TY - JOUR
T1 - Surgical Outcomes of Superotemporal Versus Inferonasal Placement of Aurolab Aqueous Drainage Implant in Refractory Pediatric Glaucoma
AU - Puthuran, George Varghese
AU - Wijesinghe, Hiruni Kaushalya
AU - Gedde, Steven J.
AU - Chiranjeevi, Kousalya Pavani
AU - Mani, Iswarya
AU - Krishnadas, Subbaiah Ramasamy
AU - Lee Robin, Alan
AU - Palmberg, Paul
N1 - Funding Information:
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. Funding/Support: This study received no funding. Financial Disclosures: A.L.R. is the Executive Vice President of the American Glaucoma Society and has been a consultant for Versant Health and Perfuse Therapeutics. P.P. has been a consultant and medical monitor for InnFocus, Inc, a Santen company, and for the U.S. Food and Drug Administration (FDA) trial of the MicroShunt, including honoraria and travel support for attending international meetings to present data from the US-Europe FDA trial of the MicroShunt. P.P. received no stock options or equity in any specific company, and no intellectual property rights, and has received honoraria and travel support for being an invited speaker at the Moroccan Ophthalmology Society and University of California, Los Angeles–Doheny. All authors attest that they meet the current ICMJE criteria for authorship. We acknowledge the inputs from Dr Sabyasachi Sengupta for statistical analysis.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/4
Y1 - 2021/4
N2 - Purpose: 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. Design: Retrospective comparative interventional case series. Methods: 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) ≤21 mm Hg or reduced by ≥20% below baseline on 2 consecutive follow-up visits after 3 months, IOP ≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision. Results: 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 ± 7.4 mm Hg vs 13.7 ± 6.2 mm 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). Conclusions: 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.
AB - Purpose: 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. Design: Retrospective comparative interventional case series. Methods: 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) ≤21 mm Hg or reduced by ≥20% below baseline on 2 consecutive follow-up visits after 3 months, IOP ≤5 mm Hg on 2 consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision. Results: 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 ± 7.4 mm Hg vs 13.7 ± 6.2 mm 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). Conclusions: 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.
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U2 - 10.1016/j.ajo.2020.12.003
DO - 10.1016/j.ajo.2020.12.003
M3 - Article
C2 - 33309809
AN - SCOPUS:85100115713
SN - 0002-9394
VL - 224
SP - 102
EP - 111
JO - American journal of ophthalmology
JF - American journal of ophthalmology
ER -