Computational Study of Aqueous Humor Dynamics Assessing the Vault and the Pupil Diameter in Two Posterior-Chamber Phakic Lenses

Abstract

Purpose: To compare the behavior of aqueous humor (AH) and analyze flow differences by comparing the volume and velocity of the flow after two different models of implantable collamer lens (ICL) placement. Methods: Computational fluid dynamics with numerical simulation using Ansys Fluent software was performed to compare the AH flow through a peripheral iridotomy (PI), which is typically performed after implantation of a V4b lens to the central hole of a V4c lens. The volume and flow rate in 24 scenarios were compared according to the type of lens, pupil diameter (PD) (3.5 or 5.5 mm), the vault (100, 350, and 800 μm) and the PI (single or double, 180 or 360 μm). Results: With a standard vault (350 μm) and a PD of 3.5 mm, the volume of AH that flows from the posterior to the anterior chamber through the PI (V4b lens: 73.4% in 360 μm and 17.3% in 180 μm) and for the central hole (V4c lens: 75.7%) is larger than in the case of a PD of 5.5 mm (13.9%, 0.91%, and 15.3% respectively). When the vault is low (100; PD 3.5 mm), the volume of AH that reaches the central hole of the V4c lens is diminished (52.0%), being 5.1% if the pupil is enlarged. Conclusions: AH flow varies depending on the type of ICL implanted, whether it is implanted with an iridotomy or a central hole on the lens, the PD, and the vault.