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Xian Zhang, Rong Liu, guangbin Shao, Henry Henry Oliver Tenadooah Ware, Dandan Ke, Nan Xiang, Hao F Zhang, cheng sun; Development of customized lacrimal bypass ducts using high resolution 3D-printing technology. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6245.
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© ARVO (1962-2015); The Authors (2016-present)
Bypass artificial lacrimal ducts implantation has been widely accepted for treating the proximal lacrimal drainage obstruction. However, its long-term surgical outcomes are still constrained by several issues, including 1) mismatch between rigid glass tube and soft tissue, 2) separation of Medpor mesh from the glass tube, 3) limited flexibility in customization in accommodating individual patient’s anatomies. In addressing these issues, we developed a comprehensive solution by exploiting a high-resolution 3D printing technology.
Customized lacrimal duct designs were created in Computer-aid-design solid models, and then fabricated by micro-Continuous Liquid Interface Production 3D printing system using photocurable HEMA (2-Hydroxyethyl methacrylate) hydrogel resin. Both morphology and mechanical properties of the 3D printed lacrimal ducts were experimentally. In vivo experiments were conducted by implanting 3D printed lacrimal ducts in back muscle and orbit of rabbit model, which focus to investigate their effectiveness to promote infusion by the surrounding tissue. Their biocompatibility was tested again the possible side effects, such as implant rejection, inflammation, infection, duct dislocation, and further validated via histology of peritubular tissues.
Scanning electron microscope images demonstrated the intricate morphology of the lacrimal duct design can be faithfully 3D printed with high fidelity. The formulation of the HEMA hydrogel has been optimized the compressive Young’s Modulus dramatically reduced to 0.16~3.36 MPa in PBS to better match with human tissue. The animal studies suggested the lacrimal duct promotes the infusion with surrounding tissues and thus, significantly reduced dislocation rate to 10%, in contrast to 90% found in the smooth tube. No infection was detected in all the cases and the histology study showed peritubular tissue had mild inflammation at the first 4 weeks and completely disappeared after 8 weeks upon implantation.
Our study demonstrated the 3D printed lacrimal ducts exhibit excellent biocompatibility. Tailoring the rigidity to match with the surrounding tissue, while monolithographically integrating the mesh shell, are found to be effective in promoting infusion of the surrounding tissue. Finally, 3D printing also offers the flexibility in customization to better accommodate individual patient’s anatomies.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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