Advertisement

Biomedical Microdevices

, 21:92 | Cite as

Semi-permanent transcorneal filter support and in vivo surgical implantation technique for open-angle glaucoma treatment

  • Brett CollarEmail author
  • Gabriel Simón
  • Quan Yuan
  • Sui Shen
  • Pedro Irazoqui
Article
  • 36 Downloads

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 

Notes

Acknowledgements

This study was partially supported by the Center for Implantable Devices (CID) at Purdue University and a grant from Bionode LLC. The authors would also like to acknowledge the contributions of Jay Shah and Rachael Swenson for providing invaluable manuscript feedback, as well as the expertise of surgical technician Curtis Slaubaugh.

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted (PACUC Protocol #1309000929).

References

  1. M.J. Bak, J.S. McIntosh, E.M. Scmidt, Long-term implants of parylene-c coated microelectrodes. Med. Biol. Eng. Comput. 26, 96–101 (1988)CrossRefGoogle Scholar
  2. G. Beidoe, S. Mousa, Current primary open-angle glaucoma treatments and future directions. Clin. Ophthalmol. 6, 1699–1707 (2012)Google Scholar
  3. R. Brubaker, Flow of aqueous humor in humans. Invest. Ophthalmol. Vis. Sci. 32, 3145–3166 (1991)Google Scholar
  4. T. Chan, S. Payor, B. Holden, Corneal thickness profiles in rabbits using an ultrasonic pachometer. Invest. Ophthalmol. Vis. Sci. 24(10), 1408–1410 (1983)Google Scholar
  5. H.D. Jampel, Guidelines on design and reporting of glaucoma surgical trials (Kugler, Amsterdam, 2009)Google Scholar
  6. V. Kapetanakis, M. Chan, P. Foster, D. Cook, C. Owen, A. Rudnicka, Global variations and time trends in the prevalence of primary open angle glaucoma (POAG): a systematic review and meta-analysis. British J. Ophthalmol. 100, 86–93 (2016)CrossRefGoogle Scholar
  7. D. Lee, E. Higginbotham, Glaucoma and its treatment: A review. Am. J. Health Syst. Pharm. 62(7), 691–699 (2005)CrossRefGoogle Scholar
  8. T. Leeungurasatien, P. Khunsongkiet, K. Pathanapitoon, D. Wiwatwongwana, Incidence of short-term complications and associated factors after primary trabeculectomy in Chiang Mai University Hospital. Indian J. Ophthalmol. 64(10), 737–742 (2016)CrossRefGoogle Scholar
  9. E.W. Leung, F.A. Medeiros, R.N. Weinreb, Prevalence of ocular surface disease in Glaucoma patients. J. Glaucoma 17(5), 350–355 (2008)CrossRefGoogle Scholar
  10. L. Levin, S. Nilsson, J. Ver Hoeve, S. Wu, P. Kaufman, A. Alm, Adler's physiology of the eye, Elsevier Inc., (2011)Google Scholar
  11. N.P. Macdonald, F. Zhu, C.J. Hall, J. Reboud, P.S. Crosier, E.E. Patton, D. Wlodkowic, J.M. Cooper, Assessment of biocompatibility of 3D printed photopolymers using zebrafish embryo toxicity assays. Lab Chip 16(2), 291–297 (2016)CrossRefGoogle Scholar
  12. J. I. Orlando, Machine learning for ophthalmic screening and diagnostics from fundus images. KU Leuven, National University of Central Buenos Aires, (2017)Google Scholar
  13. A.M. Palanca-Capistrano, J. Hall, L.B. Cantor, L. Morgan, J. Hoop, D. Wudunn, Long-term outcomes of intraoperative 5-fluorouracil versus intraoperative Mitomycin C in primary trabeculectomy surgery. Ophthalmology 116(2), 185–190 (2009)CrossRefGoogle Scholar
  14. H.A. Quigley, A.T. Broman, The number of people with glaucoma worldwide in 2010 and 2020. British J. Ophthalmol. 90, 262–267 (2006)CrossRefGoogle Scholar
  15. I. Riva, G. Roberti, F. Oddone, A.G. Konstas, L. Quaranta, Ahmed glaucoma valve implant: surgical technique and complications. Clin. Ophthalmol. 11, 357–367 (2017)CrossRefGoogle Scholar
  16. R. Rosenquist, D. Epstein, S. Melamed, M. Johnson, W.M. Grant, Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy. Curr. Eye Res. 8(12), 1233–1240 (1989)CrossRefGoogle Scholar
  17. L. R. Schneider, S. B. Hannush, Boston Keratoprosthesis type I: Surgical techniques. Keratoprostheses and Artificial Corneas, Berlin: Springer, 2015, pp. 77–80Google Scholar
  18. R. Suzuki, C. Dickens, A. Iwach, H. Hoskins, J. Hetherington, R. Juster, P. Wong, M. Klufas, C. Leong, N. Nguyen, Long-term follow-up of initially successful trabeculectomy with 5-fluorouracil injections. Ophthalmology 109(10), 1921–1924 (2002)CrossRefGoogle Scholar
  19. C. Toris, M. Yablonski, Y. Wang, C. Camras, Aqueous humor dynamics in the aging human eye. Am J. Ophthalmol. 127(4), 407–412 (1999)CrossRefGoogle Scholar
  20. C. Vass, C. Hirn, E. Unger, W. Mayr, M. Georgopoulos, G. Rainer, S. Richter-Mueksch, Human aqueous humor viscosity in cataract, primary open angle glaucoma and pseudoexfoliation syndrome. Investig. Ophthalmol. Visual Sci. 45(13), 5030 (2004)Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringPurdue UniversityWest LafayetteUSA
  2. 2.Department of Electrical and Computer EngineeringPurdue UniversityWest LafayetteUSA
  3. 3.Ophthalmological Institute of Gabriel SimónMadridSpain

Personalised recommendations