A model for designing intraocular pressure-regulating glaucoma implants.
Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for vision. The key risk factor for the development and progression of this disease is increased intraocular pressure (IOP). Implantable glaucoma drainage devices have been developed to divert aqueous hum...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0273672 |
| _version_ | 1797842448199712768 |
|---|---|
| author | Inês C F Pereira Hans M Wyss Leonard Pinchuk Henny J M Beckers Jaap M J den Toonder |
| author_facet | Inês C F Pereira Hans M Wyss Leonard Pinchuk Henny J M Beckers Jaap M J den Toonder |
| author_sort | Inês C F Pereira |
| collection | DOAJ |
| description | Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for vision. The key risk factor for the development and progression of this disease is increased intraocular pressure (IOP). Implantable glaucoma drainage devices have been developed to divert aqueous humor from the glaucomatous eye as a means of reducing IOP. The artificial drainage pathway created by these devices drives the fluid into a filtering bleb. The long-term success of filtration surgery is dictated by the proper functioning of the bleb and overlying Tenon's and conjunctival tissue. To better understand the influence of the health condition of these tissues on IOP, we have developed a mathematical model of fluid production in the eye, its removal from the anterior chamber by a particular glaucoma implant-the PRESERFLO® MicroShunt-, drainage into the bleb and absorption by the subconjunctival vasculature. The mathematical model was numerically solved by commercial FEM package COMSOL. Our numerical results of IOP for different postoperative conditions are consistent with the available evidence on IOP outcomes after the implantation of this device. To obtain insight into the adjustments in the implant's hydrodynamic resistance that are required for IOP control when hypotony or bleb scarring due to tissue fibrosis take place, we have simulated the flow through a microshunt with an adjustable lumen diameter. Our findings show that increasing the hydrodynamic resistance of the microshunt by reducing the lumen diameter, can effectively help to prevent hypotony. However, decreasing the hydrodynamic resistance of the implant will not sufficiently decrease the IOP to acceptable levels when the bleb is encapsulated due to tissue fibrosis. Therefore, to effectively reduce IOP, the adjustable glaucoma implant should be combined with a means of reducing fibrosis. The results reported herein may provide guidelines to support the design of future glaucoma implants with adjustable hydrodynamic resistances. |
| first_indexed | 2024-04-09T16:48:04Z |
| format | Article |
| id | doaj.art-795834c5b99e49c698052056766ee41e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T16:48:04Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-795834c5b99e49c698052056766ee41e2023-04-22T05:32:02ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01179e027367210.1371/journal.pone.0273672A model for designing intraocular pressure-regulating glaucoma implants.Inês C F PereiraHans M WyssLeonard PinchukHenny J M BeckersJaap M J den ToonderGlaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for vision. The key risk factor for the development and progression of this disease is increased intraocular pressure (IOP). Implantable glaucoma drainage devices have been developed to divert aqueous humor from the glaucomatous eye as a means of reducing IOP. The artificial drainage pathway created by these devices drives the fluid into a filtering bleb. The long-term success of filtration surgery is dictated by the proper functioning of the bleb and overlying Tenon's and conjunctival tissue. To better understand the influence of the health condition of these tissues on IOP, we have developed a mathematical model of fluid production in the eye, its removal from the anterior chamber by a particular glaucoma implant-the PRESERFLO® MicroShunt-, drainage into the bleb and absorption by the subconjunctival vasculature. The mathematical model was numerically solved by commercial FEM package COMSOL. Our numerical results of IOP for different postoperative conditions are consistent with the available evidence on IOP outcomes after the implantation of this device. To obtain insight into the adjustments in the implant's hydrodynamic resistance that are required for IOP control when hypotony or bleb scarring due to tissue fibrosis take place, we have simulated the flow through a microshunt with an adjustable lumen diameter. Our findings show that increasing the hydrodynamic resistance of the microshunt by reducing the lumen diameter, can effectively help to prevent hypotony. However, decreasing the hydrodynamic resistance of the implant will not sufficiently decrease the IOP to acceptable levels when the bleb is encapsulated due to tissue fibrosis. Therefore, to effectively reduce IOP, the adjustable glaucoma implant should be combined with a means of reducing fibrosis. The results reported herein may provide guidelines to support the design of future glaucoma implants with adjustable hydrodynamic resistances.https://doi.org/10.1371/journal.pone.0273672 |
| spellingShingle | Inês C F Pereira Hans M Wyss Leonard Pinchuk Henny J M Beckers Jaap M J den Toonder A model for designing intraocular pressure-regulating glaucoma implants. PLoS ONE |
| title | A model for designing intraocular pressure-regulating glaucoma implants. |
| title_full | A model for designing intraocular pressure-regulating glaucoma implants. |
| title_fullStr | A model for designing intraocular pressure-regulating glaucoma implants. |
| title_full_unstemmed | A model for designing intraocular pressure-regulating glaucoma implants. |
| title_short | A model for designing intraocular pressure-regulating glaucoma implants. |
| title_sort | model for designing intraocular pressure regulating glaucoma implants |
| url | https://doi.org/10.1371/journal.pone.0273672 |
| work_keys_str_mv | AT inescfpereira amodelfordesigningintraocularpressureregulatingglaucomaimplants AT hansmwyss amodelfordesigningintraocularpressureregulatingglaucomaimplants AT leonardpinchuk amodelfordesigningintraocularpressureregulatingglaucomaimplants AT hennyjmbeckers amodelfordesigningintraocularpressureregulatingglaucomaimplants AT jaapmjdentoonder amodelfordesigningintraocularpressureregulatingglaucomaimplants AT inescfpereira modelfordesigningintraocularpressureregulatingglaucomaimplants AT hansmwyss modelfordesigningintraocularpressureregulatingglaucomaimplants AT leonardpinchuk modelfordesigningintraocularpressureregulatingglaucomaimplants AT hennyjmbeckers modelfordesigningintraocularpressureregulatingglaucomaimplants AT jaapmjdentoonder modelfordesigningintraocularpressureregulatingglaucomaimplants |