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Intermediate-term outcomes of Aurolab aqueous drainage implant in refractory paediatric glaucoma
George Varghese Puthuran1, Paul Frederic Palmberg2, Hiruni Kaushalya Wijesinghe3
1Glaucoma, Aravind Eye Hospital, Madurai, India georgeputhuran@gmail.com.
Insights
The Aurolab aqueous drainage implant (AADI) shows good success in pediatric glaucoma patients up to two years. After two years, failure rates increase, suggesting a need for long-term studies.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Pediatric Ophthalmology
Background:
- Refractory glaucoma in children presents unique management challenges.
- The Aurolab aqueous drainage implant (AADI) is a surgical option for managing complex glaucomas.
Purpose of the Study:
- To evaluate the intermediate-term outcomes of Aurolab aqueous drainage implant (AADI) surgery in pediatric eyes with refractory glaucoma.
Main Methods:
- Retrospective analysis of 101 pediatric patients (<18 years) who underwent AADI surgery between 2012-2015.
- Minimum follow-up of 2 years, with data collected on intraocular pressure (IOP), visual acuity, medications, complications, and reoperations.
- Failure defined by specific IOP criteria, need for reoperation, or vision loss.
Main Results:
- Mean follow-up was 40.9 months. Common diagnoses included post-cataract surgery glaucoma and primary congenital glaucoma.
- Cumulative failure rates were 15.8% at 1 year, 22.7% at 2 years, 42.5% at 3 years, and 62.1% at 4 years.
- The AADI demonstrated good efficacy in the initial two years post-surgery.
Conclusions:
- The AADI is effective in the intermediate term for pediatric refractory glaucoma, with success rates declining after two years.
- Longer-term prospective studies are necessary to fully assess the AADI's sustained efficacy in pediatric glaucoma management.
Aim:
To report the intermediate-term outcomes of Aurolab aqueous drainage implant (AADI) surgery in paediatric eyes with refractory glaucoma.
Methods:
Case records of patients below 18 years, who underwent AADI surgery between 2012 and 2015 with >2 years follow-up, were analysed. The intraocular pressure (IOP), visual acuity, number of antiglaucoma medications, complications and resurgery if any were recorded at baseline, day 1and then at months 1, 3, 6, 9, 12, 18, 24 and at the last visit. Failure was defined as IOP >18 mm Hg or not reduced by at least 30% below baseline, IOP ≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for a complication or loss of light perception vision.
Results:
101 eyes of 101 patients were included with a mean age of 10.4±4.7 years at the time of surgery and a mean follow-up of 40.9±15.1 months. Glaucoma following cataract surgery was the most common type of glaucoma (n=31, 30%), followed by primary congenital glaucoma (n=29, 29%). The cumulative probability of failure was 15.8% (95% CI 10.1% to 24.5%) at 1 year, 22.7% (95% CI 15.7% to 32.2%) at 2 years, 42.5% (95% CI 32.6% to 53.9%) at 3 years and 62.1% (95% CI 49.5% to 74.8%) at the 4 years time point.
Conclusion:
The AADI showed excellent success until 2 years after surgery in paediatric eyes after which failure rates increased. Further prospective studies with longer follow-up are required to evaluate the long-term success of the AADI for paediatric glaucomas.
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