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Puthuran GV, Ramesh S, Maheswari P, Reddy MM, S MSU, Krishnadas SR, Gedde SJ. Long-term surgical outcomes of Aurolab aqueous drainage implant in pediatric eyes with primary congenital glaucoma versus aphakic glaucoma. Br J Ophthalmol 2023; 107:1823-1827. [PMID: 36229180 DOI: 10.1136/bjo-2022-321571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare the outcomes of the Aurolab aqueous drainage implant (AADI) placed in eyes with refractory primary congenital glaucoma (PCG) versus aphakic glaucoma (APG). DESIGN Retrospective comparative interventional case series. METHODS Case files of consecutive eyes with PCG or APG that underwent AADI surgery between January 2013 and December 2016 and had a minimum 4 years follow-up were extracted from a computerised database. Failure was defined as intraocular pressure (IOP)>21 mm Hg or reduced<20% below baseline on two consecutive follow-up visits after 3 months, IOP≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception. RESULTS Eighty-nine eyes underwent AADI placement, including 42 eyes (47%) with PCG and 47 eyes (53%) with APG. Both groups were comparable at baseline. At 1 year, the APG group had lower mean IOP (13.6±8.1 mm Hg vs 17.6±7.5 mm Hg, p=0.02) with use of fewer IOP-lowering medications (0.8±1.0 vs 1.5±1.0, p=0.01) than the PCG group. The cumulative failure rate at 4 years was 57% (95% CI 43% to 72%) in PCG versus 40% (95% CI 28% to 56%) in the APG eyes (p=0.11). Eyes with PCG had greater tube-related complications (48% vs 38%, p=0.07) and number of reoperations (40% vs 32%, p=0.02) compared with eyes with APG. CONCLUSIONS Eyes with APG had relatively better outcomes after AADI placement compared with PCG during 4 years of follow-up. Reoperations accounted for more than 70% of the failures.
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Affiliation(s)
| | | | | | | | | | | | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
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Kaushik S, Singh J, Pandav SS. Secondary developmental glaucoma. Taiwan J Ophthalmol 2023; 13:425-433. [PMID: 38249512 PMCID: PMC10798401 DOI: 10.4103/tjo.tjo-d-23-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 01/23/2024] Open
Abstract
The basic pathophysiology of all childhood glaucoma results from impaired outflow through the trabecular meshwork. Anterior Segment Dysgeneses (ASD) are a group of nonacquired anomalies associated with secondary developmental glaucoma, characterized by impaired development of the structures of the anterior segment. Many genes impact the development of the anterior segment. The cause of the development of the abnormalities is thought to be multifactorial. Molecular research has helped our understanding of the molecular basis of ASD and the developmental mechanisms underlying these conditions. Identifying the genetic changes underlying ASD has gradually led to the recognition that some of these conditions may be parts of a disease spectrum rather than isolated anomalies. The characterization of the underlying genetic abnormalities responsible for glaucoma is the first step toward developing diagnostic and screening tests, which could identify individuals at risk for disease before irreversible optic nerve damage occurs. It is also crucial for genetic counseling and risk stratification of later pregnancies. It also aids prenatal testing by various methods allowing for effective genetic counseling. This review summarizes various ocular and systemic conditions that result in secondary developmental glaucoma and provide an overview of the phenotypes, the diagnosis and principles of management of the various disorders.
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Affiliation(s)
- Sushmita Kaushik
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyoti Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Pandav
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bitrian E. Treatment of Pediatric Glaucoma. Int Ophthalmol Clin 2023; 63:185-198. [PMID: 37755451 DOI: 10.1097/iio.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
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Shen R, Li VSW, Wong MOM, Chan PPM. Pediatric Glaucoma-From Screening, Early Detection to Management. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020181. [PMID: 36832310 PMCID: PMC9954748 DOI: 10.3390/children10020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.
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Affiliation(s)
- Ruyue Shen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Venice S. W. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Mandy O. M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Poemen P. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-5807
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Jayasri P, Kaliaperumal S, Behera G, Stephen M. Safety and efficacy of Aurolab aqueous drainage implant in refractory glaucoma: A prospective study. Indian J Ophthalmol 2022; 70:4212-4216. [PMID: 36453316 PMCID: PMC9940568 DOI: 10.4103/ijo.ijo_1391_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non-valved glaucoma drainage device (GDD) surgery in refractory glaucoma. Methods This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM). Results Thirty-four eyes were analyzed and the mean follow-up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively. Conclusion AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long-term follow-up studies are needed to assess long-term IOP control and cost-effectiveness.
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Affiliation(s)
- P Jayasri
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India,Correspondence to: Prof. Subashini Kaliaperumal, Department of Ophthalmology, JIPMER, Puducherry - 605 006, India. E-mail:
| | - Geeta Behera
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Mary Stephen
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Sisodia VPS, Krishnamurthy R. Aurolab Aqueous Drainage Implant (AADI): Review of Indications, Mechanism, Surgical Technique, Outcomes, Impact and Limitations. Semin Ophthalmol 2022; 37:856-868. [PMID: 35656796 DOI: 10.1080/08820538.2022.2082254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this review is to place together all the knowledge available on aurolab aqueous drainage implant (AADI) in one place for the benefit of all glaucoma specialists who are interested in low-cost implants in developing world with desired results. METHODS A comprehensive literature search was done on AADI and its use in glaucoma management. 35 results were obtained from the literature search. Out of these 35, 2 were commentaries, 6 were case reports and rest 27 were studies (prospective and retrospective) discussing the surgical outcomes, modifications and comparison of AADI with other glaucoma drainage devices (GDDs). Out of these, 2 commentaries were excluded and rest 33 articles were included, cited and discussed appropriately in this review. RESULTS AADI resulted in a significant reduction in the intra ocular pressure (IOP) and also in the number of antiglaucoma medications. AADI can be implanted alone or combined with cataract surgery. It was found to be beneficial in both pediatric and adult refractory glaucoma. There was no significant difference seen in the pre and post operative visual acuity. But AADI was also associated with various hypotony related and tube related early and late onset complications. Some of these complications were managed conservatively and some needed surgical intervention. CONCLUSIONS AADI is a low-cost non-valved GDD with successful results in both adult as well as pediatric refractory glaucomas. Early and late onset complications are common and can be managed with appropriate and timely medical or surgical intervention.
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Wijesinghe HK, Puthuran GV, Ramulu PY, Ponnat AK, Reddy MM, Mani I, Krishnadas SR, Gedde SJ. Intraocular Pressure Control Following Phacoemulsification in Eyes With Pre-existing Aurolab Aqueous Drainage Implant. J Glaucoma 2022; 31:456-461. [PMID: 34628424 DOI: 10.1097/ijg.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to investigate intraocular pressure (IOP) control after phacoemulsification in adult glaucomatous eyes with a functioning nonvalved Aurolab Aqueous Drainage Implant (AADI) compared with eyes that did not have cataract extraction post-AADI. METHODS In this retrospective study, we reviewed records of 47 patients (47 eyes) who had a clear corneal phacoemulsification after AADI placement with a minimum of 2 years of follow up. The control group included 89 patients (89 eyes) who had a functional AADI at 1 year, minimum of 3 years of follow up post-AADI implantation, and no cataract extraction. The main outcome measure was failure (IOP >21 mm Hg or increased by >20% from prephacoemulsification level requiring at least 1 additional glaucoma medication, IOP ≤5 mm Hg, reoperation for glaucoma, or loss of light perception vision). RESULTS The median interval between AADI and phacoemulsification was 11.5 months (range: 4 to 68 mo), and the mean follow-up time after phacoemulsification was 35.6±6.4 months. The cumulative probability of failure was 14% (95% confidence interval=6%-31%) in the phaco group and 6% (95% confidence interval=3%-13%) in the control group at 2 years (P=0.11). Mean IOP was reduced from 16.5±4.5 mm Hg preoperatively to 15.4±4.7 mm Hg at 2 years after phacoemulsification (P=0.10). Mean LogMAR visual acuity improved from 1.1±0.6 preoperatively to 0.6±0.7 at 2 years after phacoemulsification (P<0.001). CONCLUSIONS In eyes with a pre-existing AADI, phacoemulsification resulted in visual improvement without a significant rise in IOP or increased risk of AADI failure after 2 years follow up.
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Affiliation(s)
| | | | | | | | | | - Iswarya Mani
- Department of Biostatistics, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | | | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
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AlJaloud A, AlHilali S, Edward DP, Ahmad K, Malik R. Preliminary Surgical Outcomes of a Trimmed-Plate Aurolab Aqueous Drainage Implant (AADI) in Eyes at High Risk of Hypotony. Clin Ophthalmol 2022; 16:1487-1496. [PMID: 35592670 PMCID: PMC9113450 DOI: 10.2147/opth.s343378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We describe the technique of trimming the 350 mm2 AADI glaucoma shunt plate and report preliminary results that test the hypothesis that the IOP-lowering efficacy of the trimmed AADI glaucoma shunt is comparable to the Baerveldt 250 mm2 glaucoma drainage implant with a comparable safety profile to the standard AADI implant. Methods Consecutive patients who had received the modified trimmed-plate AADI, standard AADI and Baerveldt 250 mm2 were included in the study. This included patients with refractory or primary or secondary glaucoma of all ages and eyes with and without previous glaucoma surgery. The decision for trimming the AADI plate was made according to the surgeon’s perceived risk of hypotony. Pre-operative, intraoperative and post-operative data were collected from the hospital electronic medical record system. Surgical success was defined as IOP ≥5 mmHg and ≤21 mmHg on two consecutive visits after 3 months, whilst maintaining at least LP vision and avoiding re-operation for glaucoma. Results The sample consisted of 69 eyes (19 with trimmed-plate AADI implant; 36 eyes with the standard AADI implant and 14 eyes who received a BGI-250). The mean IOP reduction at 1 year was 15 mmHg for the Baerveldt-250, 10 mmHg for the AADI and 13 mmHg for the trimmed-plate AADI. The surgical success rate of the implants over 1 year was 85.7% (95% CI, 53.9–96.2%) for BGI-250, 81.5% (62.6–91.5%) for standard AADI and 78.2% (51.7–91.3%) for the trimmed AADI. Conclusion Trimming the plate of the AADI manually may provide a safe and low-cost method of obtaining a successful surgical outcome in eyes at high risk of hypotony.
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Affiliation(s)
- Ahmad AlJaloud
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- King Abdullah bin AbdulAziz University Hospital, Riyadh, Saudi Arabia
| | - Sara AlHilali
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Deepak P Edward
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- University of Illinois Eye and Ear Infirmary Chicago, Chicago, IL, USA
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Correspondence: Khabir Ahmad, Research Department, King Khaled Eye Specialist Hospital, Al Aruba Branch Road, Riyadh, 12329, Saudi Arabia, Tel +966 11 482 1308, Email
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
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Babu N, Baliga G, Puthuran GV, Ramasamy K. Retinal detachment in eyes treated with Aurolab aqueous drainage implant for refractory glaucoma - Incidence and outcomes. Indian J Ophthalmol 2022; 70:1287-1293. [PMID: 35326036 PMCID: PMC9240567 DOI: 10.4103/ijo.ijo_1546_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To analyze the incidence of rhegmatogenous retinal detachment (RRD) in patients who have undergone prior Aurolab aqueous drainage implant (AADI) surgery and report outcomes in terms of anatomic, visual acuity, and intraocular pressure (IOP) findings. Methods: Case records of all patients who underwent RRD repair after AADI surgery from 2013 to 2019 were retrospectively analyzed. Data collected included patient demographics, ocular examination findings at all visits including IOP and best-corrected visual acuity (BCVA) and clinical findings related to RRD both at baseline and postoperatively. Results: Ten eyes of nine patients were included in study. The mean age of patients was 28.2 years (median: 15 years, range: 6–83 years). Mean duration between AADI and RRD was 14 months (median 2.5 months; range 2 days-72 months). All eyes underwent pars plana vitrectomy with silicon oil injection. The preoperative LogMAR BCVA (logarithm of the minimum angle of resolution) was 2.52 ± 0.15 which improved to 2.29 ± 0.58 at final follow-up; however, only one eye had vision ≥ 20/400 largely due to recurrent RRD and advanced glaucomatous disc damage. Postoperatively retina was attached in 6 eyes (60%) and IOP was ≤ 21 mmHg in 5 out of 6 eyes with anatomic success Conclusion: The incidence of RRD following AADI was found to be 0.86% in our study. Pars plana vitrectomy (PPV) with silicon oil tamponade was the preferred approach in the management of these eyes with IOP being well controlled post PPV. However, visual acuity outcomes were largely unsatisfactory due to recurrent RRD and preexisting advanced glaucoma.
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Affiliation(s)
- Naresh Babu
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Girish Baliga
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - George Varghese Puthuran
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Puthuran GV, Wijesinghe HK, Jain M, Palmberg P. Management of a recurrent encapsulated bleb with a cost-effective non-valved glaucoma drainage device. BMJ Case Rep 2022; 15:e244553. [PMID: 35288423 PMCID: PMC8921842 DOI: 10.1136/bcr-2021-244553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/04/2022] Open
Abstract
Despite the advancements in the surgical management of glaucoma, childhood glaucoma remains a challenging surgical disease worldwide. An early adolescent boy with primary congenital glaucoma, status after glaucoma drainage device (GDD) implantation, on maximum medical therapy, was presented with a swelling in the superotemporal orbital region. The patient had undergone an uneventful GDD implantation 2 years prior to presentation. A similar swelling, which was diagnosed to be a Tenon's cyst, had been excised on three earlier occasions. Given that the repeat capsular excision would also have the same likelihood of failure, and poor intraocular pressure control, a non-valved, cost-effective Aurolab aqueous drainage implant (AADI, Aurolab, Madurai, India) implantation was done inferonasally. In this patient, AADI proved to be a safe and effective alternative for the known GDDs.
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Affiliation(s)
| | | | - Mayank Jain
- Paediatric Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Paul Palmberg
- Glaucoma Services, University of Miami School of Medicine, Bascom Palmer Eye Institute, Miami, Florida, USA
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Kader MA, Dabke SB, Shukla AG, Reddy V, Abdul Khadar SM, Maheshwari D, Ramakrishnan R. Pars plana Aurolab aqueous drainage implantation for refractory glaucoma: Outcome of a new modified technique. Indian J Ophthalmol 2022; 70:839-845. [PMID: 35225526 PMCID: PMC9114538 DOI: 10.4103/ijo.ijo_1791_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. METHODS A retrospective study was done between April 2016 and April 2018 on patients with ≥12 months of follow-up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ≤5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. RESULTS : The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti-glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow-up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan-Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8-33.5%) at 3 months, 18.7% (95% CI; 8.9-37.0%) at 6 months, and 25.0% (95% CI; 13.4-43.8%) at 12 months. CONCLUSION Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti-glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology.
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Affiliation(s)
- Mohideen A Kader
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Shylesh B Dabke
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Aakriti G Shukla
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - Venugopal Reddy
- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Syed M Abdul Khadar
- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Devendra Maheshwari
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Rengappa Ramakrishnan
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Parija S, Sen S. Childhood glaucoma – A review of basics. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Khan AM, Ahmad K, Alarfaj M, Alotaibi H, AlJaloud A, Malik R. Surgical outcomes of the Aurolab aqueous drainage implant (AADI) versus the Ahmed glaucoma valve for refractory paediatric glaucoma in Middle Eastern children. BMJ Open Ophthalmol 2021; 6:e000831. [PMID: 34786485 PMCID: PMC8587650 DOI: 10.1136/bmjophth-2021-000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Objective The Aurolab aqueous drainage implant (AADI) has the potential advantages of less encapsulation and greater cost-effectiveness than the Ahmed glaucoma valve (AGV). The aim of this study was to compare the surgical success and outcomes of the AADI compared to the AGV in Middle-Eastern children. Methods A comparative retrospective study of consecutive paediatric patients in a tertiary eye hospital was undertaken. Data collected included demographics, type of glaucoma, intraocular pressure (IOP), number of anti-glaucoma medications (AGMs) and any subsequent complications or further surgeries. Analysis The mean IOP, number of AGMs, surgical success and number of reoperations was compared for the two groups. Surgical success at each visit was defined as IOP of ≥6 mm Hg and ≤21 mm Hg or if the reduction of IOP was ≥20% reduced from baseline. Results A total of 126 tube surgeries (56 eyes in AADI and 70 eyes in AGV) were performed in patients aged ≤18 years from 2014 to 2019. No difference was observed in the mean IOP between the two groups except at the first month post-operative visit. After six months, the AADI group had a consistently significant lower mean number of AGMs. At last follow-up, 21 (37.5%) eyes in the AADI group were glaucoma medication-free vs 15 (21.4%) eyes in the AGV group (pp=0.047). Kaplan-Meier analysis showed equivalent cumulative probability of success at two years of 69.9% [(45.9%–84.9%)] for AADI vs 66.8% [(53.4%–77.1%])) for the AGV, respectively. Twenty-four eyes in the AGV group needed one or more subsequent surgeries, whereas 13 eyes needed one or more surgery in the AADI group. Conclusions This study shows an acceptable safety profile for the AADI in children, with a rate of failure that is comparable to the AGV, but less need for glaucoma re-operation or glaucoma medication in the first post-postoperative year.
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Affiliation(s)
- Abdullah M Khan
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Motazz Alarfaj
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Humoud Alotaibi
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ahmad AlJaloud
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Wijesinghe HK, Puthuran GV, Gedde SJ, Pradhan C, Uduman MS, Krishnadas SR, Kannan NB, Robin AL, Palmberg P. Incidence and Outcomes of Suprachoroidal Hemorrhage Following Aurolab Aqueous Drainage Implant in Adult and Pediatric Glaucoma. J Glaucoma 2021; 30:497-501. [PMID: 33337717 DOI: 10.1097/ijg.0000000000001761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/28/2020] [Indexed: 11/26/2022]
Abstract
PRCIS Postoperative suprachoroidal hemorrhage (PSCH) is an infrequent but devastating complication after nonvalved aqueous drainage implant surgery and demonstrated a bimodal distribution. The final outcomes of either conservative management or surgical drainage of the hemorrhage remained poor. PURPOSE The aim was to report the incidence and outcomes of eyes developing PSCH after undergoing Aurolab aqueous drainage implant (AADI) surgery for adult and pediatric refractory glaucomas. MATERIALS AND METHODS In this retrospective series, case files of all patients who underwent AADI between May 2012 and December 2019 were retrieved from an electronic database. A PSCH was defined as the presence of hemorrhagic choroidal detachment, confirmed by ultrasound B scan, occurring in a closed system in the postoperative period. RESULTS Of the 986 eyes that underwent AADI during the study period, 7 (0.7%), developed PSCH (95% confidence interval=0.3-1.6%). There were no differences in the preoperative parameters between those with and without PSCH. Of these, 4 were seen in pediatric eyes (4/288, 1.4%) and 3 in adult eyes (3/698, 0.4%) (P<0.01). Four eyes (57%) had PSCH in the immediate postoperative period (ie, between 24 and 48 h of AADI surgery), while the remaining 3 had onset ranging from 6 to 7 weeks after surgery. Anatomic risk factors were present in all eyes including hypotony (n=4), myopia (n=3), microcornea (n=2), microphthalmos (n=1), postvitrectomy (n=1), and staphyloma (n=1). Visual acuity improved in only 1 (14%) eye while 3 (43%) eyes developed phthisis bulbi, all in the pediatric age group. CONCLUSIONS PSCH is a rare complication following AADI and is seen in <1% eyes. The incidence is higher in the pediatric age group. Visual and anatomic outcomes are dismal following PSCH with globe salvage possible in only about half these eyes.
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Affiliation(s)
| | | | - Steven J Gedde
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
| | | | | | | | | | - Alan L Robin
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI
| | - Paul Palmberg
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
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Puthuran GV, Wijesinghe HK, Gedde SJ, Chiranjeevi KP, Mani I, Krishnadas SR, Lee Robin A, Palmberg P. Surgical Outcomes of Superotemporal Versus Inferonasal Placement of Aurolab Aqueous Drainage Implant in Refractory Pediatric Glaucoma. Am J Ophthalmol 2021; 224:102-111. [PMID: 33309809 DOI: 10.1016/j.ajo.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We sought to describe the outcomes of the Aurolab aqueous drainage implant (AADI) placed in the superotemporal (ST) versus the inferonasal (IN) quadrant in pediatric eyes with refractory glaucoma. DESIGN Retrospective comparative interventional case series. METHODS This was a retrospective study of patients ≤18 years of age who underwent AADI implantation and completed a minimum of 2-year follow-up. The choice of the quadrant depended upon the amount of scarring and conjunctival mobility. Cumulative success at 2 years was defined as intraocular pressure (IOP) ≤21 mm Hg or reduced by ≥20% below baseline on 2 consecutive follow-up visits after 3 months, IOP ≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision. RESULTS A total of 144 patients (144 eyes) underwent AADI placement, including 48 eyes (33%) in the IN and 96 eyes (67%) in the ST quadrants. The IOP was significantly higher in the IN group (17.5 ± 7.4 mm Hg vs 13.7 ± 6.2 mm Hg, P = .005) with a greater number of medications (1.5 ± 1.0 vs 0.8 ± 0.9, P = .001) after 2 years of follow-up. Cumulative success rates at 2 years were 50.7% (95% confidence interval 35.4%-63.9%) in the IN group and 65.6% (95% confidence interval 56.5%-75.7%) in the ST group (P = .15). Complications occurred more frequently in the IN group, with significantly more tube exposure (12% vs 0%, P = .05). CONCLUSIONS Placement of the AADI in the ST quadrant has better IOP-related outcomes and is a safer surgical option in pediatric eyes compared with the IN quadrant. It may be prudent to avoid AADI in the IN quadrant in children unless the ST location is not a viable option.
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Moreno-Montañés J, Muñoz-Negrete F. Drainage devices for glaucoma surgery: New advances and new models. ACTA ACUST UNITED AC 2021; 96:173-174. [PMID: 33478755 DOI: 10.1016/j.oftal.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J Moreno-Montañés
- Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, España; Retics Oftared, Madrid, España.
| | - F Muñoz-Negrete
- Retics Oftared, Madrid, España; Hospital Ramón y Cajal, Universidad de Alcalá, IRYICIS, Madrid, España
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Puthuran GV, Wijesinghe HK, Gedde SJ, Tara TD, Uduman MS, Krishnadas SR, Lee Robin A, Palmberg P. Incidence and Outcomes of Hypertensive Phase Following Aurolab Aqueous Drainage Implant Surgery in Adults with Refractory Glaucoma. Am J Ophthalmol 2021; 221:75-82. [PMID: 32828879 DOI: 10.1016/j.ajo.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence and outcomes of hypertensive phase (HP) following Aurolab Aqueous Drainage Implant (AADI) (Aurolab) surgery in adults with refractory glaucoma. DESIGN Retrospective, noncomparative, interventional case series. METHODS All eyes that received the AADI and had a minimum of 2-year follow-up were identified, and data of patients who had intraocular pressure (IOP) ≤21 mm Hg at 6 weeks (ie, the time at which the tube-ligature suture dissolves) were used for statistical analysis. HP was defined as IOP >21 mm Hg during the first 3 months after the release of the tube ligating suture (with or without medications) in the absence of tube obstruction. RESULTS A total of 200 eyes were included in the study, and HP was seen in 64 eyes (32%) with a peak IOP (mean ± SD) of 29.6 ± 7.8 mm Hg and peak incidence at 2-3 months after surgery. HP resolved within 3 months of its onset in 60 of the 64 eyes (94%) with additional IOP-lowering medications. The cumulative success rates were 71.8% (95% CI = 59.3%-81.2%) in HP eyes and 76.4% (95% CI = 68.7%-82.7%) in non-HP eyes (P = .23). Unadjusted Cox proportional hazards analysis showed that eyes experiencing HP had a marginally higher risk of failure (HR = 1.16, 95% CI = 0.6-2.1), but this relationship was not statistically significant (P = .61). CONCLUSIONS A third of eyes that underwent AADI placement experienced HP. HP was successfully managed with additional IOP-lowering medications in a majority of cases and did not have a significant influence on long-term success rate.
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Affiliation(s)
| | | | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | | | | | | | - Alan Lee Robin
- Department of Ophthalmology, University of Michigan, Michigan, USA
| | - Paul Palmberg
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
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Aurolab Aqueous Drainage Implant With and Without Scleral Patch Graft in Refractory Adult and Pediatric Glaucomas: A Comparative Study. Am J Ophthalmol 2020; 216:226-236. [PMID: 32222366 DOI: 10.1016/j.ajo.2020.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the 2-year outcomes of eyes that received the Aurolab aqueous drainage implant (AADI) with and without a scleral patch graft. DESIGN Retrospective comparative interventional case series. METHODS Eyes with AADI and a minimum of a 2-year follow-up were included. Eyes that underwent implantation before January 2016 had surgery with a scleral patch graft covering the distal end of the tube, whereas those that were implanted after this period underwent surgery using a needle-generated scleral tunnel without the patch graft. The cumulative failure of the AADI was defined as intraocular pressure (IOP) >18 mm Hg or not reduced by 30% below baseline on 2 consecutive follow-up visits after 3 months. RESULTS We included 215 adult eyes (n = 147 with patch graft, n = 68 without patch graft) and 111 pediatric eyes (n = 73 with patch graft, n = 38 without a patch graft). The mean IOP in eyes without the patch graft was higher at 1 month in adult eyes (before, 27.5 ± 14.1 vs after, 22.3 ± 11.1; P = .01) but not in pediatric eyes (14.3 ± before, 5.8 vs after, 17.8 ± 11.0; P = .39); there were no differences in IOP, vision, number of antiglaucoma medications, and complications between groups at all other time points. None of the eyes without the patch graft experienced tube exposure. Cumulative success rates at 2 years in adults (66.2% vs 63.9%, respectively; P = .85) were similar to those in children (77.2% vs 71.9%, respectively; P = .83) with both techniques. CONCLUSIONS AADI placed without a scleral patch graft is as safe and effective as AADI placed with a patch graft in pediatric and adult refractory glaucomas.
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Affiliation(s)
- Abdelrahman M. Elhusseiny
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Deborah K. VanderVeen
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Puthuran GV, Palmberg PF, Wijesinghe HK, Shreya TS, Krishnadas SR, Gedde SJ, Robin AL. Comparison of outcomes between Aurolab aqueous drainage implant placed in the
superotemporal versus inferonasal quadrant. Br J Ophthalmol 2020; 105:521-525. [DOI: 10.1136/bjophthalmol-2019-315558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/02/2020] [Accepted: 05/25/2020] [Indexed: 11/04/2022]
Abstract
Aim
To determine the outcomes of Aurolab aqueous drainage implant (AADI)
placed in the superotemporal versus the inferonasal quadrant in adult eyes with
refractory glaucoma.
Methods
This was a retrospective study of eyes that had AADI placement and
completed a minimum of 2-year follow-up. The choice of the quadrant was at the
surgeon’s discretion and mainly depended on the amount of scarring and
conjunctival mobility. The cumulative failure rate of the AADI was defined as
intraocular pressure (IOP) >21 mm Hg or not reduced by 20% below baseline on
two consecutive follow-up visits after 3 months, IOP ≤5 mm Hg on two
consecutive follow-up visits after 3 months, reoperation for glaucoma or a
complication, or loss of light perception vision.
Results
We included 84 eyes with AADI in the inferonasal quadrant versus 69 eyes
in the superotemporal quadrant. A significant drop in IOP was seen in both
groups (18.4±10.4 mm Hg in the inferonasal group vs 17.7±11.1 mm Hg in the
superotemporal group; p=0.63) at 3-month follow-up and this was maintained
until last follow-up. Best-corrected visual acuity, IOP, number of IOP-lowering
medications and complications were similar between the two groups at all time
points. The cumulative success rate at 2-year follow-up without IOP-lowering
medications was 57.1% (47.1%–68.1%) in the inferonasal group and 50.7%
(39.8%–63.1%) in the superotemporal group (p=0.47).
Conclusions
Inferonasal AADI placement appears to be an equally safe and effective
surgical option compared with superotemporal AADI placement and may be helpful
in certain clinical situations.
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Outcome of a low-cost glaucoma drainage device with posterior chamber/pars plana insertion of the tube. Eye (Lond) 2020; 35:901-912. [PMID: 32467637 DOI: 10.1038/s41433-020-0994-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The Aurolab aqueous drainage implant (AADI) is a low-cost glaucoma drainage device that is modelled on the Baerveldt glaucoma implant. Studies on AADI have reported absolute success rates of 41.8-93.1% at 1 year. Most studies report on tube placement in the anterior chamber. We report on results of tube insertion in the sulcus/pars plana. MATERIAL AND METHODS A retrospective chart review of all patients who had undergone AADI implantation (with insertion of tube in the sulcus/posterior segment) between June 2015 and November 2018 was done. Patients were asked to stop anti-glaucoma medications on the 40th post-operative day. RESULTS The mean age was 57.4 ± 13.8 years (n = 30). The mean IOP prior to surgery was 34.4 ± 6.1 mmHg which reduced to 15.4 ± 8.6 mmHg on the 45th post-operative day (p < 0.001). The absolute success at last review was 10% and the qualified success was 80%. The complication rate was 26.7%. Three patients had hypotony related complications noted at/after the 45th day review (none before 40th day). The incidence of ocular motility disturbances was 26.7% though none of the patients reported diplopia. One patient had sideways rotation of the scleral patch graft resulting in tube exposure. This complication was not seen after we shifted to using 9-0 nylon sutures to anchor the graft. Six patients had loss of best corrected visual acuity and one patient developed endophthalmitis. The endophthalmitis was preceded by conjunctival retraction and sloughing off of the scleral patch graft. DISCUSSION AADI implantation results in a substantial drop in IOP. However, many patients continue to require anti-glaucoma medications. Allowing overlap of scleral/corneal patch graft onto the scleral flap may be effective in preventing peritubular leak. It may be advisable to use 9-0 nylon sutures to secure the scleral patch graft anti-glaucoma medications can be temporarily suspended after the 40th post-operative day to minimize hypotony related complications. Melting of the scleral patch graft may be an early sign of endophthalmitis. It would be prudent to specifically look for ocular motility problems in patients undergoing AADI implantation.
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Hafeezullah N, AlHilali S, Alghulaydhawi F, Edward DP, Ahmad S, Malik R. A preliminary comparison of the Aravind aurolab drainage implant with the Baerveldt glaucoma implant: A matched case-control study. Eur J Ophthalmol 2020; 31:445-452. [PMID: 32186212 DOI: 10.1177/1120672120912383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The Aurolab® aqueous drainage implant is a low-cost alternative to the Baerveldt glaucoma implant. The aim of this study was to test the hypothesis that the two implants are comparable in terms of surgical success and safety. METHODS We conducted a retrospective case-control study of Aurolab aqueous drainage implant done at our institution from May 2015 and May 2017. Twenty-five consecutive patients who received an Aurolab aqueous drainage implant were matched by age and diagnosis to patients who received a Baerveldt glaucoma implant. Data were collected pre-operative and post-operative visits, including visual acuity and intraocular pressure, number of medications, and complications. Surgical success was defined as intraocular pressure between 5 and 21 mmHg with a minimum 20% reduction from baseline, without loss of light perception or the need for further glaucoma surgery. Cox regression analysis was used to predict factors associated with surgical success. RESULTS The median (interquartile range, IQR) intraocular pressure at 1 year was 16.0 (8.0) mmHg for the Baerveldt glaucoma implant and 13.0 (8.0) mmHg for the Aurolab aqueous drainage implant, p = 0.38. Success (mean ± SE) at 1 year for the intraocular pressure >21-mmHg failure criterion was 65% ± 15% for the Baerveldt glaucoma implant and 79% ± 11% for the Aurolab aqueous drainage implant (p = 0.80). The frequency of complications listed was similar for the two groups (Fisher's exact p = 0.71). In the Cox regression, the type of implant was not found to be associated with surgical success. CONCLUSIONS Our preliminary results suggest that the Aurolab aqueous drainage implant is comparable to the Baerveldt glaucoma implant. Further long-term data in a larger population are needed to confirm these findings.
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Affiliation(s)
- Najla Hafeezullah
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sara AlHilali
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Fahad Alghulaydhawi
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Deepak P Edward
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Illinois Eye and Ear Infirmary, The University of Illinois at Chicago, Chicago, IL, USA
| | - Sameer Ahmad
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,Glaucoma Consultants of Washington, Herndon, VA, USA
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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International Study of Childhood Glaucoma. ACTA ACUST UNITED AC 2020; 3:145-157. [DOI: 10.1016/j.ogla.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/22/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW The management of pediatric glaucoma poses a unique challenge in terms of maintaining lifelong vision and combating an aggressive scarring response from surgery. Contemporary literature regarding the surgical management of children with pediatric glaucoma who fail, or are at a high risk of failure, from conventional surgery is limited. The aim of this review is to highlight recent developments in relation to the current opinion regarding the management of children with refractory pediatric glaucoma. RECENT FINDINGS Some studies have reported impressive success rates with circumferential trabeculotomy, even in eyes with previous failed surgery. Early results of deep sclerectomy in populations which may not respond well to conventional angle surgery are encouraging but data is limited for the pediatric age group. In compliant patients in whom multiple postoperative examinations under anesthesia are possible, trabeculectomy remains an effective procedure. Multiple recent studies have demonstrated that glaucoma drainage device (GDD) surgery is associated with 5-year success rates of over 70% in primary childhood glaucomas. SUMMARY Glaucoma drainage device surgery is likely to remain a mainstay of surgical management for refractory glaucoma in older children. More prospective data are needed on the success of circumferential trabeculotomy, deep sclerectomy and micropulse laser in pediatric eyes with previous failed surgery. VIDEO ABSTRACT: http://links.lww.com/COOP/A34.
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Maheshwari D, Dabke S, Rajagopal S, Kadar MA, Ramakrishnan R. Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber. Indian J Ophthalmol 2019; 67:1303-1308. [PMID: 31332114 PMCID: PMC6677071 DOI: 10.4103/ijo.ijo_1341_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the outcome of a nonvalved Aurolab aqueous drainage implant (AADI) in the management of refractory glaucoma. Methods Retrospective case series of patients with refractory glaucoma underwent AADI implantation in posterior segment (PS group) or anterior chamber (AC group) with minimum follow-up of 1 year. Primary outcome criterion was success, defined as intraocular pressure (IOP) <18 or >6 mm Hg or IOP reduced to <20% from baseline, for two consecutive visits after 3 months. Failure was defined as inability to meet IOP criteria, any additional glaucoma surgery, loss of light perception, and implant explantation. Secondary outcome criteria compared groups based on mean IOP, mean glaucoma medication use, best-corrected visual acuity, and complications at each postoperative visit. Results In the AC and PS group of 64 patients, 32 tubes each were placed. Preoperative mean IOP was 37.41 ± 8.6 and 43.38 ± 10.3 mm Hg in AC and PS, respectively. Postoperatively IOP reduced to 14.22 ± 4.9 and 15.21 ± 8.1 mm Hg in AC and PS groups, respectively (P < 0.001). Preoperative mean antiglaucoma medication changed from 2.56 ± 0.9 and 3.44 ± 0.5 to 1.03 ± 0.9 and 1.67 ± 0.5 in AC and PS, respectively, postoperatively (P < 0.001). No significant change in VA was noted in either group. At 12 months, success rate was 84% in AC group and 72% in PS group, with PS group having 2.63 times higher hazard (risk) of failure than AC group. Conclusion AADI implantation in PS or AC is a safe and effective method for IOP control in refractory glaucoma with its low cost being of significance in developing countries.
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Affiliation(s)
- Devendra Maheshwari
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Shylesh Dabke
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Sindhushree Rajagopal
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohideen A Kadar
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Rengappa Ramakrishnan
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Outcome of a Low-Cost Glaucoma Implant versus the Baerveldt Glaucoma Implant for Paediatric Glaucoma in a Tertiary Hospital in Egypt. J Ophthalmol 2019; 2019:5134190. [PMID: 32082618 PMCID: PMC6939413 DOI: 10.1155/2019/5134190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/12/2019] [Accepted: 12/02/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare safety and efficacy between a low-cost glaucoma drainage device (GDD), the Aurolab aqueous drainage implant (AADI), and the Baerveldt glaucoma implant (BGI) in refractory childhood glaucoma in Egypt. Methods This is a retrospective study of patients who received either an AADI or BGI at a tertiary care postgraduate teaching institute. Children aged <16 years with uncontrolled intraocular pressure (IOP) with or without prior failed trabeculectomy who completed a minimum 6-month follow-up were included. The outcome measures were IOP reduction from preoperative values and postoperative complications. Results Charts of 57 children (younger than 16 years old) diagnosed with refractory childhood glaucoma were included. Of these, 27 eyes received AADI implants (group A), while 30 received BGI implants (group B). The mean preoperative baseline IOP was 34 ± 5 mmHg in group A versus 29 ± 2 mmHg in group B (p=0.78) in patients on maximum allowed glaucoma medications. In group A versus group B, the mean IOP decreased to 13.25 ± 8.74 mmHg (p=0.6), 12.8 ± 5.4 mmHg (p=0.7), and 12.6 ± 5.6 mmHg (p=0.9) after 1 week, 3 months, and 6 months, respectively. However, in group A, an anterior chamber reaction appeared around the tube in 14 cases starting from the first month and resolved with treatment in only 4 cases. In the other 10 cases, the reaction became more severe and required surgical intervention. This complication was not observed in any eye in group B. Conclusion AADI, a low-cost glaucoma implant, is effective in lowering IOP in patients with recalcitrant paediatric glaucoma. However, an intense inflammatory reaction with serious consequences developed in some of our patients; we believe these events are related to the valve material. We therefore strongly recommend against its use in children.
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Puthuran GV, Palmberg PF, Wijesinghe HK, Pallamparthy S, Krishnadas SR, Robin AL. Intermediate-term outcomes of Aurolab aqueous drainage implant in refractory paediatric glaucoma. Br J Ophthalmol 2019; 104:962-966. [DOI: 10.1136/bjophthalmol-2019-314399] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/11/2019] [Accepted: 09/25/2019] [Indexed: 11/04/2022]
Abstract
AimTo report the intermediate-term outcomes of Aurolab aqueous drainage implant (AADI) surgery in paediatric eyes with refractory glaucoma.MethodsCase records of patients below 18 years, who underwent AADI surgery between 2012 and 2015 with >2 years follow-up, were analysed. The intraocular pressure (IOP), visual acuity, number of antiglaucoma medications, complications and resurgery if any were recorded at baseline, day 1and then at months 1, 3, 6, 9, 12, 18, 24 and at the last visit. Failure was defined as IOP >18 mm Hg or not reduced by at least 30% below baseline, IOP ≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for a complication or loss of light perception vision.Results101 eyes of 101 patients were included with a mean age of 10.4±4.7 years at the time of surgery and a mean follow-up of 40.9±15.1 months. Glaucoma following cataract surgery was the most common type of glaucoma (n=31, 30%), followed by primary congenital glaucoma (n=29, 29%). The cumulative probability of failure was 15.8% (95% CI 10.1% to 24.5%) at 1 year, 22.7% (95% CI 15.7% to 32.2%) at 2 years, 42.5% (95% CI 32.6% to 53.9%) at 3 years and 62.1% (95% CI 49.5% to 74.8%) at the 4 years time point.ConclusionThe AADI showed excellent success until 2 years after surgery in paediatric eyes after which failure rates increased. Further prospective studies with longer follow-up are required to evaluate the long-term success of the AADI for paediatric glaucomas.
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Pandav SS, Seth NG, Thattaruthody F, Kaur M, Akella M, Vats A, Kaushik S, Raj S. Long-term outcome of low-cost glaucoma drainage device (Aurolab aqueous drainage implant) compared with Ahmed glaucoma valve. Br J Ophthalmol 2019; 104:557-562. [DOI: 10.1136/bjophthalmol-2019-313942] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/12/2019] [Accepted: 06/05/2019] [Indexed: 11/04/2022]
Abstract
PurposeTo compare the long-term outcome of Aurolab aqueous drainage device (AADI) and Ahmed glaucoma valve (AGV).MethodRetrospective analysis of patients with refractory glaucoma who underwent AGV (AGV-FP7) and AADI (AADI Model 350) implantation. The outcome measures were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs) and re-surgery for IOP control. The postoperative complications were classified as early (≤3 months), intermediate (>3 months to ≤1 year) or late (>1 year).Results173 patients (189 eyes) underwent AGV implantation (AGV Group) while 201 patients (206 eyes) underwent AADI implantation (AADI group). The IOP in AADI group was significantly lower than AGV group at all time points till 2 years and comparable at 3 years. AADI group had significantly higher number of AGM in preoperative period and significantly lower number in postoperative period till 3 years compared with AGV group. AADI group had more hypotony-related complications but statistically insignificant (p = 0.07). The surgical interventions were significantly higher in AGV (n = 18) compared with AADI group (n = 5) in late postoperative period (p = 0.01). At 3 years, overall success was seen in 58.18% in AGV and 73.08% in AADI group (p = 0.15). Complete success was seen in 7.27% patients in AGV and 25.00% patients in AADI group (p = 0.02).ConclusionBoth AADI and AGV implant had comparable mean IOP at 3 years with lesser requirement of AGM in the AADI group. Both procedures appear to be safe with slight preponderance of hypotony-related complications in AADI group.
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Philip R, Chandran P, Aboobacker N, Dhavalikar M, Raman GV. Intermediate-term outcome of Aurolab aqueous drainage implant. Indian J Ophthalmol 2019; 67:233-238. [PMID: 30672476 PMCID: PMC6376828 DOI: 10.4103/ijo.ijo_675_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To report the intermediate-term safety and efficacy of Aurolab aqueous drainage implant (AADI) in patients with glaucoma. Methods: Retrospective review of patients who underwent AADI between January 2013 and December 2016. Patients aged >16 years and with a minimum follow-up of 6 months were included. Success was defined as complete when the intraocular pressure was ≥6 and ≤21 mmHg without antiglaucoma medication and as qualified if those requiring additional antiglaucoma medications were included. Results: The study included 55 patients (55 eyes) with a mean age ± standard deviation (SD) of 47.3 ± 18.1 years with a mean follow-up of 16.7 ± 11.4 months. Mean intraocular pressure reduced from 30.8 ± 11.1 mmHg to 13.1 ± 4.7, 14.1 ± 4.8, 15.7 ± 2.5 (P < 0.001) mmHg at 6 months, 1 year, and 2 years, respectively. The mean number of antiglaucoma medications reduced from 3.4 ± 1 to 0.8 ± 1.2, 0.7 ± 1.1, 0.8 ± 1 (P < 0.001) at 6 months, 1 year, and 2 years, respectively. The cumulative probability of complete and qualified success was 62% and 100% at 6 months, 54% and 92% at 1 year, and 43% and 88% at 2 years, respectively. Four patients failed during the follow-up period. Postoperative complication occurred in 28 eyes (51%), of which 17 eyes (31%) required intervention. Conclusion: AADI is a safe and effective treatment for the control of intraocular pressure in patients with glaucoma.
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Affiliation(s)
- Reji Philip
- Department of Glaucoma, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Premanand Chandran
- Department of Glaucoma, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Nabeed Aboobacker
- Department of Glaucoma, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Mrunali Dhavalikar
- Department of Glaucoma, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Ganesh V Raman
- Department of Glaucoma, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Dong A, Han L, Shao Z, Fan P, Zhou X, Yuan H. Glaucoma Drainage Device Coated with Mitomycin C Loaded Opal Shale Microparticles to Inhibit Bleb Fibrosis. ACS APPLIED MATERIALS & INTERFACES 2019; 11:10244-10253. [PMID: 30689341 DOI: 10.1021/acsami.8b18551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Excessive fibrosis is the topmost factor for the defeat of surgical glaucoma drainage device (GDD) implantation. Adjuvant drug approaches are promising to help reduce the scar formation and excessive fibrosis. Opal shale (OS), as a natural state and noncrystalline silica substance with poriferous nature and strong adsorbability, is highly likely to undertake drug loading and delivery. Here, we employed OS microparticles (MPs) by ultrasound and centrifugation and presented an innovative and improved GDD coated with OS MPs, which were loaded with mitomycin C (MMC). MMC-loaded OS MPs were physically absorbed on the Ahmed glaucoma valve surface through OS' adsorbability. About 5.51 μg of MMC was loaded on the modified Ahmed glaucoma valve and can be released for 18 days in vitro. MMC-loaded OS MPs inhibited fibroblast proliferation and showed low toxicity to primary Tenon's fibroblasts. The ameliorated drainage device was well tolerated and effective in reducing the fibrous reaction in vivo. Hence, our study constructed an improved Ahmed glaucoma valve using OS MPs without disturbing aqueous humor drainage pattern over the valve surface. The modified Ahmed glaucoma valve successfully alleviated scar tissue formation after GDD implantation surgery.
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Affiliation(s)
- Aimeng Dong
- Department of Ophthalmology , The Second Affiliated Hospital of Harbin Medical University , Harbin , Heilongjiang 150081 , P. R. China
- The Key Laboratory of Myocardial Ischemia , Harbin Medical University, Ministry of Education , Harbin , Heilongjiang Province 150081 , P. R. China
| | - Liang Han
- Department of Pharmaceutics, College of Pharmaceutical Sciences , Soochow University , Suzhou 215123 , P. R. China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences , Soochow University , Suzhou 215123 , P. R. China
| | - Zhengbo Shao
- Department of Ophthalmology , The Second Affiliated Hospital of Harbin Medical University , Harbin , Heilongjiang 150081 , P. R. China
| | - Pan Fan
- Department of Ophthalmology , The Second Affiliated Hospital of Harbin Medical University , Harbin , Heilongjiang 150081 , P. R. China
| | - Xinrong Zhou
- Department of Ophthalmology , The Second Affiliated Hospital of Harbin Medical University , Harbin , Heilongjiang 150081 , P. R. China
| | - Huiping Yuan
- Department of Ophthalmology , The Second Affiliated Hospital of Harbin Medical University , Harbin , Heilongjiang 150081 , P. R. China
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Kaushik S. Commentary on: Glaucoma drainage devices: Boon or bane. Indian J Ophthalmol 2019; 67:238-239. [PMID: 30672477 PMCID: PMC6376842 DOI: 10.4103/ijo.ijo_1234_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sushmita Kaushik
- Glaucoma Services, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Senthil S, Gollakota S, Ali MH, Turaga K, Badakere S, Krishnamurthy R, Garudadri CS. Comparison of the New Low-Cost Nonvalved Glaucoma Drainage Device with Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma in Indian Eyes. ACTA ACUST UNITED AC 2018; 1:167-174. [DOI: 10.1016/j.ogla.2018.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/16/2022]
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Rathi SG, Seth NG, Kaur S, Thattaruthody F, Kaushik S, Raj S, Pandav SS, Ram J. A prospective randomized controlled study of Aurolab aqueous drainage implant versus Ahmed glaucoma valve in refractory glaucoma: A pilot study. Indian J Ophthalmol 2018; 66:1580-1585. [PMID: 30355865 PMCID: PMC6213703 DOI: 10.4103/ijo.ijo_427_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/28/2018] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To study the efficacy of the Aurolab aqueous drainage implant (AADI) compared to Ahmed glaucoma valve (AGV) in patients with refractory glaucoma. METHODS This was a prospective, randomized controlled trial. Thirty-eight adult patients (>18 years) scheduled for a glaucoma drainage device (GDD) were randomized into two groups to receive either AGV or AADI. Primary outcome measures: intraocular pressure (IOP) control and requirement of antiglaucoma medications; secondary outcome measures: final best correct visual acuity (log MAR), visual field (Visual field index [VFI], mean deviation [MD] and pattern standard deviation [PSD]), postoperative complications and additional interventions. Complete success was defined as IOP ≥5-≤18 mmHg without antiglaucoma medications/laser/additional glaucoma surgery or any vision threatening complications. RESULTS There were 19 age and sex-matched patients in each group. Both groups had comparable IOP before surgery (P = 0.61). The AGV group had significantly lower IOP compared to AADI group (7.05 ± 4.22 mmHg vs 17.90 ± 10.32 mmHg, P = <0.001) at 1 week. The mean postoperative IOP at 6 months was not significantly different in the two groups (13.3 ± 4.2 and 11.4 ± 6.8 mmHg respectively; P = 0.48). At 6 months, complete success rate according to antiglaucoma medication criteria was 78.94% in AADI and 47.36% in AGV groups. AGV group required 1.83 times more number of topical medications than AADI group. There was no significant difference in early (P = 0.75) and late (P = 0.71) postoperative complications in the AADI and AGV group. The complete success rate was higher in AADI group (68.42%) than AGV group (26.31%) (P = 0.034). CONCLUSION In this study, AADI appears to have comparable efficacy versus AGV implant with higher complete success rate at 6 months follow-up.
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Affiliation(s)
- Shweta G Rathi
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Natasha G Seth
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Faisal Thattaruthody
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Kaushik
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Srishti Raj
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Pandav
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Pathak-Ray V. Commentary: AADI: New kid on the block. Indian J Ophthalmol 2018; 66:1585-1586. [PMID: 30355866 PMCID: PMC6213684 DOI: 10.4103/ijo.ijo_1118_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vanita Pathak-Ray
- Senior Glaucoma and Cataract Specialist Centre for Sight, Banjara Hills; Neoretina Eyecare Institute, Abids; Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
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Outcomes of Silicone Ahmed Glaucoma Valve Implantation in Refractory Pediatric Glaucoma. J Glaucoma 2018; 27:769-775. [DOI: 10.1097/ijg.0000000000001032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pathak Ray V, Rao DP. Surgical outcomes of a new affordable non-valved glaucoma drainage device and Ahmed glaucoma valve: comparison in the first year. Br J Ophthalmol 2018; 103:bjophthalmol-2017-311716. [PMID: 29945893 DOI: 10.1136/bjophthalmol-2017-311716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/18/2018] [Accepted: 06/06/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND A new low-cost, indigenously manufactured, non-valved glaucoma drainage device (GDD) has been introduced and its design is based on the Baerveldt Glaucoma Device. We aim to demonstrate the efficacy and safety of this GDD (Aurolab aqueous drainage implant, AADI) vis-à-vis the valved device, Ahmed glaucoma valve (AGV), in the management of refractory glaucomas. DESIGN Retrospective, comparative, interventional. PARTICIPANTS Case review of consecutive patients who underwent GDD surgery by a single fellowship-trained surgeon at a Tertiary Centre between January 2014 and November 2016. PRIMARY OUTCOME MEASURE Intraocular pressure (IOP). SECONDARY Antiglaucoma medication (AGM), LogMAR best-corrected visual acuity (BCVA), complications. RESULTS A total of 88 eyes of 83 patients were included; 36 eyes received AGV and 52 AADI. Preoperative parameters were similar between groups. Median follow-up was 13 and 12 months for AADI and AGV, respectively. Overall success rate was higher in AADI (92.3%) vs AGV (80.5%) (p<0.001). The median IOP in mm Hg (Quartiles; IQR) (AADI 14 (10,15;5) vs AGV 16 (14,20;6)) and AGM (AADI: 0 (0,1;1) vs AGV 2 (1,2.75;1.75)) was significantly lower in the AADI group at last follow-up (p<0.001). LogMAR BCVA improved in both groups; complication rates (AADI 44.2% vs AGV 52.7%) were comparable (p=0.59). CONCLUSIONS Both procedures were effective in reduction of IOP and need for AGM. Nevertheless, overall success rate was higher in the AADI group and IOP and number of AGM required was significantly lower in the AADI group; this affordable GDD could have a tremendous impact in the management of refractory glaucomas in low-income to middle-income countries.
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Affiliation(s)
- Vanita Pathak Ray
- Department of Glaucoma, Centre for Sight, Banjara Hills, Hyderabad, India
| | - Divya P Rao
- L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
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Surgical Outcomes of a New Low-Cost Nonvalved Glaucoma Drainage Device in Refractory Glaucoma: Results at 1 Year. J Glaucoma 2018; 27:433-439. [DOI: 10.1097/ijg.0000000000000930] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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