Outcome of a low-cost glaucoma drainage device with posterior chamber/pars plana insertion of the tube

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

Download Full-text

Recurrent intraocular haemorrhage due to pars plana Baerveldt glaucoma drainage device

Clinical and Experimental Ophthalmology ◽

10.1111/ceo.13004 ◽

2017 ◽

Vol 46 (1) ◽

pp. 90-92

Author(s):

Alison Fraenkel ◽

Lawrence R Lee ◽

Graham A Lee

Keyword(s):

Glaucoma Drainage Device ◽

Drainage Device ◽

Pars Plana

Download Full-text

Outcome of a Low-Cost Glaucoma Implant versus the Baerveldt Glaucoma Implant for Paediatric Glaucoma in a Tertiary Hospital in Egypt

Journal of Ophthalmology ◽

10.1155/2019/5134190 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Mahmoud F. Rateb ◽

Hazem Abdel Motaal ◽

Mohamed Shehata ◽

Mohamed Anwar ◽

Dalia Tohamy ◽

...

Keyword(s):

Low Cost ◽

Tertiary Care ◽

Tertiary Hospital ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Group A ◽

Baerveldt Glaucoma Implant ◽

The Mean ◽

Group B

Purpose. To compare safety and efficacy between a low-cost glaucoma drainage device (GDD), the Aurolab aqueous drainage implant (AADI), and the Baerveldt glaucoma implant (BGI) in refractory childhood glaucoma in Egypt. Methods. This is a retrospective study of patients who received either an AADI or BGI at a tertiary care postgraduate teaching institute. Children aged <16 years with uncontrolled intraocular pressure (IOP) with or without prior failed trabeculectomy who completed a minimum 6-month follow-up were included. The outcome measures were IOP reduction from preoperative values and postoperative complications. Results. Charts of 57 children (younger than 16 years old) diagnosed with refractory childhood glaucoma were included. Of these, 27 eyes received AADI implants (group A), while 30 received BGI implants (group B). The mean preoperative baseline IOP was 34 ± 5 mmHg in group A versus 29 ± 2 mmHg in group B (p=0.78) in patients on maximum allowed glaucoma medications. In group A versus group B, the mean IOP decreased to 13.25 ± 8.74 mmHg (p=0.6), 12.8 ± 5.4 mmHg (p=0.7), and 12.6 ± 5.6 mmHg (p=0.9) after 1 week, 3 months, and 6 months, respectively. However, in group A, an anterior chamber reaction appeared around the tube in 14 cases starting from the first month and resolved with treatment in only 4 cases. In the other 10 cases, the reaction became more severe and required surgical intervention. This complication was not observed in any eye in group B. Conclusion. AADI, a low-cost glaucoma implant, is effective in lowering IOP in patients with recalcitrant paediatric glaucoma. However, an intense inflammatory reaction with serious consequences developed in some of our patients; we believe these events are related to the valve material. We therefore strongly recommend against its use in children.

Download Full-text

Pars Plana Tube Insertion of Glaucoma Drainage Device

Journal of Glaucoma ◽

10.1097/ijg.0000000000001300 ◽

2019 ◽

Vol Publish Ahead of Print ◽

Author(s):

George Varghese Puthuran ◽

Hiruni Kaushalya Wijesinghe ◽

Naresh Babu Kannan

Keyword(s):

Glaucoma Drainage Device ◽

Tube Insertion ◽

Drainage Device ◽

Pars Plana

Download Full-text

A Novel Technique for Recurrent Tube Exposure Repair

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/6878025 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

J. Minjy Kang ◽

Yen Cheng Hsia ◽

Ying Han

Keyword(s):

Case Report ◽

Pars Plana Vitrectomy ◽

Glaucoma Drainage Device ◽

Effective Technique ◽

Novel Technique ◽

Drainage Device ◽

Device Implantation ◽

Pars Plana ◽

Successful Technique

Purpose. Tube exposure can lead to vision-threatening consequences and requires prompt surgical attention. Posterior repositioning of the tube to the pars plana has previously been reported as a successful technique. However, this method requires a pars plana vitrectomy (PPV). Here, we describe a novel technique of repositioning the tube into the ciliary sulcus without requiring PPV. Methods. This is a retrospective interventional case report of two patients who had undergone prior glaucoma drainage device implantation and prior tube exposure repair and developed recurrent tube exposure. Tube exposure in the subjects was repaired by repositioning the tube in the ciliary sulcus. Results. The two eyes remained exposure free postoperatively with 51- and 60-month follow-ups. Conclusions. Repositioning the tube to the ciliary sulcus may be an effective technique to avoid reexposure.

Download Full-text

Comparison of the New Low-Cost Nonvalved Glaucoma Drainage Device with Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma in Indian Eyes

Ophthalmology Glaucoma ◽

10.1016/j.ogla.2018.07.001 ◽

2018 ◽

Vol 1 (3) ◽

pp. 167-174 ◽

Cited By ~ 9

Author(s):

Sirisha Senthil ◽

SriRamani Gollakota ◽

Mohammad Hasnat Ali ◽

Kiranmaye Turaga ◽

Swathi Badakere ◽

...

Keyword(s):

Low Cost ◽

Glaucoma Drainage Device ◽

Ahmed Glaucoma Valve ◽

Drainage Device ◽

Pediatric Glaucoma

Download Full-text

Safety and efficacy of a low-cost glaucoma drainage device for refractory childhood glaucoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310276 ◽

2017 ◽

Vol 101 (12) ◽

pp. 1623-1627 ◽

Cited By ~ 21

Author(s):

Sushmita Kaushik ◽

Pankaj Kataria ◽

Srishti Raj ◽

Surinder Singh Pandav ◽

Jagat Ram

Keyword(s):

Low Cost ◽

Glaucoma Drainage Device ◽

Safety And Efficacy ◽

Drainage Device

Download Full-text

Surgical Outcomes of a New Low-Cost Nonvalved Glaucoma Drainage Device in Refractory Glaucoma

Journal of Glaucoma ◽

10.1097/ijg.0000000000000930 ◽

2018 ◽

Vol 27 (5) ◽

pp. 433-439 ◽

Cited By ~ 6

Author(s):

Vanita Pathak Ray ◽

Divya P. Rao

Keyword(s):

Surgical Outcomes ◽

Low Cost ◽

Glaucoma Drainage Device ◽

Refractory Glaucoma ◽

Drainage Device

Download Full-text

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

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311716 ◽

2018 ◽

Vol 103 (5) ◽

pp. 659-665 ◽

Cited By ~ 7

Author(s):

Vanita Pathak Ray ◽

Divya P Rao

Keyword(s):

Success Rate ◽

Low Income ◽

Low Cost ◽

Primary Outcome Measure ◽

Glaucoma Drainage Device ◽

Complication Rates ◽

Case Review ◽

Ahmed Glaucoma Valve ◽

Drainage Device

BackgroundA 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.DesignRetrospective, 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).SecondaryAntiglaucoma medication (AGM), LogMAR best-corrected visual acuity (BCVA), complications.ResultsA 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).ConclusionsBoth 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.

Download Full-text