Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber

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.

Aurolab aqueous drainage implant in the vitreous cavity: Our modifications over the conventional technique of glaucoma implant surgery

“…AC insertion of the drainage tube is contraindicated in some instances such as shallow or disorganized AC, vitreous in AC, presence of peripheral anterior synechiae, or in cases of preexisting corneal diseases. [ 6 ]…”

“…[ 8 ] Maheswari et al , in their study, showed similar outcomes in both the groups with a 74% success rate in controlling IOP. [ 6 ]…”

Commentary: Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber

“…Maheshwari et al found marginally better success rates at 1 year for anterior segment placement although the risks of complications were higher in the PS placement. [2] In this study, tube placement in PS was done if “concurrent” vitrectomy was done. [2] The posterior placement can also be a staged procedure especially if a tamponading agent is needed in the initial retinal surgery.…”

“…[2] In this study, tube placement in PS was done if “concurrent” vitrectomy was done. [2] The posterior placement can also be a staged procedure especially if a tamponading agent is needed in the initial retinal surgery.…”

Commentary: Aurolab aqueous drainage implant: Posterior versus anterior segment implantation

“…The present paper by Maheshwari D et al [8] is the first direct comparison between posterior and anterior placement of the AADI. The authors have evaluated the clinical outcome of AADI inserted in posterior segment in eyes undergoing concurrent pars plana vitrectomy compared with anterior chamber tube placement in non vitrectomized eyes.…”