Surgical Outcomes of Superotemporal Versus Inferonasal Placement of Aurolab Aqueous Drainage Implant in Refractory Pediatric Glaucoma

Abstract

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. Retrospective comparative interventional case series. 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) ≤21mm Hg or reduced by ≥20% below baseline on 2 consecutive follow-up visits after 3months, IOP ≤5mm Hg on 2 consecutive follow-up visits after 3months, reoperation for glaucoma or a complication, or loss of light perception vision. 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 ± 7.4mm Hg vs 13.7 ± 6.2mm 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). 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.