Surgical outcomes of the Aurolab aqueous drainage implant (AADI) versus the Ahmed glaucoma valve for refractory paediatric glaucoma in Middle Eastern children

Abdullah M Khan; Khabir Ahmad; Motazz Alarfaj; Humoud Alotaibi; Ahmad AlJaloud; Rizwan Malik

doi:10.1136/bmjophth-2021-000831

Surgical outcomes of the Aurolab aqueous drainage implant (AADI) versus the Ahmed glaucoma valve for refractory paediatric glaucoma in Middle Eastern children

BMJ Open Ophthalmol. 2021 Nov 10;6(1):e000831. doi: 10.1136/bmjophth-2021-000831. eCollection 2021.

Authors

Abdullah M Khan¹, Khabir Ahmad², Motazz Alarfaj^{3

4}, Humoud Alotaibi³, Ahmad AlJaloud^{1

4}, Rizwan Malik³

Affiliations

¹ Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
² Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
³ Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
⁴ Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Abstract

Objective: The 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 the surgical success and outcomes of the AADI compared to the AGV in Middle-Eastern children.

Methods: A comparative retrospective study of consecutive paediatric patients in a tertiary eye hospital was undertaken. Data collected included demographics, type of glaucoma, intraocular pressure (IOP), number of anti-glaucoma medications (AGMs) and any subsequent complications or further surgeries.

Analysis: The mean IOP, number of AGMs, surgical success and number of reoperations was compared for the two groups. Surgical success at each visit was defined as IOP of ≥6 mm Hg and ≤21 mm Hg or if the reduction of IOP was ≥20% reduced from baseline.

Results: A total of 126 tube surgeries (56 eyes in AADI and 70 eyes in AGV) were performed in patients aged ≤18 years from 2014 to 2019. No difference was observed in the mean IOP between the two groups except at the first month post-operative visit. After six months, the AADI group had a consistently significant lower mean number of AGMs. At last follow-up, 21 (37.5%) eyes in the AADI group were glaucoma medication-free vs 15 (21.4%) eyes in the AGV group (pp=0.047). Kaplan-Meier analysis showed equivalent cumulative probability of success at two years of 69.9% [(45.9%-84.9%)] for AADI vs 66.8% [(53.4%-77.1%])) for the AGV, respectively. Twenty-four eyes in the AGV group needed one or more subsequent surgeries, whereas 13 eyes needed one or more surgery in the AADI group.

Conclusions: This study shows an acceptable safety profile for the AADI in children, with a rate of failure that is comparable to the AGV, but less need for glaucoma re-operation or glaucoma medication in the first post-postoperative year.

Keywords: aqueous humour; child health (paediatrics); glaucoma; intraocular pressure; optic nerve; treatment surgery.