Samsudin, AB; (2014) An Assessment of Flow and Pressure Control in Experimental Models of Glaucoma Drainage Surgery. Doctoral thesis , UCL (University College London).

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Abstract

There are a number of surgical methods for treating glaucoma, including trabeculectomy and the insertion of drainage devices. At the current time, these procedures are still associated with post-operative problems for a significant number of patients, particularly with the control of aqueous humour flow and pressure e.g. hypotony. The main aim of this work was to look at ways of improving the outcomes of the procedures. The usual approach in assessing surgical techniques is to test them on live human or animal eyes. This is inherently complex, with a significant challenge to keep some of the major parameters e.g. aqueous humour inflow and wound healing consistent throughout a series of tests, and with this the problem of reproducibility. The approach used in this work includes a review and analysis of the different surgical methods and devices from an engineering perspective, the use of scaling analysis and a large-scale physical model coupled with image processing to study trabeculectomy scleral flap characteristics and its effect on flow and pressure, and also the use of model drainage devices in ex vivo settings to look at flow and pressure. For each experiment, implications for clinical practice are discussed. Applying engineering principles to glaucoma procedures and devices provided novel insight into their functions. It was found that the trabeculectomy scleral flap acts as a valve to guard from excessive aqueous humour outflow and low pressures, and parameters such as the number and position of sutures and scleral flap geometry can be tailored to alter aqueous humour outflow. Additionally, 50 μm internal diameter tubes show promise for controlled aqueous humour flow into the subconjunctival space with avoidance of low pressures. Engineering methodology can be used in the development of new treatments and devices. However, some results may not translate exactly into the more complex living eye.

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