Modifying Aqueous Humor Dynamics for the Treatment of Glaucoma

Abstract

Glaucoma is one of the leading causes of irreversible blindness in the world, and the leading cause in many developing countries. It is a progressive loss of optic nerve tissue typically caused by increased intraocular pressure and treated by lowering the pressure. In developing nations where the disease is most common medications are not affordable and surgery is expensive and unstable. A new surgical approach and drainage device material that could lead to a cost effective, permanent solution were studied. A tube connected to an e-PTFE reservoir shunts fluid from inside the eye to the subconjunctival reservoir. E-PTFE was chosen because it is biocompatible and porous, while promoting angiogenesis and lymphangiogenesis on its surface. The surrounding vessels can carry the fluid back into the systemic circulation. A tangential surgical approach was evaluated because it could spare and protect lymphatic vessels. Recent studies have shown that lymphatics are important in aqueous outflow. Preliminary results showed that theePTFE device could sufficiently lower IOP and that the lymphatics are potentially involved in aqueous outflow after surgery. These results indicate the importance of further evaluating a new surgical approach that addresses the role of lymphatics in fluid outflow from a glaucoma drainage device.