Optimization of surgical protocol for laser iridotomy based on the numerical simulation of aqueous flow.

Abstract

Primary angle-closure glaucoma (PACG) is a major cause of blindness worldwide, with a particularly high prevalence in Asian populations. Laser iridotomy (LI) has been the standard therapeutic modality for treating PACG to avoid blindness. However, the complex structure of the eyeball, the aqueous fluidity, and the limitation of detecting equipment will cause difficulty in surgery and the probability of complications. Numerical simulation was conducted to investigate aqueous humor (AH) flow under different physiological structures before and after laser surgery. When the anterior chamber depth decreases from 2.8 mm to 2.0 mm (caused by angle-closure glaucoma), the maximum velocity of natural convection is doubled, and the pressure difference between the posterior and anterior chambers increases by 20%. Therefore, a shallow anterior chamber depth is crucial for the accurate investigation of glaucoma. Pupil block sharply increases the intraocular pressure (IOP). When the gap between the lens and iris decreases from 10 μm to 0.5 μm, P between the posterior and anterior chambers is approximately 37 times higher than before, thereby damaging intraocular tissues. LI can effectively reduce the IOP caused by pupil block, but the velocity of AH after operation is 40 times the normal condition, and the increased corneal shear stress could lead to corneal damage, which can be solved by adjusting the incident angle of laser beam On the basis of the allowable angle range of surgical equipment and the effect of different incident angles on the cornea and iris, the optimum angle of laser drilling is 45°.