Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling

Kendall S Hunter,1 Todd Fjield,2 Hal Heitzmann,2 Robin Shandas,1 Malik Y Kahook3 1Department of Bioengineering, University of Colorado Denver, Aurora, CO, USA; 2Glaukos Corporation, Laguna Hills, CA, USA; 3University of Colorado Hospital Eye Center, Aurora, CO, USA Abstract: Micro-invasive glaucom...

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Autores principales:	Hunter KS, Fjield T, Heitzmann H, Shandas R, Kahook MY
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/080b04e2e8ef4208abfec8a3bf68f1e9
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spelling	oai:doaj.org-article:080b04e2e8ef4208abfec8a3bf68f1e92021-12-02T08:45:22ZCharacterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling1177-5483https://doaj.org/article/080b04e2e8ef4208abfec8a3bf68f1e92014-03-01T00:00:00Zhttp://www.dovepress.com/characterization-of-micro-invasive-trabecular-bypass-stents-by-ex-vivo-a16051https://doaj.org/toc/1177-5483 Kendall S Hunter,1 Todd Fjield,2 Hal Heitzmann,2 Robin Shandas,1 Malik Y Kahook3 1Department of Bioengineering, University of Colorado Denver, Aurora, CO, USA; 2Glaukos Corporation, Laguna Hills, CA, USA; 3University of Colorado Hospital Eye Center, Aurora, CO, USA Abstract: Micro-invasive glaucoma surgery with the Glaukos iStent® or iStent inject® (Glaukos Corporation, Laguna Hills, CA, USA) is intended to create a bypass through the trabecular meshwork to Schlemm's canal to improve aqueous outflow through the natural physiologic pathway. While the iStent devices have been evaluated in ex vivo anterior segment models, they have not previously been evaluated in whole eye perfusion models nor characterized by computational fluid dynamics. Intraocular pressure (IOP) reduction with the iStent was evaluated in an ex vivo whole human eye perfusion model. Numerical modeling, including computational fluid dynamics, was used to evaluate the flow through the stents over physiologically relevant boundary conditions. In the ex vivo model, a single iStent reduced IOP by 6.0 mmHg from baseline, and addition of a second iStent further lowered IOP by 2.9 mmHg, for a total IOP reduction of 8.9 mmHg. Computational modeling showed that simulated flow through the iStent or iStent inject is smooth and laminar at physiological flow rates. Each stent was computed to have a negligible flow resistance consistent with an expected significant decrease in IOP. The present perfusion results agree with prior clinical and laboratory studies to show that both iStent and iStent inject therapies are potentially titratable, providing clinicians with the opportunity to achieve lower target IOPs by implanting additional stents. Keywords: glaucoma, iStent, trabecular bypass, intraocular pressure, ab-interno, CFDHunter KSFjield THeitzmann HShandas RKahook MYDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 499-506 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Hunter KS Fjield T Heitzmann H Shandas R Kahook MY Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling
description	Kendall S Hunter,1 Todd Fjield,2 Hal Heitzmann,2 Robin Shandas,1 Malik Y Kahook3 1Department of Bioengineering, University of Colorado Denver, Aurora, CO, USA; 2Glaukos Corporation, Laguna Hills, CA, USA; 3University of Colorado Hospital Eye Center, Aurora, CO, USA Abstract: Micro-invasive glaucoma surgery with the Glaukos iStent® or iStent inject® (Glaukos Corporation, Laguna Hills, CA, USA) is intended to create a bypass through the trabecular meshwork to Schlemm's canal to improve aqueous outflow through the natural physiologic pathway. While the iStent devices have been evaluated in ex vivo anterior segment models, they have not previously been evaluated in whole eye perfusion models nor characterized by computational fluid dynamics. Intraocular pressure (IOP) reduction with the iStent was evaluated in an ex vivo whole human eye perfusion model. Numerical modeling, including computational fluid dynamics, was used to evaluate the flow through the stents over physiologically relevant boundary conditions. In the ex vivo model, a single iStent reduced IOP by 6.0 mmHg from baseline, and addition of a second iStent further lowered IOP by 2.9 mmHg, for a total IOP reduction of 8.9 mmHg. Computational modeling showed that simulated flow through the iStent or iStent inject is smooth and laminar at physiological flow rates. Each stent was computed to have a negligible flow resistance consistent with an expected significant decrease in IOP. The present perfusion results agree with prior clinical and laboratory studies to show that both iStent and iStent inject therapies are potentially titratable, providing clinicians with the opportunity to achieve lower target IOPs by implanting additional stents. Keywords: glaucoma, iStent, trabecular bypass, intraocular pressure, ab-interno, CFD
format	article
author	Hunter KS Fjield T Heitzmann H Shandas R Kahook MY
author_facet	Hunter KS Fjield T Heitzmann H Shandas R Kahook MY
author_sort	Hunter KS
title	Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling
title_short	Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling
title_full	Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling
title_fullStr	Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling
title_full_unstemmed	Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling
title_sort	characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/080b04e2e8ef4208abfec8a3bf68f1e9
work_keys_str_mv	AT hunterks characterizationofmicroinvasivetrabecularbypassstentsbyexvivoperfusionandcomputationalflowmodeling AT fjieldt characterizationofmicroinvasivetrabecularbypassstentsbyexvivoperfusionandcomputationalflowmodeling AT heitzmannh characterizationofmicroinvasivetrabecularbypassstentsbyexvivoperfusionandcomputationalflowmodeling AT shandasr characterizationofmicroinvasivetrabecularbypassstentsbyexvivoperfusionandcomputationalflowmodeling AT kahookmy characterizationofmicroinvasivetrabecularbypassstentsbyexvivoperfusionandcomputationalflowmodeling
_version_	1718398344888320000

Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling

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