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Abstract
Glaucoma drainage devices (GDDs) are prosthetic-treatment devices for treating primary open-angle glaucoma. Despite their effectiveness in reducing intraocular pressures (IOP), endothelial cell damage (ECD) is a commonly known side-effect. There have been different hypotheses regarding the reasons for ECD with one being an induced increase in shear on the corneal wall. A computational fluid dynamics (CFD) model was used to investigate this hypothesis in silico. The Ahmed Glaucoma Valve (AGV) was selected as the subject of this study using an idealised 3D model of the anterior chamber with insertion angles and positions that are commonly used in clinical practice. It was found that a tube-cornea distance of 1.27 mm or greater does not result in a wall shear stress (WSS) above the limit where ECD could occur. Similarly, a tube-cornea angle of 45° or more was shown to be preferable. It was also found that the ECD region has an irregular shape, and the aqueous humour flow fluctuates at certain insertion angles and positions. This study shows that pathological amounts of WSS may occur as a result of certain GDD placements. Hence, it is imperative to consider the associated fluid force interactions when performing the GDD insertion procedure.
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Details
1 University of Twente, Department of Thermal & Fluid Engineering, Faculty of Engineering Technology, Enschede, The Netherlands (GRID:grid.6214.1) (ISNI:0000 0004 0399 8953); University of Witwatersrand, Johannesburg, Mechanical, Industrial & Aeronautical Engineering, Faculty of Engineering & the Built Environment, Johannesburg, South Africa (GRID:grid.11951.3d) (ISNI:0000 0004 1937 1135)
2 University of Witwatersrand, Johannesburg, Mechanical, Industrial & Aeronautical Engineering, Faculty of Engineering & the Built Environment, Johannesburg, South Africa (GRID:grid.11951.3d) (ISNI:0000 0004 1937 1135)
3 Aston University, Department of Mechanical, Biomedical and Design Engineering, School of Engineering & Technology, College of Engineering and Physical Sciences, Birmingham, UK (GRID:grid.7273.1) (ISNI:0000 0004 0376 4727)
4 University of Cape Town, Division of Ophthalmology, Faculty of Health Sciences, Cape Town, South Africa (GRID:grid.7836.a) (ISNI:0000 0004 1937 1151)
5 University of the Witwatersrand, Division of Ophthalmology, School of Clinical Medicine, Faculty of Health Sciences, Johannesburg, South Africa (GRID:grid.11951.3d) (ISNI:0000 0004 1937 1135)
6 Agency for Science, Technology and Research, Bioprocessing Technology Institute, Singapore, Singapore (GRID:grid.452198.3) (ISNI:0000 0004 0485 9218); Nanyang Technological University, School of Mechanical and Aerospace Engineering, Singapore, Singapore (GRID:grid.59025.3b) (ISNI:0000 0001 2224 0361)