Surgical outcomes of glaucoma drainage device surgery in an African context

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.

ObjectiveThe 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...

Glaucoma drainage devices (GDDs) play a crucial role in managing refractory pediatric glaucoma. The Aurolab aqueous drainage implant (AADI) is a promising option, especially in regions where cost-effective interventions are essential. We aimed to assess the long-term outcomes of AADI compared to the Ahmed glaucoma valve (AGV) in Saudi children. A cohort study was conducted at a tertiary eye care center in Riyadh, including patients ≤18 years who underwent AADI or AGV implantation between July 2014 and November 2019. Primary outcomes were intraocular pressure (IOP) control, anti-glaucoma medication (AGM) usage, the need for additional glaucoma surgery, and complications. Factors associated with treatment failure were examined using Cox proportion hazard modeling. Among 126 eyes (AADI = 56, AGV = 70), the mean follow-up was 55.52 ± 14.47 and 53.02 ± 21.85 months for AADI and AGV, respectively. AADI demonstrated comparable IOP control and AGM reduction to AGV over five years. The AADI group exhibited higher success rates than AGV (76.8% vs. 47%). AGV showed a significantly higher risk of failure compared to AADI (adjusted hazard ratio 2.75, P = 0.041). AADI proves to be a safe and effective option for refractory pediatric glaucoma. The long-term outcomes of AADI were not inferior to AGV. Despite consistently lower IOP and AGM usage in the AADI group from the 3rd to the 60th month, statistical significance was not achieved.

Glaucoma is the leading cause of irreversible blindness worldwide. Though trabeculectomy still remains the surgical modality of choice for the management of glaucoma, the outcome of glaucoma drainage devices (GDDs) too has been encouraging in recent years. To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. We retrospectively studied the charts of the patients with refractory glaucoma who had undergone GDD implantation at Tilganga Institute of Ophthalmology (TIO), Kathmandu, Nepal. Depending on which GDD was implanted, the eyes of the patients were divided into: AGV group and AADI group. The outcome measures of the study were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs), surgical success and complications. There were 24 eyes of 23 patients in AGV group and 31 eyes of 30 patients in AADI group with a median (quartiles) follow-up of 12 (12,12) months. In the final visit, IOP and AGMs were both significantly lower than the baseline in both the groups (P <0.001). The median IOP in mmHg and AGMs were both significantly lower in the AADI group compared to AGV group in the final visit, p <0.001 and p=0.002, respectively. The overall success was similar in both the groups: AGV (n=22, 91.67%) and AADI (n=29, 93.55%), p=1.0. However, complete success was significantly more in AADI group (n=16, 51.61%) compared to AGV group (n=6, 25%), p=0.046. Complications and their rates were comparable between the two groups (p=0.4). Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.

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.

Comparison of Short-term Outcomes of Aurolab Aqueous Drainage Implant with Ahmed Glaucoma Valve in Post–Penetrating Keratoplasty Glaucoma: A Retrospective Follow-up Study at a Tertiary Care Center

Glaucoma drainage devices are invaluable in the management of secondary/ refractory glaucomas. This study aimed to compare the efficacy and safety of Aurolab Aqueous Drainage Implant (AADI) and the Ahmed Glaucoma Valve (AGV) in filtration-surgery-naïve secondary glaucoma eyes. For this purpose, a retrospective, comparative review was conducted on patients with secondary glaucoma (open and closed) who underwent primary tube procedures, either AADI or AGV. The primary outcome measure was intraocular pressure (IOP), and secondary measures included best-corrected visual acuity (BCVA), number of antiglaucoma medications (AGMs), and complications. This study included 59 eyes in the AADI group with a mean follow-up of 20.3 ± 12.9 months and 61 eyes in the AGV group with a mean follow-up of 19.8 ± 11.8 months. Preoperative IOP, AGM use, and BCVA did not significantly differ between the groups. However, at the last visit, both IOP and AGM use were significantly lower in the AADI group (12.9 ± 3.7 mmHg and 0.6 ± 0.9 vs. 15.7 ± 2.7 and 1.8 ± 1.0 respectively, all p < .001). Moreover, the AADI group exhibited a significantly higher rate of complete success (57.6%) compared to the AGV group (14.7%, p < .001); corresponding qualified success was 91.5% and 80.3%. Serious complication rates were comparable between the two groups. In conclusion, toth AADI and AGV procedures effectively reduced IOP and the need for AGMs. However, the reductions were significantly greater in the AADI group, which also showed a higher rate of complete success. Considering its affordability, AADI could have a substantial positive impact, particularly in resource-constrained settings.

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.

BackgroundTo evaluate the safety and efficacy of a low-cost glaucoma drainage device (GDD), Aurolab aqueous drainage implant (AADI), similar in design to the Baerveldt glaucoma implant (BGI), in refractory childhood...

Purpose: To evaluate clinical outcomes of Glaucoma Drainage Device (GDD) insertions at three anatomical sites; Anterior Chamber (AC), Ciliary Sulcus (CS) and Pars Plana (PP), with respect to various corneal transplantation techniques; Penetrating Keratoplasty (PK), Deep Anterior Lamellar Keratoplasty (DALK), Descemet’s Membrane Endothelial Keratoplasty (DMEK) and Descemet’s Stripping Endothelial Keratoplasty (DSEK). Design: Single-centre, nonrandomized retrospective case series. Participants: Patients aged 18 years or older who had GDD insertion at Sydney Eye Hospital (SEH) between 2006 to 2015, and who also had a corneal transplant at any time period in the same eye. Methods: Patients in this study either had a Baerveldt 101-350 GDD or a Molteno-R2 GDD placed into one of the anterior chamber (AC), ciliary sulcus (CS) or pars plana (PP) from 2006 to 2015. GDD data was combined with the type of corneal transplant performed, either penetrating keratoplasty (PK) or endothelial keratoplasty (DSEK/DMEK), at any time before or after GDD insertion. Patient data was collected preoperatively for each procedure and postoperatively up to a total of five years where possible. Surgical outcome measures were recorded in the form of intraocular pressure (IOP), visual acuity (VA), number of glaucoma medications and surgical complications at each follow-up visit. The timing between GDD insertion and corneal transplantation along with method of GDD stent occlusion, use of antimetabolites and total follow-up duration was noted as well. Results: 25 eyes from 25 patient records that met study inclusion criteria were identified. All GDD insertions at the three sites (AC/CS/PP) resulted in a postoperative reduction in IOP. Mean IOP pre-GDD insertion was 25.8 mmHg and mean IOP post-GDD insertion at one year was 13.0 mmHg. The number of glaucoma medications also decreased post-GDD insertion. CS-GDD with keratoplasty had the largest IOP reduction post-GDD insertion on the least number of glaucoma medications. Visual acuity was also best preserved in this group. Overall graft failure rate at six months and one year was 16.7% and 20.8% respectively. Corneal decompensation was highest in AC-GDDs (43%). GDD with endothelial grafts (DSEK/DMEK) had higher graft failure rates in the first year of follow-up compared to PK (37.5% versus 13.3% respectively). Combined qualified GDD and keratoplasty success rate at one year was 82.6%. Conclusion: GDD insertion is an effective means of IOP control in patients with corneal transplants. CS-GDD insertion with keratoplasty was shown to have the best clinical outcomes in terms of IOP reduction and reduction of number of glaucoma medications. CS-GDD with DSEK graft was associated with best postoperative visual acuity. PPGDD with PK graft was shown to have the best graft survival rate in the long-term. There was no statistical significance in GDD and corneal graft outcomes by having GDD insertion prior to keratoplasty, no previous glaucoma surgery or by being pseudophakic.

The purpose of this study was to report the early outcomes in terms of efficacy and safety of a new, indigenously manufactured, low-cost nonvalved drainage device [AADI (Aurolab Aqueous Drainage Implant)] in the management of refractory glaucoma in the Indian population. Retrospective review of consecutive patients older than 12 years, who underwent glaucoma drainage device surgery (GDD) using AADI, by a single fellowship-trained surgeon, between January 2014 and December 2016, who had at least 3 months of documented post-op follow-up. Primary-intraocular pressure (IOP).Secondary-number of antiglaucoma medication (AGM), LogMAR best corrected visual acuity (BCVA), and complications.Complete success was defined as IOP ≥5 mm Hg and ≤21 mm Hg or reduction of IOP by ≥20% from baseline without AGM; qualified success with use of AGM. Failure was defined as inability to meet IOP criteria, loss of perception of light, explantation or any additional glaucoma surgery. A total of 54 eyes of 51 patients were included. Mean follow up was 12.1±6.3 months. The IOP and number of AGM required was significantly lower at every visit postoperatively (P<0.001). Median LogMAR BCVA remained unchanged (P=0.5). Complications occurred in 22 patients (40.7%). Complete success was seen in 66.6%; overall success was 92.6%. New nonvalved GDD (AADI) surgery is effective in reducing IOP and need for AGM with a safety profile similar to published reports of prevailing GDDs. It thus has the ability to breach the cost barrier in low-to-middle income countries; further follow-up is required to determine sustainability over time.

Background: Management of refractory glaucoma is difficult and this study aims to find the success rate of glaucoma drainage device (GDD) among such advanced glaucoma patients. Materials and Methods: This study was done in 37 patients who underwent GDD implantation, either Ahmed glaucoma valve (AGV) (21 cases) or Aurolab aqueous drainage implant (AADI) (16 cases) for management of refractory glaucoma. Surgery was performed by a single surgeon, over a duration of 1 year; outcome measures were assessed sequentially over 1 year and after that medical records from GDD implanted patients were analyzed. The surgical method was glaucoma valve implantation with patch less scleral graft with “tunnel and track” technique. Main outcome measures included intraocular pressure (IOP), visual acuity (V/A) before and after surgery, complications, need for repeat procedure, comparison between AGV and AADI and success rate. Surgical success was defined as IOP between 5 and 22 mmHg with or without antiglaucoma medications or need for further IOP lowering surgeries or at least V/A of perception of light. In all visits, IOP was measured with Goldmann/Perkins applanation tonometer. Results: The most prevalent cause of refractory glaucoma in the study group was neovascular glaucoma (NVG) in 51.35% cases. Mean IOP before surgery among 37 patients was 43.05 ± 8.14 mmHg and after 1 year follow-up, mean IOP was found to be 17.02 ± 6.84 mmHg. Repeat procedure was done in 37.83% cases and it included hyphema wash in 27% and tube-repositioning in 2.7%. Improvement of vision was not significant in the study group. Common complications encountered were early postoperative hyphema (27%), hypotony (10.8%), hypertensive phase (18.91%), tube block (2.7%), and valve dislocation (2.7%). Success was achieved in 72.97% cases. Among the two types of valve, AADI cases had more than 5 mm lower IOP values at 1 year compared to AGV. Conclusion: GDD implantation is a very useful method to reduce IOP in refractory glaucoma. As success was achieved in over 70% cases, this surgery can be eye saving in conditions where prognosis is very poor and traditional methods are destined to fail. This surgery can be particularly suitable for NVG and postretinal surgery glaucoma as well.

PurposeWe 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.MethodsConsecutive 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.ResultsThe 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.ConclusionTrimming 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.

Background:Glaucoma is one of the major causes of irreversible blindness in the world, with trabeculectomy still being the primary surgical modality for the management of glaucoma. Glaucoma drainage devices (GDDs) have been conventionally used for the treatment of refractory glaucoma and are found to be beneficial in eyes with prior unsuccessful filtration surgeries and primary choice of surgery in certain glaucoma. Aurolab aqueous drainage implant (AADI) is a nonvalved device useful in refractory glaucoma to achieve low intraocular pressure (IOP). The device has been commercially available in India since 2013 and is like the Baerveldt glaucoma implant in design and function. AADI being the most economical and effective GDD in controlling IOP is becoming a popular choice among ophthalmologist in developing countries. AADI surgery has steep learning curve due to large end-plate surface area which needs a rigorous conjunctival dissection, muscle hooking, meticulous plate fixations, and careful tube ligations and insertion. There are different techniques of performing AADI surgery, but the authors have tried to simplify the complex surgery for easy and catchable learning of the procedure by novice surgeon with their experience and have elaborated a step-wise most effective way of performing surgery.Purpose:This video-based skill transfer depicts steps of AADI surgery with compilation of various modifications and authors’ tips and tricks to novice surgeons.Synopsis:This video depicts detailed steps of AADI surgery with micro-points and authors experience. Video also shows various tailor-made modifications of surgical techniques for different case scenarios.Highlights:Steps of AADI surgery, modifications, and surgical pearls.Video Link:https://youtu.be/vmVqBb2FvP4

Aurolab Aqueous Drainage Implant With and Without Scleral Patch Graft in Refractory Adult and Pediatric Glaucomas: A Comparative Study