Abstract
Purpose
We report the in vivo testing of a large-lumen glaucoma drainage (LL-GDD) device equipped with a flow regulator. The device’s membrane can be non-invasively opened with laser in the postoperative period to adjust aqueous flow and intraocular pressure.
Methods
The initial LL-GDD prototypes were constructed using 22 G silicone angiocatheters cut down to size. A 10 nm PVDF membrane was then affixed to the end using cyanoacrylate. The LL-GDD was tested first in a model eye equipped with ports for infusion and pressure measurement and in New Zealand rabbits.
Results
New Zealand white satin cross rabbits were used, two eyes receiving the LL-GDD and the two fellow eyes serving as the control group with no intervention performed. After the procedure, the IOP in the LL-GGD surgical group dropped an average of 5.5 mm Hg (P=0.001), which was maintained until the membrane laser procedure at week 5 resulting in an average IOP reduction of 1.8 mm Hg. At week 7, the average IOP in the surgical group was 11 mm Hg compared with 18 mm Hg in the control group (P<0.001). A second laser procedure was done to completely open the membrane face, which resulted in an immediate drop in the average IOP of the surgical group by another 2.7 mm Hg, which was maintained until the study termination at day 55.
Conclusions
The large-lumen glaucoma drainage device demonstrated an ability both to prevent immediate postoperative hypotony and to allow progressively lower IOP on demand in this proof-of-concept study.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Oliver JE, Hattenhauer MG, Herman D, Hodge DO, Kennedy R, Fang-Yen M et al. Blindness and glaucoma: a comparison of patients progressing to blindness from glaucoma with patients maintaining vision. Am J Ophthalmol 2002; 133 (6): 764–772.
Boland MV, Ervin AM, Friedman DS, Jampel HD, Hawkins BS, Vollenweider D et al. Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013; 158 (4): 271–279.
Fremont AM, Lee PP, Mangione CM, Kapur K, Adams JL, Wickstrom SL et al. Patterns of care for open-angle glaucoma in managed care. Arch Ophthalmol 2003; 121 (6): 777–783.
Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL et al. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 2012; 153 (5): 789–803. e2.
Eldaly MA, Bunce C, Elsheikha OZ, Wormald R . Non-penetrating filtration surgery versus trabeculectomy for open-angle glaucoma. Cochrane Database Syst Rev 2014; 2: Cd007059.
Samuelson TW, Katz LJ, Wells JM, Duh YJ, Giamporcaro JE, US iStent Study Group. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology 2011; 118 (3): 459–467.
Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL et al. Three-year follow-up of the tube versus trabeculectomy study. Am J Ophthalmol 2009; 148 (5): 670–684.
Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC . Surgical complications in the Tube Versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 2007; 143 (1): 23–31.
Budenz DL, Barton K, Gedde SJ, Feuer WJ, Schiffman J, Costa VP et al. Five-year treatment outcomes in the ahmed baerveldt comparison study. Ophthalmology 2015; 122 (2): 308–316.
Olson JL, Velez-Montoya R, Bhandari R . Laser activated flow regulator for glaucoma drainage devices. Transl Vis Sci Technol 2014; 3 (6): 3.
McEWEN WK . Application of Poiseuille's law to aqueous outflow. AMA Arch Ophthalmol 1958; 60 (2): 290–294.
Bailey AK, Sarkisian SR Jr . Complications of tube implants and their management. Curr Opin Ophthalmol 2014; 25 (2): 148–153.
Acknowledgements
Funding support was provided by the Colorado Bioscience Association. The study was conducted at the University of Colorado facilities and was funded by the Colorado Bioscience Discovery Grant.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Olson, J., Groman-Lupa, S. Design and performance of a large lumen glaucoma drainage device. Eye 31, 152–156 (2017). https://doi.org/10.1038/eye.2016.182
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2016.182


