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      Aurolab aqueous drainage implant in the vitreous cavity: Our modifications over the conventional technique of glaucoma implant surgery

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          Abstract

          Glaucoma drainage devices (GDDs) are used for managing refractory glaucoma due to failed trabeculectomy, neovascular glaucoma, traumatic glaucoma, and secondary glaucoma post keratoplasty. Aurolab aqueous drainage implant (AADI) is a nonvalved drainage implant conventionally implanted with the tube placed in the anterior chamber. Studies about the outcome of the various aqueous drainage devices implanted in the anterior chamber have reported complications such as tube extrusion, migration, blockage, erosion, and corneal decompensation. We propose modifying the conventional GDD implantation technique by placing the tube in the vitreous cavity, thereby negating the risk of anterior segment complications in patients with refractory glaucoma whose anterior segment is already compromised. Another novel approach implemented in this technique was making a scleral tunnel instead of using a scleral or corneal patch graft to cover the tube to prevent its migration. This article describes the surgical steps of this technique and its advantages, along with a surgical video.

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          Glaucoma in a rural population of southern India: the Aravind comprehensive eye survey.

          James Tielsch, Praveen K Nirmalan, Vijay R. Ramakrishnan … (2003)
          To determine the prevalence of glaucoma and risk factors for primary open-angle glaucoma in a rural population of southern India. A population-based cross-sectional study. A total of 5150 subjects aged 40 years and older from 50 clusters representative of three southern districts of Tamil Nadu in southern India. All participants had a comprehensive eye examination at the base hospital, including visual acuity using logarithm of the minimum angle of resolution illiterate E charts and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated central 24-2 full-threshold perimetry. Definite primary open-angle glaucoma (POAG) was defined as angles open on gonioscopy and glaucomatous optic disc changes with matching visual field defects, whereas ocular hypertension was defined as intraocular pressure (IOP) greater than 21 mmHg without glaucomatous optic disc damage and visual field defects in the presence of an open angle. Manifest primary angle-closure glaucoma (PACG) was defined as glaucomatous optic disc damage or glaucomatous visual field defects with the anterior chamber angle partly or totally closed, appositional angle closure or synechiae in the angle, and absence of signs of secondary angle closure. Secondary glaucoma was defined as glaucomatous optic nerve damage and/or visual field abnormalities suggestive of glaucoma with ocular disorders that contribute to a secondary elevation in IOP. The prevalence (95% confidence interval) of any glaucoma was 2.6% (2.2, 3.0), of POAG it was 1.7% (1.3, 2.1), and if PACG it was 0.5% (0.3, 0.7), and secondary glaucoma excluding pseudoexfoliation was 0.3% (0.2,0.5). On multivariate analysis, increasing age, male gender, myopia greater than 1 diopter, and pseudoexfoliation were significantly associated with POAG. After best correction, 18 persons (20.9%) with POAG were blind in either eye because of glaucoma, including 6 who were bilaterally blind and an additional 12 persons with unilateral blindness because of glaucomatous optic neuropathy in that eye. Of those identified with POAG, 93.0% had not been previously diagnosed with POAG. The prevalence of glaucoma in this population is not lower than that reported for white populations elsewhere. A large proportion of those with POAG had not been previously diagnosed. One fifth of those with POAG had blindness in one or both eyes from glaucoma. Early detection of glaucoma in this population will reduce the burden of blindness in India.
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            Prevalence and risk factors for primary glaucomas in adult urban and rural populations in the Andhra Pradesh Eye Disease Study.

            Chandrasekhar Garudadri, Sirisha Senthil, Rohit C. Khanna … (2010)
            To compare the prevalence of and risk factors for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in urban and rural populations in the Andhra Pradesh Eye Disease Study. A population-based, cross-sectional study using a stratified, random, cluster, and systematic sampling strategy. Between 1996 and 2000, participants from 94 clusters in 1 urban and 3 rural areas representative of the population were included. We performed a detailed eye examination, including applanation tonometry, gonioscopy, and dilated fundus evaluation after ruling out risk of angle closure. Humphrey threshold 24-2 visual fields were performed when indicated. Glaucoma was diagnosed and categorized using International Society of Geographical and Epidemiological Ophthalmology criteria. The prevalence and risk factors for POAG and PACG in subjects aged > or = 40 years were compared between the urban and rural cohorts. There were 3724 subjects > or = 40 years, with 934 in the urban and 2790 in the rural cohort. The prevalence of POAG was greater in the urban compared with the rural cohort (4% vs 1.6%; P<0.001). Age and intraocular pressure (IOP) were risk factors for POAG in both cohorts. Blindness owing to POAG was 11.1% in the rural and 2.7% in the urban cohort. The prevalence of PACG (1.8% vs 0.7%; P<0.01), primary angle closure (PAC) (0.8% vs 0.2%; P = 0.02) and primary angle closure suspect (PACS; 3.5% vs 1.5%; P<0.01) were significantly different between the urban and rural cohorts. Increasing age was a risk factor in the urban cohort. Intraocular pressure was a risk factor in both the populations. Blindness owing to PACG was equal (20%) in both the populations. Female gender was a risk factor in the rural cohort (P = 0.032). The prevalence of both POAG and PACG was greater in urban than in the rural population. Intraocular pressure was a significant risk factor for both POAG and PACG in both cohorts. Increasing age was a significant risk factor for POAG in both cohorts and for PACG in the urban cohort. Female gender was a risk factor for PACG in the rural cohort. There was more blindness owing to PACG than to POAG. The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma

              Sirisha Senthil, Harsha Rao, Jonnadula G Babu … (2013)
              Purpose: To compare the safety and efficacy of trabeculectomy with Ologen implant vs. trabeculectomy with Mitomycin C (MMC). Materials and Methods: In a prospective, randomized, pilot study, 39 eyes of 33 subjects with medically uncontrolled primary glaucoma, aged 18 years or above underwent trabeculectomy either with MMC (20 eyes) or with Ologen implant (19 eyes). The primary outcome measure was cumulative success probability, defined as complete if the intraocular pressure (IOP) was > 5 and ≤ 21 mm Hg without anti-glaucoma medications or additional surgery and qualified if an IOP was > 5 and ≤ 21 mm Hg with or without anti-glaucoma medications. Results: Mean (± standard deviation) follow-up in Ologen group was 19.1 ± 8.1 months, and in MMC group was 18.0 ± 8.4 months. Mean IOP reduction at 6 months was significantly lower (P = 0.01) in the MMC group (11.9 ± 2.9 mm Hg) as compared to Ologen group (14.6 ± 2.7 mm Hg). However, at 12 months (P = 0.81) and 24 months (P = 0.32), the mean IOP was similar between the 2 groups. Complete success probability at the end of 6 months in Ologen group was 100% (95% confidence interval: 59.1 - 99.0) was similar (P = 0.53) to that in MMC group (93.8%, 95% CI: 63.2 - 99.1). The incidences of early post-operative complications were similar in the 2 groups, except hyphema, which was significantly more in Ologen group (P = 0.02). Conclusion: In this pilot study, the success of trabeculectomy and complications were similar in both Ologen and MMC groups at the end of 6 months.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Ophthalmol
                Journal ID (iso-abbrev): Indian J Ophthalmol
                Journal ID (publisher-id): IJO
                Title: Indian Journal of Ophthalmology
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0301-4738
                ISSN (Electronic): 1998-3689
                Publication date (Print): July 2021
                Publication date (Electronic): 18 June 2021
                Volume: 69
                Issue: 7
                Pages: 1950-1952
                Affiliations
                [1]Department of Retina & Vitreous, Tirunelveli, Tamil Nadu, India
                [1 ]Department of Glaucoma, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
                Author notes
                Correspondence to: Dr. Vinit J Shah, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India. E-mail: drvjshah@ 123456gmail.com
                Article
                Publisher ID: IJO-69-1950
                DOI: 10.4103/ijo.IJO_3348_20
                PMC ID: 8374777
                PubMed ID: 34146065
                SO-VID: 19c04662-62f0-4aeb-a807-dc0c0c7f20ab
                Copyright © Copyright: © 2021 Indian Journal of Ophthalmology
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 24 October 2020
                Date revision received : 24 December 2020
                Date accepted : 04 March 2021
                Categories
                Subject: Surgical Technique

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: refractory glaucoma,aurolab aqueous drainage device,vitreous cavity,anterior chamber,surgical technique,intraocular pressure
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: refractory glaucoma, aurolab aqueous drainage device, vitreous cavity, anterior chamber, surgical technique, intraocular pressure

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