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Translaminar Autonomous System Model for the Modulation of Intraocular and Intracranial Pressure in Human Donor Posterior Segments
Published on: April 24, 2020
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A model for designing intraocular pressure-regulating glaucoma implants.
Inês C F Pereira1,2, Hans M Wyss1,2, Leonard Pinchuk3,4
1Microsystems, Department of Mechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Plos One
|September 2, 2022
Summary
This study developed a mathematical model to understand how glaucoma drainage devices affect intraocular pressure (IOP). Adjustable implant resistance can prevent hypotony but requires anti-fibrosis strategies for effective IOP reduction in glaucoma treatment.
Area of Science:
- Ophthalmology
- Biomedical Engineering
- Mathematical Modeling
Background:
- Glaucoma damages the optic nerve, with elevated intraocular pressure (IOP) as a primary risk factor.
- Glaucoma drainage devices reduce IOP by diverting aqueous humor, creating a filtering bleb.
- Long-term success depends on bleb function and overlying tissue health (Tenon's and conjunctiva).
Purpose of the Study:
- To develop a mathematical model simulating fluid dynamics for glaucoma implant (PRESERFLO® MicroShunt) function.
- To investigate the influence of tissue health on IOP and the impact of adjustable implant resistance.
- To explore strategies for optimizing IOP control in the presence of hypotony or bleb scarring.
Main Methods:
- Developed a mathematical model of aqueous humor flow, including production, anterior chamber removal, bleb drainage, and subconjunctival absorption.
- Numerically solved the model using COMSOL Multiphysics.
- Simulated flow through a microshunt with adjustable lumen diameter to assess hydrodynamic resistance adjustments.
Main Results:
- Numerical results for IOP outcomes align with existing clinical evidence for the PRESERFLO® MicroShunt.
- Increasing microshunt hydrodynamic resistance by reducing lumen diameter effectively prevents hypotony.
- Decreasing implant resistance does not sufficiently lower IOP when bleb encapsulation due to fibrosis occurs.
Conclusions:
- Adjustable glaucoma implants can help manage IOP by preventing hypotony through resistance modification.
- Effective IOP reduction in cases of bleb fibrosis requires combining adjustable implants with anti-fibrosis treatments.
- Findings provide insights for designing future glaucoma implants with adjustable hydrodynamic resistances.
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