Comparison of the New Low-Cost Nonvalved Glaucoma Drainage Device with Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma in Indian Eyes

Abstract

To compare outcomes of a nonvalved glaucoma drainage device (the Aurolab aqueous drainage device [AADI] with a valved glaucoma drainage device (the Ahmed glaucoma valve [AGV]) in refractory pediatric glaucoma. Retrospective interventional case series. One hundred sixteen eyes of 97 children with refractory pediatric glaucoma. Children (≤16 years) treated with drainage implants from January 2007 through December 2016 with a minimum follow-up of 6 months (operated by a single surgeon) were included. Success was defined as intraocular pressure (IOP) ≥6 mmHg or ≤21 mmHg (complete without antiglaucoma medications [AGMs] and qualified with AGM); repeat glaucoma surgery or loss of light perception was failure. Comparison of success rates and complications with AADI (350 mm2) and silicone AGV (models FP7 [182-mm2 surface area] and FP8 [102-mm2 surface area]) implantation. Outcomes of 116 eyes of 97 children (AADI, 36 eyes; AGV, 85 eyes; FP7, n= 14; FP8, n= 72) were analyzed. Median follow-up for AADI was 16.8 months (interquartile range [IQR], 11.7-24.5 months) and for AGV was 27 months (IQR, 15.3-52.3 months). Preoperative parameters (age, IOP, number of AGMs) were similar in both groups except number of previous nonglaucoma surgeries, which were significantly more in AADI (P= 0.05). Qualified success was similar (P= 0.81) in both groups, 91% and 88% at 1 year and 81% and 84% at 3 years with AADI and AGV, respectively. With AADI, the complete success was significantly more (41.8% vs.13.7%; P < 0.005). The postoperative mean IOP (12.6±5.5 mmHg vs. 17.6±6.8 mmHg; P= 0.001), median number of AGMs (1 [IQR, 0-2] vs. 2 [IQR, 1-3]; P < 0.001), and hypertensive phase (16.5% [n= 7] vs. 40% [n= 34]; P= 0.02) were significantly less in AADI compared with AGV. Transient complications (AADI, 30.5% [n= 11/36] vs. AGV, 21.1% [n= 18/85]; P= 0.26), sight-threatening complications (AADI, 13.9% [n= 5/36) vs. AGV, 7% [n= 6/85]; P= 0.22), and complications needing intervention (AADI, 19.4% [n= 7/36] vs. AGV, 14.1% [n= 12/85]; P= 0.46) were similar in both groups. In refractory pediatric glaucoma, both AGV and AADI showed similar qualified success and complication rates at 1 and 3 years. However, the AADI showed greater complete success, better IOP control, less need for AGM, and lesser incidence of an hypertensive phase.