Incidence, Outcomes, and Risk of Surgical Failure After Development of Early Hypotony Following Aurolab Aqueous Drainage Implant Surgery

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2023 Feb 2

PMID 36727367

Authors

Hiruni Kaushalya Wijesinghe

George Varghese Puthuran

Deeba Ishrath

Vineela Patnam

Iswarya Mani

Subbaiah Ramasamy Krishnadas

Steven Jon Gedde

Affiliations

Soon will be listed here.

Abstract

Purpose: To report the incidence, outcomes, and risk of surgical failure after early postoperative hypotony following Aurolab Aqueous Drainage Implant (AADI) surgery for adult and pediatric refractory glaucoma.

Methods: Medical records of patients who underwent AADI between January 2013 and March 2017 with a minimum of 2-years follow-up were retrospectively reviewed. Early postoperative hypotony was defined as IOP ≤5 mmHg within the first 3 months after AADI. Surgical failure of AADI was defined as IOP >21 mmHg or reduced <20% below baseline on two consecutive follow-up visits after 3 months, IOP ≤5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision.

Results: Early postoperative hypotony was seen in 15/213 eyes (7%) in the adult group and in 6/101 eyes (6%) in the pediatric group. The onset of hypotony was significantly earlier in the pediatric group (median = 39 days post AADI, IQR = 20-58 days) compared with adult eyes (median = 51 days post AADI, IQR = 30-72 days) (P = 0.02). Eyes with early postoperative hypotony did not have an increased risk of cumulative surgical failure as compared with eyes without hypotony in both adult (33.3% vs. 23.7%; P = 0.48) and pediatric (33.3% vs. 13.7%; P = 0.16) refractory glaucoma. All eyes recovered from hypotony, though one adult eye developed retinal detachment and one pediatric eye developed corneal decompensation and lost vision.

Conclusion: Early postoperative hypotony was an infrequent complication post AADI and occurred earlier in pediatric eyes. Early postoperative hypotony did not increase risk of surgical failure up to 2 years.

Citing Articles

Commentary: Countering the hype related to hypotony in nonvalved Aurolab aqueous drainage implant.

Pathak Ray V Indian J Ophthalmol. 2023; 71(2):593-594.

PMID: 36727368 PMC: 10228974. DOI: 10.4103/ijo.IJO_2284_22.

References

Pathak Ray V, Rao D . Two-Year Outcomes of the New Low-cost Nonvalved Aurolab Aqueous Drainage Implant in Refractory Glaucoma. J Glaucoma. 2020; 29(9):767-772. DOI: 10.1097/IJG.0000000000001532. View

Puthuran G, Palmberg P, Wijesinghe H, Srivastav K, Krishnadas S, Robin A . Aurolab Aqueous Drainage Implant With and Without Scleral Patch Graft in Refractory Adult and Pediatric Glaucomas: A Comparative Study. Am J Ophthalmol. 2020; 216:226-236. DOI: 10.1016/j.ajo.2020.03.022. View

Wijesinghe H, Puthuran G, Gedde S, Pradhan C, Uduman M, Krishnadas S . Incidence and Outcomes of Suprachoroidal Hemorrhage Following Aurolab Aqueous Drainage Implant in Adult and Pediatric Glaucoma. J Glaucoma. 2020; 30(6):497-501. DOI: 10.1097/IJG.0000000000001761. View

Puthuran G, Palmberg P, Wijesinghe H, Pallamparthy S, Krishnadas S, Robin A . Intermediate-term outcomes of Aurolab aqueous drainage implant in refractory paediatric glaucoma. Br J Ophthalmol. 2019; 104(7):962-966. DOI: 10.1136/bjophthalmol-2019-314399. View

Senthil S, Gollakota S, Ali M, Turaga K, Badakere S, Krishnamurthy R . Comparison of the New Low-Cost Nonvalved Glaucoma Drainage Device with Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma in Indian Eyes. Ophthalmol Glaucoma. 2020; 1(3):167-174. DOI: 10.1016/j.ogla.2018.07.001. View

Tsai J, Johnson C, Kammer J, Dietrich M . The Ahmed shunt versus the Baerveldt shunt for refractory glaucoma II: longer-term outcomes from a single surgeon. Ophthalmology. 2006; 113(6):913-7. DOI: 10.1016/j.ophtha.2006.02.029. View

Gedde S, Schiffman J, Feuer W, Herndon L, Brandt J, Budenz D . Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012; 153(5):789-803.e2. PMC: 4460598. DOI: 10.1016/j.ajo.2011.10.026. View

Stein J, McCoy A, Asrani S, Herndon L, Lee P, McKinnon S . Surgical management of hypotony owing to overfiltration in eyes receiving glaucoma drainage devices. J Glaucoma. 2009; 18(8):638-41. DOI: 10.1097/IJG.0b013e31819aa4e0. View

Suner I, Greenfield D, Miller M, Nicolela M, Palmberg P . Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment. Ophthalmology. 1997; 104(2):207-14; discussion 214-5. DOI: 10.1016/s0161-6420(97)30332-7. View

10.

Lim K, Allan B, Lloyd A, Muir A, Khaw P . Glaucoma drainage devices; past, present, and future. Br J Ophthalmol. 1999; 82(9):1083-9. PMC: 1722728. DOI: 10.1136/bjo.82.9.1083. View

11.

Ishida K, Mandal A, Netland P . Glaucoma drainage implants in pediatric patients. Ophthalmol Clin North Am. 2005; 18(3):431-42, vii. DOI: 10.1016/j.ohc.2005.05.009. View

12.

Philip R, Chandran P, Aboobacker N, Dhavalikar M, Raman G . Intermediate-term outcome of Aurolab aqueous drainage implant. Indian J Ophthalmol. 2019; 67(2):233-238. PMC: 6376828. DOI: 10.4103/ijo.IJO_675_18. View

13.

Christakis P, Kalenak J, Tsai J, Zurakowski D, Kammer J, Harasymowycz P . The Ahmed Versus Baerveldt Study: Five-Year Treatment Outcomes. Ophthalmology. 2016; 123(10):2093-102. DOI: 10.1016/j.ophtha.2016.06.035. View

14.

Pandav S, Gautam Seth N, Thattaruthody F, Kaur M, Akella M, Vats A . Long-term outcome of low-cost glaucoma drainage device (Aurolab aqueous drainage implant) compared with Ahmed glaucoma valve. Br J Ophthalmol. 2019; 104(4):557-562. DOI: 10.1136/bjophthalmol-2019-313942. View

15.

Tseng V, Kim C, Romero P, Yu F, Robertson-Brown K, Phung L . Risk Factors and Long-Term Outcomes in Patients with Low Intraocular Pressure after Trabeculectomy. Ophthalmology. 2017; 124(10):1457-1465. DOI: 10.1016/j.ophtha.2017.05.014. View

16.

Arora K, Robin A, Corcoran K, Corcoran S, Ramulu P . Use of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012. Ophthalmology. 2015; 122(8):1615-24. DOI: 10.1016/j.ophtha.2015.04.015. View

17.

Budenz D, Barton K, Gedde S, Feuer W, Schiffman J, Costa V . Five-year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology. 2014; 122(2):308-16. PMC: 4306613. DOI: 10.1016/j.ophtha.2014.08.043. View

18.

Puthuran G, Palmberg P, Wijesinghe H, Krishnadas S, Robin A . Intermediate-Term Outcomes of an Affordable Aqueous Drainage Implant in Adults with Refractory Glaucoma. Ophthalmol Glaucoma. 2020; 2(4):258-266. DOI: 10.1016/j.ogla.2019.03.009. View

19.

Saeedi O, Jefferys J, Solus J, Jampel H, Quigley H . Risk factors for adverse consequences of low intraocular pressure after trabeculectomy. J Glaucoma. 2013; 23(1):e60-8. DOI: 10.1097/IJG.0000000000000008. View

20.

Christakis P, Zhang D, Budenz D, Barton K, Tsai J, Ahmed I . Five-Year Pooled Data Analysis of the Ahmed Baerveldt Comparison Study and the Ahmed Versus Baerveldt Study. Am J Ophthalmol. 2017; 176:118-126. DOI: 10.1016/j.ajo.2017.01.003. View