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Jomar DE, Al-Shahwan S, Al-Beishri AS, Freidi A, Malik R. Risk Factors for Glaucoma Drainage Device Exposure in Children: A Case-Control Study. Am J Ophthalmol 2023; 245:174-183. [PMID: 36002072 DOI: 10.1016/j.ajo.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify the risk factors for glaucoma drainage device (GDD) exposure in children. DESIGN Retrospective case-control study. METHODS The study population comprised children (one eye each) who presented with a history of GDD exposure to a tertiary care eye hospital over the period January 2014 to January 2020. Consecutive children (age <18 years) were included. A control group from the same time period (children without GDD exposure) were included in the ratio of 5 controls to every 1 case of exposure. The main outcome measures included risk factors for exposure (univariate and multivariate analysis). RESULTS A total of 21 eyes (of 21 children with implant exposure) and 115 eyes (of 115 children without exposure) were included in this study. During the same study period, a total of 494 eyes had undergone GDD implantation, giving an estimated incidence of exposure of 4.25%). In the bivariate analysis, GDD exposure was associated with multiple previous ocular surgeries (P = .001), longer follow-up duration (P < .001), combined procedure at the time of primary implantation (P = .002), and a younger age at the time of primary implantation (P = .006). The former 3 risk factors continued to prove a statistically significant association on multivariable regression analysis. Postoperative use of eye lubricants was more common among children in the control group (P = .007). CONCLUSION In pediatric glaucoma patients, younger age and combined procedure at the time of primary GDD implantation, in addition to multiple previous ocular surgeries, were associated with greater risk of implant exposure. Postoperative use of eye lubricants may be protective.
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Affiliation(s)
- Deema E Jomar
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia
| | - Sami Al-Shahwan
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia
| | - Ali S Al-Beishri
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia
| | - Alia Freidi
- Faculty of Health Sciences, American University of Beirut (A.F.), Beirut, Lebanon
| | - Rizwan Malik
- From the Glaucoma Division, King Khaled Eye Specialist Hospital (D.E.J., S.A.-S., A.S.A.-B., R.M.), Riyadh, Saudi Arabia; Department of Ophthalmology and Visual Science, University of Alberta (R.M.), Edmonton, Alberta, Canada; Department of Ophthalmology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
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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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Rajendrababu S, Puthuran GV, Alia LA, Uduman MS, Wijesinghe HK. Intermediate-term outcomes of combined phacoemulsification and Aurolab aqueous drainage implant in eyes with refractory glaucoma and coexistent cataract. Int Ophthalmol 2022; 42:2609-2618. [PMID: 35445344 DOI: 10.1007/s10792-022-02251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the efficacy and safety of non-valved Aurolab aqueous drainage implant (AADI) surgery combined with phacoemulsification in eyes with refractory glaucoma and coexistent cataract. METHODS Included patients of 18 years or older who underwent combined AADI-Phacoemulsification from June 2015 to January 2017 with at least 12 months of consecutive follow-up. The best-corrected visual acuity, intraocular pressure (IOP), and the number of IOP-lowering medications were recorded at baseline, 2 weeks, 1, 3, 6, 12, 18, and 24 months. Cumulative probability of success was defined as IOP < 18 mmHg or 30% reduction from the baseline at two consecutive postoperative visits after 3-months. Loss of light perception or reoperation for uncontrolled glaucoma or a complication was considered failure apart from IOP criteria. RESULTS Seventeen eyes of 17 patients with a mean follow-up of 22.6 ± 4.0 months were included. Baseline IOP and ocular hypotensive drugs reduced significantly from 27.9 ± 7.6 mmHg to 14.0 ± 3.0 mmHg (p < 0.001) and 3.24 ± 0.7 to 1.33 ± 1.1 (p = 0.001), respectively, at 24 months. Cumulative probability of qualified success was 71.4% (95% Confidence Interval [CI] 40.6-88.2%) at 3 months and was maintained from 6 months onwards at 64.3% (95% CI 34.3-83.3%), up to 2 years. Intravitreal steroid was injected in one eye (5.9%) of chronic cystoid macular edema, and tube repositioning was done in another for focal corneal decompensation. CONCLUSIONS Combined AADI-Phacoemulsification surgery is a safe and effective option in providing favorable visual and IOP outcomes at an affordable cost in eyes with refractory glaucoma and coexistent cataract.
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Affiliation(s)
- Sharmila Rajendrababu
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India.
| | - George Varghese Puthuran
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India
| | - Laxmi Ananya Alia
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India
| | - Mohammed Sithiq Uduman
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India
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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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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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Tan RJD, Sharma IP, Lucero-Prisno DE. Childhood Blindness: Beyond VISION 2020 and the COVID-19 Pandemic. Glob Pediatr Health 2021; 8:2333794X211022910. [PMID: 34350306 PMCID: PMC8295931 DOI: 10.1177/2333794x211022910] [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: 02/17/2021] [Accepted: 05/18/2021] [Indexed: 11/15/2022] Open
Abstract
The World report on vision in 2019 found it difficult to evaluate VISION 2020's impact on childhood blindness and VI since data on prevalence and causes were scarce. Considering the high chance of the global initiative missing its desired goal in children, we recommend that a sustainable version of it be launched soon. Central to this new initiative shall be better data collection on prevalence and causes of childhood blindness and VI, eye care provision and an updated and uniform system of reporting. Complete and updated data can better reflect the burden and monitor the impact of interventions. However, data collection will continue to be difficult due to the COVID-19 pandemic so the initial phase shall be tailored to the current situation.
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Affiliation(s)
- Roland Joseph D Tan
- Baguio General Hospital and Medical Center, Baguio City, Philippines.,University of the Philippines Manila, Manila, Philippines
| | | | - Don Eliseo Lucero-Prisno
- London School of Hygiene and Tropical Medicine, London, UK.,University of the Philippines Open University, Los Banos, Philippines
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