Microfluidics in the eye: a review of glaucoma implants from an engineering perspective,Lab on a Chip

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Microfluidics in the eye: a review of glaucoma implants from an engineering perspective
Lab on a Chip ( IF 6.1 ) Pub Date : 2023-10-17 , DOI: 10.1039/d3lc00407d
Zecong Fang ₁ , Shuzhen Bi ₂ , J David Brown ₃ , Junyi Chen _{4,

5} , Tingrui Pan _{1,

2,

6}

Affiliation

Glaucoma is a progressive optic neuropathy in the eye, which is a leading cause of irreversible blindness worldwide and currently affects over 70 million individuals. Clinically, intraocular pressure (IOP) reduction is the only proven treatment to halt the progression of glaucoma. Microfluidic devices such as glaucoma drainage devices (GDDs) and minimally invasive glaucoma surgery (MIGS) devices are routinely used by ophthalmologists to manage elevated IOP, by creating an artificial pathway for the over-accumulated aqueous humor (AH) in a glaucomatous eye, when the natural pathways are severely blocked. Herein, a detailed modelling and analysis of both the natural microfluidic pathways of the AH in the eye and artificial microfluidic pathways formed additionally by the various glaucoma implants are conducted to provide an insight into the causes of the IOP abnormality and the improvement schemes of current implant designs. The mechanisms of representative glaucoma implants have been critically reviewed from the perspective of microfluidics, and we have categorized the current implants into four groups according to the targeted drainage sites of the AH, namely Schlemm's canal, suprachoroidal space, subconjunctival space, and ocular surface. In addition, we propose to divide the development and evolution of glaucoma implant designs into three technological waves, which include microtube (1st), microvalve (2nd) and microsystem (3rd). With the emerging trends of minimal invasiveness and artificial intelligence in the development of medical implants, we envision that a comprehensive glaucoma treatment microsystem is on the horizon, which is featured with active and wireless control of IOP, real-time continuous monitoring of IOP and aqueous rate, etc. The current review could potentially cast light on the unmatched needs, challenges, and future directions of the microfluidic structural and functional designs of glaucoma implants, which would enable an enhanced safety profile, reduced complications, increased efficacy of lowering IOP and reduced IOP fluctuations, closed-loop and on-demand control of IOP, etc.

中文翻译：

眼中的微流体：从工程角度回顾青光眼植入物

青光眼是一种进行性眼部视神经病变，是全世界不可逆性失明的主要原因，目前影响超过 7000 万人。临床上，降低眼压（IOP）是唯一被证明可以阻止青光眼进展的治疗方法。眼科医生通常使用青光眼引流装置 (GDD) 和微创青光眼手术 (MIGS) 装置等微流体装置来控制升高的眼压，方法是在青光眼眼中为过度积累的房水 (AH) 创建人工通道。自然通道被严重堵塞。本文对眼内AH的自然微流体通路和各种青光眼植入物额外形成的人工微流体通路进行了详细的建模和分析，以深入了解眼压异常的原因和现有植入物的改进方案设计。从微流控的角度对代表性青光眼植入物的机制进行了严格的回顾，我们根据 AH 的目标引流部位将当前的植入物分为四组，即施累姆氏管、脉络膜上腔、结膜下间隙和眼表。此外，我们建议将青光眼植入物设计的发展和演变分为三个技术浪潮，包括微管（第一波）、微阀（第二波）和微系统（第三波）。随着微创和人工智能在医疗植入物发展中的新兴趋势，我们预计，一种全面的青光眼治疗微系统即将面世，该系统具有主动无线控制眼压、实时连续监测眼压和房水的特点。率等当前的审查可能会揭示青光眼植入物的微流体结构和功能设计的无与伦比的需求、挑战和未来方向，这将能够提高安全性，减少并发症，提高降低眼压的功效并减少眼压波动，关闭-IOP的循环和按需控制等。

更新日期：2023-10-17

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