Semi-permanent transcorneal filter support and in vivo surgical implantation technique for open-angle glaucoma treatment
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Semi-permanent transcorneal filter support and in vivo surgical implantation technique for open-angle glaucoma treatment Brett Collar 1,2
&
Gabriel Simón 1,3 & Quan Yuan 1 & Sui Shen 1 & Pedro Irazoqui 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Primary open-angle glaucoma is a progressive disease affecting nearly 60 million people worldwide which, if left untreated, can lead to optic nerve head damage and complete loss of sight. Current interventions include: pharmaceutical drops, laser surgery, shunts, and bleb; however, these methods provide insufficient long-term efficacy in intraocular pressure management. We developed a semi-permanent, implantable transcorneal duct as a new aid in the treatment of this disease. The duct, composed of an intracorneal stabilizing washer and hollow screw, creates an interface between the anterior chamber and the external environment, allowing for the outflow of excess aqueous humor. We discuss the fluid mechanics behind designing and implementing a filter material capable of preventing the ingress of bacteria and viruses while modifying aqueous humor outflow resistances to pre-glaucomatous levels, finding the effective radius of such a material to be 10.44 μm. After performing surgical implantation in four rabbit eyes, subsequent testing showed successful integration between the screw and washer. Colored saline injections highlighted fluid flow progression out of the eye through the duct, suggesting that the device may be a viable approach to treating high intraocular pressure created by open-angle glaucoma. Keywords Glaucoma . Microfluidic device . Filtration . Design . Surgery
1 Introduction Primary open-angle glaucoma (POAG) is the most common type of glaucoma, accounting for 74% of all reported cases (Quigley and Broman 2006). According to recent estimates, in 2015, POAG affected approximately 58 million patients over the age of 40 worldwide (Kapetanakis et al. 2016). If a patient fails to manage their high intraocular pressures caused by POAG, complications include optic nerve head damage, irreversible loss of peripheral vision, and eventual loss of central vision in late disease stages (Lee and Higginbotham 2005). Currently, management guidelines for POAG comprises pharmaceuticals, laser surgery, shunts, and incisional surgery
* Brett Collar [email protected] 1
Department of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive, West Lafayette, IN 47907, USA
2
Department of Electrical and Computer Engineering, Purdue University, 465 Northwestern Ave, West Lafayette, IN 47907, USA
3
Ophthalmological Institute of Gabriel Simón, Calle de Fuencarral, 7, 28004 Madrid, Spain
(Beidoe and Mousa 2012). Studies have found surgical interventions to have failure rates of up to 39% after a 5-year follow-up, and medical drops fail to decrease IOP by more than 25%, prompting the need for an additional semipermanent intervention to aid in elevated IOP management (Beidoe and Mousa 2012) (Suzuki et al. 2002). In the healthy h
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