Dao-Yi Yu

Clinical benefits for the monitoring and modulating of subconjunctival tissue following glaucoma filtration surgery

Glaucoma filtration surgery (GFS) can be defined as an attempt to lower intraocular pressure (IOP) by the surgical formation of an artificial drainage pathway from the anterior chamber to the subconjunctival space. Surgical techniques and devices to create the drainage pathway have been continuously improved since the first attempts almost 180 years ago. Filtering procedures, such as trabeculectomy or drainage implant surgery have been used extensively in the treatment of glaucoma. Glaucoma affects >60 million people worldwide and is the second most common cause of irreversible blindness. A minimally invasive surgical technique including a bioengineered microfistula tube, a sophisticated implanter, and an ab-interno surgical procedure was developed by our team. Such minimally invasive surgery without surgical damage to the conjunctiva will significantly reduce the inflammatory reaction and scarring process and provide more optimal surgical outcomes. It also creates an opportunity to clinically investigate the question of the consequences of the presence of aqueous humor in the subconjunctival tissue. Our patents were licensed to a startup company (AqueSys), to commercially develop the technology and AqueSys has recently been acquired by Allergan. Commercialization also creates new opportunities for scientific research to further improve surgical outcomes. An important topic has arisen related to the monitoring and modulation of the subconjunctival tissue after GFS. We would also like to examine the conjunctiva to select the most suitable surgical site before implantation. We believe that the answer to such questions could be critical for improving the outcomes of our procedure, and indeed all other GFS procedures. We describe three avenues of research that need to be addressed whilst the clinical use of this technique is expanding. The purpose of such research is to gain the best outcomes for each patient treated with our newly developed techniques.