Surgical outcomes of a new affordable non-valved glaucoma drainage device and Ahmed glaucoma valve: comparison in the first year

Abstract

Background: A new low-cost, indigenously manufactured, non-valved glaucoma drainage device (GDD) has been introduced and its design is based on the Baerveldt Glaucoma Device. We aim to demonstrate the efficacy and safety of this GDD (Aurolab aqueous drainage implant, AADI) vis-à-vis the valved device, Ahmed glaucoma valve (AGV), in the management of refractory glaucomas.

Design: Retrospective, comparative, interventional.

Participants: Case review of consecutive patients who underwent GDD surgery by a single fellowship-trained surgeon at a Tertiary Centre between January 2014 and November 2016.

Primary outcome measure: Intraocular pressure (IOP).

Secondary: Antiglaucoma medication (AGM), LogMAR best-corrected visual acuity (BCVA), complications.

Results: A total of 88 eyes of 83 patients were included; 36 eyes received AGV and 52 AADI. Preoperative parameters were similar between groups. Median follow-up was 13 and 12 months for AADI and AGV, respectively. Overall success rate was higher in AADI (92.3%) vs AGV (80.5%) (p<0.001). The median IOP in mm Hg (Quartiles; IQR) (AADI 14 (10,15;5) vs AGV 16 (14,20;6)) and AGM (AADI: 0 (0,1;1) vs AGV 2 (1,2.75;1.75)) was significantly lower in the AADI group at last follow-up (p<0.001). LogMAR BCVA improved in both groups; complication rates (AADI 44.2% vs AGV 52.7%) were comparable (p=0.59).

Conclusions: Both procedures were effective in reduction of IOP and need for AGM. Nevertheless, overall success rate was higher in the AADI group and IOP and number of AGM required was significantly lower in the AADI group; this affordable GDD could have a tremendous impact in the management of refractory glaucomas in low-income to middle-income countries.

Keywords: AADI; Ahmed glaucoma valve; Aurolab Aqueous Drainage Implant; GDD; glaucoma drainage device; non-valved GDD; valved GDD.