Topology-based deep-learning segmentation method for deep anterior lamellar keratoplasty (DALK) surgical guidance using M-mode OCT data

Deep Anterior Lamellar Keratoplasty (DALK) is a partial-thickness corneal transplant procedure used to treat corneal stromal diseases. A crucial step in this procedure is the precise separation of the deep stroma from Descemet's membrane (DM) using the Big Bubble technique. To simplify the tasks of needle insertion and pneumo-dissection in this technique, we previously developed an Optical Coherence Tomography (OCT)-guided, eye-mountable robot that uses real-time tracking of corneal layers from M-mode OCT signals for control. However, signal noise and instability during manipulation of the OCT fiber sensor-integrated needle have hindered the performance of conventional deep-learning segmentation methods, resulting in rough and inaccurate detection of corneal layers. To address these challenges, we have developed a topology-based deep-learning segmentation method that integrates a topological loss function with a modified network architecture. This approach effectively reduces the effects of noise and improves segmentation speed, precision, and stability. Validation using in vivo, ex vivo, and hybrid rabbit eye datasets demonstrates that our method outperforms traditional loss-based techniques, providing fast, accurate, and robust segmentation of the epithelium and DM to guide surgery.

Reimagining partial thickness keratoplasty: An eye mountable robot for autonomous big bubble needle insertion

Autonomous surgical robots have demonstrated significant potential to standardize surgical outcomes, driving innovations that enhance safety and consistency regardless of individual surgeon experience. Deep anterior lamellar keratoplasty (DALK), a partial thickness corneal transplant surgery aimed at replacing the anterior part of cornea above Descemet membrane (DM), would greatly benefit from an autonomous surgical approach as it highly relies on surgeon skill with high perforation rates. In this study, we proposed a novel autonomous surgical robotic system (AUTO-DALK) based on a customized neural network capable of precise needle control and consistent big bubble demarcation on cadaver and live rabbit models. We demonstrate the feasibility of an AI-based image-guided vertical drilling approach for big bubble generation, in contrast to the conventional horizontal needle approach. Our system integrates an optical coherence tomography (OCT) fiber optic distal sensor into the eye-mountable micro robotic system, which automatically segments OCT M-mode depth signals to identify corneal layers using a custom deep learning algorithm. It enables the robot to autonomously guide the needle to targeted tissue layers via a depth-controlled feedback loop. We compared autonomous needle insertion performance and resulting pneumo-dissection using AUTO-DALK against 1) freehand insertion, 2) OCT sensor guided manual insertion, and 3) teleoperated robotic insertion, reporting significant improvements in insertion depth, pneumo-dissection depth, task completion time, and big bubble formation. Ex vivo and in vivo results indicate that the AI-driven, AUTO-DALK system, is a promising solution to standardize pneumo-dissection outcomes for partial thickness keratoplasty.

Gradients Stand-in for Defending Deep Leakage in Federated Learning

Federated Learning (FL) has become a cornerstone of privacy protection, shifting the paradigm towards localizing sensitive data while only sending model gradients to a central server. This strategy is designed to reinforce privacy protections and minimize the vulnerabilities inherent in centralized data storage systems. Despite its innovative approach, recent empirical studies have highlighted potential weaknesses in FL, notably regarding the exchange of gradients. In response, this study introduces a novel, efficacious method aimed at safeguarding against gradient leakage, namely, ``AdaDefense". Following the idea that model convergence can be achieved by using different types of optimization methods, we suggest using a local stand-in rather than the actual local gradient for global gradient aggregation on the central server. This proposed approach not only effectively prevents gradient leakage, but also ensures that the overall performance of the model remains largely unaffected. Delving into the theoretical dimensions, we explore how gradients may inadvertently leak private information and present a theoretical framework supporting the efficacy of our proposed method. Extensive empirical tests, supported by popular benchmark experiments, validate that our approach maintains model integrity and is robust against gradient leakage, marking an important step in our pursuit of safe and efficient FL.