Characteristics of glaucoma drainage implants during dynamic and steady-state flow conditions

Abstract

Objective This study aimed to ascertain whether the Optimed, Krupin, and Ahmed drainage devices function as valves that vary resistance depending on flow conditions to maintain pressure within a desired range. Study Design Experimental study. Intervention The three devices and a control cannula were submerged in fluid and perfused with balanced salt solution using a computer-driven apparatus that continuously monitors flow (Q) and pressure (P). In one set of experiments, the flow rates were maintained at 2, 5, 10, 25, or 50 μl/min until steady-state pressures were achieved. In another set of experiments, the flow rate was increased linearly from 0 to 100 μl/min over 15 to 20 minutes. Main outcome measures The resistance of each implant was calculated from the first set of experiments by dividing the change in pressure (P) by the change in flow (Q) between successive perfusion rates. Flow-pressure curves were plotted from the experiments in which perfusion rate was increased linearly. Results Resistance remained relatively constant for the cannula (0.18–0.24 mmHg/μl/min), the Krupin (0.09–0.25 mmHg/μl/min), and the Optimed implants (0.04–0.08) throughout the tested flow rates. For the Ahmed device, conversely, resistance decreased proportionally (2.86–0.05 mmHg/μl/min) to the increase in flow. When flow rate was increased linearly from 0 to 100 μl/min, the Optimed and Krupin devices as well as the cannula generated a linear pressure response with a constant slope. The pressure in the two devices increased at a rate of 0.11 mmHg/μl compared to 0.23 mmHg/μl/min for the cannula. The flow-pressure curve for the Ahmed implant was distinct with a steep initial pressure rise and an essentially constant pressure of 12 mmHg thereafter. Conclusion The Optimed and Krupin devices displayed resistance and pressure responses to various flow conditions that were similar to those of a cannula or flow resistor. In these devices, resistance remained relatively stable and pressure increased linearly with flow. The Ahmed device, conversely, functioned as a valve that closely regulated pressure within a desired range by decreasing or increasing resistance as a function of flow.