RU72394U1 - MULTIMEDIA OPHTHALMOENDOSCOPIC SYSTEM - Google Patents

Abstract

The utility model relates to ophthalmology and is intended to monitor intraocular structures simultaneously using an ophthalmic endoscope and a surgical microscope during operations involving retinal detachment and pathological changes in the vitreous body.

The system includes an ophthalmic endoscope with a video camera, wearable head monitors, and a surgical microscope with a video camera. Additionally contains a high-speed computer with a digital converter and head monitors, which are equipped with a head position sensor - tracker.

The system allows you to expand intraoperative diagnostic capabilities, provides the convenience of surgical equipment and reduces the risk of iatrogenic damage to intraocular structures.

Description

The proposed utility model relates to ophthalmology, and is intended to monitor intraocular structures simultaneously using an ophthalmic endoscope and a surgical microscope when performing operations for retinal detachment and pathological changes in the vitreous body, especially with damage or pathological changes in the anterior segment of the eye (cornea, lens). The system allows you to control the output of images using the head position sensor (tracker) installed in the head monitors separately from the microscope, separately from the endoscope, to obtain an image in the image (a large image from a surgical microscope and a small image from an endoscope and vice versa).

The level of technology.

Currently, the closest analogue of the proposed system is a stereoscopic endoscope connected to head monitors (Heacock et al "Viewing Ocular Tissues with A Stereoscopic Endoscope Coupled to a Head Mounted Display (HMD)" http: www.hilt.washington.edu. \ Publications \ heacock \ .Feb.17.1998,).

The system includes a video endoscope (contains two gradans), a micro camera, head monitors, a video cable connecting the video camera to the head monitors. The image from the endoscope is transmitted directly to the head monitors via a video cable.

This system allows you to get only one image from the ophthalmic endoscope on the surgeon's head monitors, and in many cases it is required to have simultaneously images not only from the ophthalmological endoscope but also from the operating microscope.

The objective of the proposed utility model is to create a comprehensive endoscopic system.

The technical result of the proposed utility model is the expansion of intraoperative diagnostic capabilities and the convenience of surgical equipment with the prevention of iatrogenic intraocular injuries with the exception of the time required for the surgeon to transfer the gaze from head monitors representing the image from the endoscope to the operating microscope, providing an image of the surgical field; as well as with the ability to remotely select the appropriate image / s.

The technical result is achieved by the inclusion in the system of a high-speed computer and a tracker built into wearable head monitors. This allows real-time processing of video sequences obtained from video cameras and a surgical microscope using a computer and supplying the processed video information to the head monitors, as well as selecting the necessary video image depending on the signals supplied from the head monitor tracker.

The task is implemented by a multimedia ophthalmic system, a diagram of which is presented in figure 1, where

1 - surgical microscope,

2 - video camera mounted on an eyepiece of a surgical microscope.

3 - digital video signal converter.

4 - system unit of a high-speed computer with two (A and B) digital inputs for a video signal.

5 - ophthalmic endoscope.

6 - video camera mounted on an endoscope.

7 - illuminator of the ophthalmic endoscope.

8 - digital video signal converter.

9 - head monitors.

10 - tracker mounted in the head monitor.

A - high-speed computer input for digital video signal from a microscope video camera.

B - input of a high-speed computer for digital video signal from a video camera of an endoscope.

Image I is an image obtained with a microscope. Image II is an image obtained with an endoscope.

The system works as follows: Fig. 1 .: the image of the surgical field I observed by the surgical microscope 1 is recorded using a video camera 2, the video signal from the camera 2 is converted by an analog-to-digital converter 3 and fed to the input A of the computer system unit 4 in a standard digital format.

Image II, observed by an ophthalmic endoscope 5, is converted by an analog-to-digital converter 8 using a video camera 6 and fed to input B of the computer system unit 4. Illuminator 7 provides the necessary illumination at the working end of the ophthalmoscope 5. After processing images I and II, the computer system unit 4 is set The program sends a signal to the head monitors 9 and is observed directly by the surgeon. When the surgeon’s head is turned at the output of the tracker 10 of the head monitors, a control signal arises that controls the selection of images output to the head monitors 9, depending on the given computer program 4.

Image selection control is carried out using the tracker built into the head monitors when turning the head to the right, left, up, down - Figure 2,

where A is the turn of the head up.

B - turning the head down.

C - turn the head to the right.

D - turn the head to the left.

When turning the head up, the tracker sends a signal to the computer and the image I of Fig. 3 appears on the head monitors of the surgeon.

When the head is turned down, the tracker gives a signal and image II appears on the head monitors. Figure 3.

When you turn the head to the right, the tracker sends a signal to the computer and image III appears on the head monitors. Figure 3.

Thus, figure 3 presents examples of images obtained in the head monitors:

image I is a surgical field observed by a surgeon under a microscope; image II - the site observed by the ophthalmoendoscope; Image III - a large image of the site observed by the endoscope and a small, in the right corner, surgical field observed under the microscope; Image IV is a large image of a surgical field observed under a microscope, and a small, in the right corner, area observed by an ophthalmoscope.

When the surgeon’s head is turned to the left, the tracker sends a signal to the computer and the image IV appears on the surgeon’s head monitors. Figure 3.

When placing the tracker in position A (figure 2), image 1 of figure 3 appears., With an operating microscope.

When the tracker is moved to position B, image 3 of Figure 3 appears., With an ophthalmic endoscope, when the tracker is moved to position C of Figure 2, image 3 of Figure 3 appears. A large image from the endoscope and a small image in the right corner from the microscope. when the tracker is moved to position D of figure 2., an image 4 of figure 3. arises, a large image from the microscope and a small image in the right corner from the endoscope.

Unlike the closest analogue, the system contains a high-speed computer, an analog-to-digital converter, a head position sensor (tracker) system located in the head monitors, through which the computer is controlled

the program, depending on the signals from the tracker, the computer processes, selects and forms the image supplied from various cameras installed at the output of the endoscope and on the eyepieces of a surgical microscope. This allows you to observe in various combinations the image from the endoscope and surgical microscope on the head monitors.

Using the tracker, a signal is sent to the computer and after that the computer issues the requested image to the head monitors.

Example: a patient of 47 years old, was admitted to the institute with a diagnosis of OD-old, total funnel-shaped retinal detachment, DVR D2, toxic-allergic uveitis, artifact. 3 months have passed since the onset of retinal detachment.

Objective studies on admission: the right eye is moderately irritated, mixed conjunctiva injection, multiple fresh and pigmented precipitates on the corneal endothelium, anterior chamber of medium depth, moisture opalescent, iris subatrophic, pupil of irregular shape, maximal diameter 3 mm, stiff, posterior synechia IOL is displaced upward, pigmented precipitates, fibrosis of the posterior capsule, in the vitreous suspension of fresh and pigmented inflammatory cells ++, anterior, on the front surface of the IOL departments vitreous sealed. Examination of the fundus is extremely difficult. The fundus behind the fleur, when examined using a Goldman three-mirror lens with sclerocompression, the optic disc is covered with blisters of a detached retina, convoluted arteries, veins are dilated, total retinal detachment with pronounced intra- and preretinal fibrosis, valvular rupture, respectively, 9.30-10 hours.

Visual acuity OD - light perception, proper light projection. Echography data: OD - total funnel-shaped retinal detachment, floating and fixed opacities in the vitreous body.

Data electrophysiological studies: OD - sharply increased the threshold of electrical sensitivity (400-500 μa).

Preoperative treatment was carried out: intravenously, dexamethasone in physiological saline, subconjunctival mesatone, parabulbar dexamethasone, installations of atropine, naklof. Partial YAG-laser synechiotomy, capsulotomy was performed. Toxic-allergic uveitis is stopped.

Surgical treatment was performed: circular filling with a silicone sponge, closed subtotal vitrectomy, endolasercoagulation, intravitreal administration of PFOS.

Due to the lack of conditions for full visualization of the fundus and the cavity of the eyeball, it was decided to use a multimedia ophthalmoscopic system during surgery.

This system includes:

Endoscope gradual endoscope.

- Increase 1.7 times.

- Resolution 9 mm - 1.

- Field of view 70 degrees.

- Weight 125 g.

- Diameter 1.7 mm.

- Length 37 cm.

Illuminator from a direct ophthalmoendoscope OR-3A: illumination 100-200 Lux.

A television camera with an optical system. As a television camera, a small-sized camera based on a CCD matrix of a standard size of 1/4-inch with a resolution of 420 * 400 pixels was used. For docking with an endoscope, an optical system with image adjustment was used.

The analog-to-digital converter of the video sequence of type - ADVC - 300 of Canopus firm.

A computer with digital video processing and recording programs. FOXCONN:

- CPU Intel Pentium D 915 2.80 GHz

- RAM - 2GB

- Disk memory - 250 GB

- DVD + R / RV

- Video card memory - 2GB

Wearable head monitors.

Monitor Specifications: The 3D Visor Z800 has two OLED displays for the left and right eyes with a resolution of 800 × 600 pixels each. Built-in motion tracker allows you to track head turns. Working with a 3D Visor Z800 helmet is equivalent to working with a 105-inch monitor at a distance of 3.6 meters, OLED screens, unlike LCD or CRT monitors, do not create flicker, which is so annoying in such devices. The device is powered by a USB port on the computer and does not require additional connection to an energy source.

CharacteristicsMagin3DVisorZ800

SVGA resolution 800 × 3 × 600 for each eye (only 2.8 MPix.).

Aspect ratio - 4: 3.

The angle of view is 40 degrees.

Equivalent to a 105 "screen at a distance of 3.6 meters.

24-bit color 16.7 million colors.

Brightness - 50 cd / sq.m.

Contrast Ratio - 200: 1.

Head position sensor - 360 degree rotation in the horizontal plane +60 degrees in the vertical plane.

Power Consumption: 1 to 1.5 watts.

Power: USB or power source. Weight 250 gr.

A panoramic ophthalmic microscope with an image inverter EIBOS 200 (Holler-Wedel International, Germany).

A circular episcleral filling with a silicone sponge was performed.

Vitrectomy was performed according to the standard 3-port technique with a Nidek vitreotome using a multimedia ophthalmic endoscopic system.

Monitoring the progress of intraocular intervention was carried out on wearable head monitors. In this case, the selection of images was carried out using a tracker, adjustable by turning the head. When the head was turned upward on the head monitors, an image of the surgical field appeared with a microscope, while the cornea and the position of the instruments inside the eye cavity (vitreotome, endoscope) were visible.

When turning the head down on the surgeon's head monitors, an image from an ophthalmological endoscope appeared, while it was possible to visualize hard-to-reach areas of the eyeball (peripheral parts of the retina, ciliary body, vitreous base, topographic position of the haptic elements of the IOL), it is these parts of the eyeball that are difficult to examine when observation using a microscope with non-contact nozzles.

When turning the head to the right, two images appeared on the head monitors, a large image from the endoscope and a small image from the endoscope in the right corner, thanks to this combination of images, the surgeon could simultaneously observe the peripheral parts of the eyeball, as well as the location of the instruments inside the eye cavity. it

significantly facilitated the work of the surgeon and reduced the risk of iatrogenic damage to the lens, since observing a picture from an endoscope it is sometimes difficult to determine the position of the vitreotome and endoscope in the cavity of the eyeball.

When turning the head to the left, a large image from the microscope and a small image in the right corner from the endoscope appeared on the surgeon's head monitors.

An intraoperative examination revealed a total funnel-shaped retinal detachment with preretinal fibrosis, immobilized by vitreoretinal moorings, the previously described valve rupture with fibrous-altered edges.

Under endoscopic control, the anterior vitreous has been removed. A thorough examination of the periphery of the retina was performed. A second hole gap was revealed, respectively, 1 hour. A complete vitrectomy, shvartectomy was performed. Cyclic membranes in the region of the ciliary body were revealed. Partial peeling was done. After straightening the detached retina using PFOS, pronounced fibrosis of the macular and paramacular zones was revealed. Endolaser coagulation around retinal breaks was performed. PFOS replaced by silicone oil.

During the operation, iatrogenic damage to the intraocular structures was avoided, since there was no period of a glance from the operating microscope to wearable head monitors.

To expand intraoperative diagnostic capabilities due to the simultaneous observation of two images on wearable head monitors.

In the postoperative period, the retina is adjacent, visual acuity OD 0.02 is eccentric.

Thus, the proposed ophthalmoscopic system allows you to expand intraoperative diagnostic capabilities and reduce the risk of iatrogenic intraocular lesions.

Claims (1)

A multimedia ophthalmic endoscopic system, including an ophthalmic endoscope with a video camera, wearable head monitors, a surgical microscope with a video camera, characterized in that it additionally contains a high-speed computer with a digital converter, and the head monitors are equipped with a head position sensor - a tracker.