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.

Test-time Controllable Image Generation by Explicit Spatial Constraint Enforcement

Recent text-to-image generation favors various forms of spatial conditions, e.g., masks, bounding boxes, and key points. However, the majority of the prior art requires form-specific annotations to fine-tune the original model, leading to poor test-time generalizability. Meanwhile, existing training-free methods work well only with simplified prompts and spatial conditions. In this work, we propose a novel yet generic test-time controllable generation method that aims at natural text prompts and complex conditions. Specifically, we decouple spatial conditions into semantic and geometric conditions and then enforce their consistency during the image-generation process individually. As for the former, we target bridging the gap between the semantic condition and text prompts, as well as the gap between such condition and the attention map from diffusion models. To achieve this, we propose to first complete the prompt w.r.t. semantic condition, and then remove the negative impact of distracting prompt words by measuring their statistics in attention maps as well as distances in word space w.r.t. this condition. To further cope with the complex geometric conditions, we introduce a geometric transform module, in which Region-of-Interests will be identified in attention maps and further used to translate category-wise latents w.r.t. geometric condition. More importantly, we propose a diffusion-based latents-refill method to explicitly remove the impact of latents at the RoI, reducing the artifacts on generated images. Experiments on Coco-stuff dataset showcase 30$\%$ relative boost compared to SOTA training-free methods on layout consistency evaluation metrics.

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.