Lim, Kin Sheng; (2001) Development of a new glaucoma drainage device. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Glaucoma filtration surgery has been shown to be more effective at preventing disease progression than other primary treatment modalities in open angle glaucoma. If it were possible to avoid complications associated with poor flow control, primary glaucoma filtration surgery would probably be offered more widely. Trabeculectomy, the procedure of choice in conventional glaucoma filtration surgery, has remained essentially unchanged tor over a quarter of a century. Local control over wound healing with antimetabolite agents such as 5-tluorouracil and mitomycin C has improved the prognosis for cases with high risk of filtration failure; but flow control remains imprecise despite the introduction of a variety of suture adjustment techniques. Glaucoma drainage devices have the potential to regulate flow consistently, eliminating hypotony after surgery. Design, material, and manufacturing deficiencies have left this potential unfulfilled in existing glaucoma drainage devices, all of which exhibit problems with poor flow control and suboptimal tissue compatibility. This thesis will examine whether a new flow resistor produced by excimer laser ablation in a polymer substrate and a new external glaucoma drainage device design could prevent hypotony in a series of in vitro experiments and a limited in vivo study. It will also investigate whether phosphorylcholine coating of polymethyl methacrylate can reduce the adhesion of cells and proteins compared to current biomaterials used in the construction of glaucoma drainage devices.

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