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Aqueous Humor Circulation in the Era of Minimally Invasive Surgery for Glaucoma

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Abstract

Glaucoma surgery with implantation of aqueous humor draining microstents may compromise long-term corneal health by disrupting aqueous humor circulation. The effect of stent numbers on this circulation was interrogated to determine the number of stents associated with minimal circulation disruption. An in vitro anterior eye model perfusion system was constructed with multiple exit ports. A 3-D model of the anterior eye was imported into ABAQUS CFD, analyzes were carried out for unsteady laminar flow and solved using Navier-Stokes equations. DT Vision Foundry was used to analyze velocity contour plot images. The field variable results output for the CFD model were fluid wall shear, fluid pressure and fluid velocity. In vitro, “aqueous” fluid flow is high through a single stent and “aqueous” stagnation is greatest in the quadrants 180° away. Increasing stent port numbers, results in an exponential decrease in the stagnant flow locations. High wall shear stress was seen in the single stent model and is markedly reduced after a second and subsequent stents are introduced. We identify two factors potentially contributing to corneal compromise post glaucoma drainage surgery: aqueous humor stagnation, remote to the stent site and higher exit flows imparting increased stent exit shear stress (particularly with a single stent). With 4 stents, there is minimal disruption of anterior chamber circulation (mimicking physiological conditions). Furthermore we propose that aqueous humor circulation disruption via the usual single-exit port approach disrupts aqueous humor circulation with long-term consequences for corneal health.

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Funding

Funding for this project was obtained as an unrestricted grant from the Look For Life Foundation of which MTC is Chairman and a Director.

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Authors and Affiliations

  1. Ophthalmic Surgeons, 2 St Pauls St, Randwick, NSW, 2031, Australia

    Minas T. Coroneo & Eric Maver

  2. Department of Ophthalmology, Prince of Wales Hospital/University of New South Wales, Sydney, Australia

    Minas T. Coroneo

  3. Medical Device Research Australia Pty Ltd, Sydney, Australia

    Gabriel Graterol-Nisi & R. Mark Gillies

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  1. Minas T. Coroneo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RMG, GG-N, EM and MTC. The first draft of the manuscript was written by MTC and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Minas T. Coroneo.

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Competing interests

A company associated with the private clinical practice of MTC but in which he has no financial interest, has filed patent applications on data presented in this manuscript. Over the last 3 years MTC has received royalties for an instrument he designed and which is sold by Katena/Corza Medical. This instrument is unrelated to the material in this manuscript. The other authors have no matters to disclose.

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Coroneo, M.T., Graterol-Nisi, G., Maver, E. et al. Aqueous Humor Circulation in the Era of Minimally Invasive Surgery for Glaucoma. Ann Biomed Eng 52, 898–907 (2024). https://doi.org/10.1007/s10439-023-03427-3

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