Validation of an Experimental Setup to Reliably Simulate Flow Through Nonvalved Glaucoma Drainage Devices

Abstract

Treatment of vision-threating elevated intraocular pressure (IOP) for severe glaucoma may require implantation of a glaucoma drainage device (GDD) to shunt aqueous humor (AH) from the anterior chamber of the eye and lower IOP to acceptable levels between 8 and 21 mm Hg. Nonvalved GDDs (NVGDDs) cannot maintain IOP in that acceptable range during the early postoperative period and require intra-operative modifications for IOP control during the first 30 days after surgery. Other GDDs have valves to overcome this issue, but are less successful with maintaining long-term IOP. Our research goal is to improve NVGDD postoperative performance. Little rigorous research has been done to systematically analyze flow/pressure characteristics in NVGDDs. We describe an experimental system developed to assess the pressure drop for physiologic flow rates through NVGDD-like microtubes of various lengths/diameters, some with annular inserts. Experimental pressure measurements for flow through hollow microtubes are within predictive theory's limits. For instance, a 50.4 μm inner diameter microtube yields an average experimental pressure of 33.7 mm Hg, while theory predicts 31.0–64.2 mm Hg. An annular example, with 358.8 μm outside and 330.7 μm inside diameters, yields an experimental pressure of 9.6 mm Hg, within theoretical predictions of 4.2–19.2 mm Hg. These results are repeatable and consistent over 25 days, which fits the 20–35 day period needed for scar tissue formation to achieve long-term IOP control. This work introduces a novel method for controlling IOP and demonstrates an experiment to examine this over 25 days. Future efforts will study insert size and degradable inserts.