Comparison of Short-term Outcomes of Aurolab Aqueous Drainage Implant with Ahmed Glaucoma Valve in Post-Penetrating Keratoplasty Glaucoma: A Retrospective Follow-up Study at a Tertiary Care Center

Abstract

Purpose: Comparison of short-term outcomes of the Aurolab aqueous drainage implant (AADI) with the Ahmed glaucoma valve (AGV) in post-penetrating keratoplasty glaucoma (PPKG).

Design: Retrospective study design.

Participants: We analyzed the data of patients who underwent glaucoma drainage device (GDD) implantation for PPKG between the time period of 2008 to 2017. A total of 57 eyes of 55 patients were included.

Methods: Parameters including age, sex, corneal graft clarity, duration between the keratoplasty and glaucoma surgery, visual acuity (VA), intraocular pressure (IOP), the number of antiglaucoma drugs (topical and oral) before surgery, and type of GDD were studied. The patients were divided into 2 groups: group I, patients undergoing AADI implantation; and group II, patients undergoing AGV implantation. Patients with at least 6 months follow-up were included. The postoperative VA and IOP were analyzed on day 1 and at 1 week, 4 weeks, 6 weeks, 3 months, and 6 months. The success of GDD was defined as complete success (IOP > 5 mmHg or <21 mmHg without topical antiglaucoma drug) or qualified success (IOP > 5 mmHg or <21 mmHg with up to 2 topical antiglaucoma drugs). Failure was defined as IOP < 5 mmHg or >21 mmHg with or without antiglaucoma medication; IOP < 21 mmHg with 3 or more topical medications or use of systemic medications irrespective of the IOP; loss of perception of light; and/or need for further glaucoma surgery.

Results: Nineteen eyes in group I (mean age = 40.16±16.36 years) and 38 eyes in group II (mean age = 56.61±19.35 years) were studied. The mean baseline IOP in group I and group II was not significantly different (28.63±11.21 vs. 30±14.61 mmHg, P = 0.72). Mean postoperative IOP at 6 months was not significantly different in the 2 groups (12.11±4.86 mmHg vs. 14.95±6.35 mmHg, P = 0.2). There was statistically significant fall in IOP at each visit compared to preoperative IOP in both the groups (P = 0.001), but there was no significant difference between the 2 groups at any time point (P > 0.05). At 6 months overall success rate was 84.21% in both groups (P = 1.00), though the complete success was slightly higher in group II, which was nonsignificant (31.58% vs. 39.47%, P = 0.56). There was no significant difference between baseline and final VA in either group.

Conclusions: Both AADI and AGV are equally effective in controlling IOP in post-penetrating glaucoma. The AADI, being a cost-effective implant, may be more suitable for developing countries.