Phacoemulsification and calculation of intraocular lenses in patients given keratorefractive surgery. Part 2

Effective rehabilitation of patients with cataracts who underwent keratorefractive surgeries requires that the optical power of the IOL be calculated correctly to avoid hyperopic error. The purpose of the 2nd part of the research (for the 1st part, see ROJ, 2021; 14 (2): 55–58) is to present the results of cataract phacoemulsification in patients subjected to keratorefractive surgery based on the author’s algorithm for calculating the optical power of the IOL. Material and methods. The algorithm used optical biometry with an IOL-Master device. The main technique of improving the accuracy of IOL calculation after keratorefractive operations has been to introduce amendments to standard IOL calculation formulas. This work proposes an alternative, which consists in using the Hoffer Q formula, as it is more consistent with changes in the anterior segment of the myopic eye after keratorefractive surgery than other basic. The main distinguishing feature of the Hoffer Q formula is that the corneal refraction is not converted into the radius of curvature but is applied directly as the optical power of a “thin lens”. Results. The empirical customized correction was +1.0 D with regard to the estimated planned postoperative refraction (for patients with initial myopia from -3 to -9 D). The use of the “thin lens” principle made it possible to extrapolate this formula and apply it after LASIK surgery and after radial keratotomy. Conclusion. The proposed technique of IOL calculation was implemented for cataract phacoemulsification in over 200 patients who underwent keratorefractive surgeries. No cases of hyperopic shift of postoperative refraction were noted. The deviation from the planned myopic refraction did not exceed 1.0 D.

Wearable Sensory Apparatus for Real-Time Feedback in Wearable Robotics

We describe the Wearable Sensory Apparatus (WSA) System, which has been implemented and verified in accordance with the relevant standards. It comprises the Inertial Measurement Units (IMUs), real-time wireless data transmission over Ultrawideband (UWB), a Master Unit and several IMU dongles forming the Wireless Body Area Network (WBAN). The WSA is designed for, but is not restricted to, wearable robots. The paper focuses on the topology of the communication network, the WSA hardware, and the organization of the WSA firmware. The experimental evaluation of the WSA incorporates the confirmation of the timing using the supply current WSA profile, measurements related to determining the less error prone position of the master device on the backpack, measurements of the quality of the data transfer in a real environment scenario, measurements in the presence of other microwave signals, and an example of raw IMU signals during human walking. Placement of the master device on the top of the backpack was found to be less error prone, with less than 0.02% packet loss for all the IMU devices placed on different body segments. The packet loss did not change significantly in public buildings or on the street. There was no impact of Wi-Fi bands on the WSA data transfer. The WSA hardware and firmware passed conformance testing in a certified lab. Most importantly, the WSA performed reliably in the laboratory and in clinical tests with exoskeletons and prostheses.

Changes in the Ocular Parameters of Patients with Graves’ Disease after Antithyroid Drug Treatment

Background and Objectives: To find the differences in ocular axial length, keratometric measurements, and intraocular lens (IOL) power in patients with Graves’ disease (GD) after treatment with a thionamide antithyroid drug (ATD), methimazole. Materials and Methods: The medical charts of 28 patients (4 males and 24 females; mean age: 47.2 ± 21.2 years) were studied. Each patient was examined twice using an IOL Master Device and keratometry at the first visit (before ATD treatment) and after 1 month of ATD treatment. The IOL power was calculated for each patient using the Hoffer Q, SRK-2, and SRK/T formulas according to axial length. Results: After 1 month, the axial length increased (right and left eyes: p < 0.001 and p = 0.05, respectively). Based on keratometry, changes in the horizontal and vertical optical power [in diopters (D)] were not statistically significant. However, the IOL power changed after 1 month of ATD treatment in 64.3% of the patients. In 14 patients (50%), there was a 0.5–1.0 D IOL power decrease in single eyes; in two patients (7.1%), an IOL power decrease of 0.5–1.0 D in both eyes; and in two patients (7.1%), a 0.5 D IOL power increase in single eyes. The calculated IOL power values were lower after ATD treatment (right and left eyes, p = 0.010 and p = 0.018, respectively). Conclusions: The IOL power changed in 64.3% of GD patients after ATD treatment. Therefore, avoiding cataract surgery at the early stage of ATD treatment would be appropriate for selecting a more accurate IOL power.

A Portable Intuitive Haptic Device on a Desk for User-Friendly Teleoperation of a Cable-Driven Parallel Robot

This paper presents a compact-sized haptic device based on a cable-driven parallel robot (CDPR) mechanism for teleoperation. CDPRs characteristically have large workspaces and lightweight actuators. An intuitive and user-friendly remote control has not yet been achieved, owing to the unfamiliar multiple-cable configuration of CDPRs. To address this, we constructed a portable compact-sized CDPR with the same configuration as that of a larger fully constrained slave CDPR. The haptic device is controlled by an admittance control for stiffness adjustment and implemented in an embedded microprocessor-based controller for easy installation on an operator’s desk. To validate the performance of the device, we constructed an experimental teleoperation setup by using the prototyped portable CDPR as a master and larger-size CDPR as a slave robot. Experimental results showed that a human operator can successfully control the master device from a remote site and synchronized motion between the master and slave device was performed. Moreover, the user-friendly teleoperation could intuitively address situations at a remote site and provide an operator with realistic force during the motion of the slave CDPR.

A Flexible Transoral Robot Towards COVID-19 Swab Sampling

There are high risks of infection for surgeons during the face-to-face COVID-19 swab sampling due to the novel coronavirus’s infectivity. To address this issue, we propose a flexible transoral robot with a teleoperated configuration for swab sampling. The robot comprises a flexible manipulator, an endoscope with a monitor, and a master device. A 3-prismatic-universal (3-PU) flexible parallel mechanism with 3 degrees of freedom (DOF) is used to realize the manipulator’s movements. The flexibility of the manipulator improves the safety of testees. Besides, the master device is similar to the manipulator in structure. It is easy to use for operators. Under the guidance of the vision from the endoscope, the surgeon can operate the master device to control the swab’s motion attached to the manipulator for sampling. In this paper, the robotic system, the workspace, and the operation procedure are described in detail. The tongue depressor, which is used to prevent the tongue’s interference during the sampling, is also tested. The accuracy of the manipulator under visual guidance is validated intuitively. Finally, the experiment on a human phantom is conducted to demonstrate the feasibility of the robot preliminarily.

Experimental Structural Stiffness Analysis of a Surgical Haptic Master Device Manipulator

This paper deals with haptic devices for master–slave telesurgical applications. Namely, a stiffness model fitting methodology and its fine-tuning are proposed based on experimental results. In particular, the proposed procedure is based on virtual joint structural stiffness modeling to be applied in time-efficient compliance compensation strategies. A specific case study is discussed by referring to the HISS haptic device that has been developed and built at Izmir Institute of Technology. Two different experimental setups are designed for stiffness evaluation tests. Experimental results are discussed to demonstrate their implementation in the proposed methodology for the fine-tuning of stiffness model.