an image of a fan-shaped cross-section of the eye is obtained.
  • the scanned area To view the scanned area then the
  • A-scans Depth information along individual scan lines (A-scans) to a rectangular one
  • Brightness image (B-scan, brightness modulated image), for which the A-scans are typically stacked in parallel instead of the A-scans, i. combine the depth profiles along each scan line in a geometrically correct format that provides a fan-shaped cross-section to match the actual scan geometry.
  • the parameters and geometry of the OCT device used for example the OCT device 11 of FIG. 1, are known. If additionally specific parameters of the respective eye, such as axial eye length, can be measured
  • Equalization is particularly helpful when, as explained with reference to FIG. 8, penetration depths are to be calculated exactly or the geometric distance between implant and structures of the retina should be correctly determined and visualized. Also, for the use of automated machine vision detection algorithms, equalization of both retinal and implant OCT scans is helpful to allow for more accurate localization and / or visualization.
  • the z-coordinate of the implant is then determined based on the OCT scan at 92, i. the height of the implant over the retina.
  • a visualization can then take place.
  • an avatar of the implant eg, the avatar 41 of FIG. 4 or the avatar 70 of the structural component as shown in Fig. 7
  • the structure of the retina is visualized at 97, as indicated by reference numeral 40 in FIGS. 4 and 7. It can be selected by an operator, which is visualized, so that, for example, the visualization of the structure of the retina or the avatar can also be switched off optionally.
  • an avatar of a functional component that is not actually present in the eye can also be displayed.
  • the OCT data of the retina may be supplemented, for example by visualizing, based on previous OCT data, as already explained, a part of the retina which is shadowed by the implant compared to the OCT device used.
  • implant penetration for example, of attachment legs or other attachment means, as explained with reference to FIG. 8, may be determined at 910 for the current position of the implant (x / y / z coordinate and tilt). This can be visualized at 913, for example in a cross-sectional view or a
  • FIG. 10 illustrates the planning
  • FIG. 11 illustrates the support during the actual operation. In order to avoid repetition, reference is made to the already described description of FIG. 9 in the description of FIGS. 10 and 11.
  • a 2D image of the retina is taken, for example, with a fundus camera or the camera of a surgical microscope.
  • This 2D image may be a wide-angle image with an image angle greater than 40 °, for example, which shows the entire fundus or a large part thereof.
  • the retina is determined, for example a point of sharpest vision, a location where the optic nerve opens into the retina, diseased areas of the retina, the course of blood vessels and the like.
  • the 2D image can then also as a basis or map for the registration of various recording modalities such as OCT scans or
  • an OCT scan of the retina is made, i. the retina is scanned with an OCT device such as the OCT device 1 1 of Fig. 1, so as to obtain information about the three-dimensional structure of the retina.
  • the OCT data thus obtained are equalized as explained with reference to FIG.
  • a virtual position (at which an avatar is also displayed) may be entered at 103 by user input, thus virtually performing a virtual operation. You can do this
  • an avatar of the implant is then displayed at the position currently dictated by the user, optionally at 106 with a functional component as described.
  • the retina is also displayed based on the OCT scans. Apart from the fact that it is not a real implant, but merely the representation of an avatar for planning, the steps 105, 106 and 107 correspond to the
  • Fig. 9 the same analysis and guidance functions as illustrated with reference to Fig. 9 can be represented here, i. at 108 a navigation, at 109 an analysis of the intrusion and at 1010 a simulation of the mechanical response to the implant, corresponding to steps 99, 910 and 911 of Fig. 9.
  • at 1011 favorable and unfavorable zones of the implant of the retina may be implanted information can be visualized at 1012 regarding penetration of the implant and at 1013 the simulation of the mechanical response may be visualized, corresponding to steps 912, 913 and 914 of FIG. 9.
  • the difference is that it is not a Visualization of a currently occurring operation, but to a virtual moving the avatar of the implant by user inputs and representing the reaction of the retina on this and thus, so to speak, a virtual operation.
  • the process of Fig. 10 may be iterative, i. based on the analysis and the
  • the user can again change the position and virtually simulate the operation procedure.
  • an operator e.g. a surgeon at 1014 add annotations to displayed images, visualizations, etc., e.g. as freehand drawing,
  • FIG. 11 illustrates the flow of the process during the operation when the planning of FIG. 10 has been previously performed.
  • an image is taken by means of a surgical microscope with camera such as the surgical microscope 12 of Fig. 1, and at 112, as at 91 in Fig. 9, the position of the implant is found in the image.
  • the planned position of the implant as well as points of interest, which become known from the planning process of FIG. 10 are transferred as input data.
  • these points of interest are identified in the microscope image.
  • an OCT scan of the implant is performed at 113 and an OCT scan of the retina adjacent to the implant at 115, corresponding to steps 92 and 94, respectively, of Fig. 9. This OCT data is equalized and read at 114 of the OCT scan of the implant, the z position of the implant
  • Steps 116-1 19 in Fig. 11 correspond to steps 95-98 of Fig. 9, and the explanations there are referenced.
  • an outline of the implant or another marker will be displayed at the intended position on the retina. This gives the surgeon a goal for the implantation.
  • the points of interest can serve as a reference with respect to which the planned position is determined.
  • the annotations can be displayed.
  • additional data obtained in the planning phase can be used to augment the illustrated visualization.
  • the mentioned wide-angle image can be used to represent a larger area of the retina than would correspond to the viewing angle of the surgical microscope.
  • data resulting from the mentioned retinal angiography can be used for augmentation.
  • steps 1111-1113 of FIG. 11 again correspond to the steps 99, 910 and 911 of FIG. 9, and reference is made to the explanations there.
  • steps 11-14-1116 correspond to steps 912-914 of FIG. 9.
  • an offset between the current position of the implant and the planned position of the implant may be displayed. for example, by means of arrows pointing in the direction of the planned position, thus helping the surgeon to bring the implant to the intended position.

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Abstract

L'invention concerne des procédés et des dispositifs destinés à visualiser un implant dans une rétine. À cet effet, une image bidimensionnelle (2D) de la rétine est acquise et des balayages OCT de la rétine et de l'implant sont effectués. Sur la base de ces derniers, une visualisation de l'implant et de la rétine est réalisée.
EP19722113.8A 2018-05-06 2019-05-06 Dispositif et procédé d'imagerie lors de l'implantation d'implants rétiniens Pending EP3790446A1 (fr)

Applications Claiming Priority (3)

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DE102018110842 2018-05-06
DE102018213872.9A DE102018213872A1 (de) 2018-05-06 2018-08-17 Vorrichtung und Verfahren zur Bildgebung bei der Implantation von Retinaimplantaten
PCT/EP2019/061497 WO2019215061A1 (fr) 2018-05-06 2019-05-06 Dispositif et procédé d'imagerie lors de l'implantation d'implants rétiniens

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DE102020115888A1 (de) 2020-06-16 2021-12-16 Carl Zeiss Meditec Ag System zum Bereitstellen von Visualisierungsdaten für die Visualisierung wenigstens eines Abschnitts eines Patientenauges aus OCT-Abtastdaten sowie computerimplementiertes Verfahren und Computerprogramm
AU2021330513A1 (en) * 2020-08-26 2023-02-09 Alcon Inc. Laser surgical systems and methods for creating a marker in an eye
WO2022058606A1 (fr) * 2020-09-21 2022-03-24 Carl Zeiss Meditec, Inc. Dispositif pour positionner un implant dans une zone cible d'un œil

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US8260428B2 (en) * 2003-05-01 2012-09-04 California Institute Of Technology Method and system for training a visual prosthesis
WO2008141271A1 (fr) * 2007-05-10 2008-11-20 Newcyte, Inc. Implant rétinien artificiel
US20090292325A1 (en) * 2008-05-02 2009-11-26 Cederna Paul S Hybrid bioelectrical interface device
WO2014031878A1 (fr) * 2012-08-22 2014-02-27 California Institute Of Technology Système de transfert d'énergie sans fil à trois bobines pour implants oculaires
US10390887B2 (en) * 2016-06-17 2019-08-27 Zimmer, Inc. System and method for intraoperative surgical planning
US10272244B2 (en) * 2016-11-03 2019-04-30 Nano Retina Ltd. Retinal implant fixation
WO2018132804A1 (fr) * 2017-01-16 2018-07-19 Lang Philipp K Guidage optique pour procédures chirurgicales, médicales et dentaires

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CN112188859A (zh) 2021-01-05
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