A simulation-based comparative study of glaucoma filtration surgeries using computational fluid dynamics

Computational fluid dynamics (CFD) offers a virtual platform to assess glaucoma surgeries, predicting intraocular pressure (IOP) outcomes. CFD shows that modified nonpenetrating deep sclerectomy (mNPDS) achieves IOP reduction comparable to trabeculectomy, guiding surgical decisions and innovations. Effective solutions for glaucoma surgical treatment represent a significant challenge in ophthalmology. The advent of numerous techniques in the last decade has complicated the evaluation of competing methodologies, typically addressed through costly and time-consuming randomized controlled clinical trials. This study explores an alternative approach using CFD to virtually assess the flow and IOP effects of glaucoma surgical procedures. A 3D model of an idealized anterior eye segment was created as a means to directly compare various glaucoma filtration surgical procedures. The CFD model was specifically utilized to compare trabeculectomy, nonpenetrating deep sclerectomy (NPDS) without the removal of the juxtacanalicular trabecular meshwork (JCT), and mNPDS including the JCT peel. The CFD results reveal that NPDS alone is less effective than trabeculectomy in lowering IOP at the time of surgery. The postoperative IOP was 7 mm Hg for trabeculectomy and 23.4 mm Hg for NPDS. However, the mNPDS procedure produced IOP results comparable to that of trabeculectomy, with a postoperative IOP of 6.98 mm Hg. An interesting additional finding in trabeculectomy is the low flows at the corneal wall. This flow pattern is not seen with NPDS and may partially explain the better safety profile of NPDS compared with trabeculectomy. While CFD does not replace clinical trials, this study underscores its potential in virtually evaluating glaucoma surgical procedures.