Biodegradable material for glaucoma drainage devices - A pilot study in rabbits.

PURPOSE: To study the morphological and histological characteristics of the fibrous capsule formed around a novel biodegradable glaucoma drainage device (GDD) implant made of oxidized regenerated cellulose (ORC) after 1 and 3 months of its implantation. METHODS: It was a prospective, interventional, preclinical experimental study using New Zealand white rabbits. All animals underwent GDD implantation with a novel biodegradable device. The device's body was made of ORC and attached to a silicone tube, connecting the body to the anterior chamber. Histopathology (hematoxylin and eosin/Masson's trichrome staining) and immunohistochemistry (Alpha-Smooth Muscle Actin expression) characteristics of the bleb formed around the novel device were noted at 1 and 3 months. RESULTS: One month post implantation, the biodegradable material produced a significant foreign body type of reaction evidenced by the exuberant infiltration by macrophages, lymphocytes, and multinucleated giant cells. The granulomatous response subsided by 3 months with disorganized collagen deposition on Masson's trichrome staining. The silicone tube was an internal control, and histopathology demonstrated well-organized collagen deposition around it at 3 months. Immunohistochemistry for α-smooth muscle actin also demonstrated more myofibroblast transformation at the site of the tube than the biodegradable implant. CONCLUSIONS: Our results indicate that the tissue response around a biodegradable GDD was different from the response to conventional devices. A diffuse, loose vascularized mesh was observed to develop, which may be more compatible with sustained IOP control over a longer period, in contrast to the usual thick and dense capsule formed around the non-biodegradable devices.

Long-Term Efficacy of Selective Laser Trabeculoplasty in Primary Angle-Closure Disease After Laser Peripheral Iridotomy.

PURPOSE: To evaluate the long-term efficacy of selective laser trabeculoplasty (SLT) in eyes with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG) following a laser peripheral iridotomy (LPI). METHOD: In this prospective cross-sectional study, 45 eyes of 34 patients with PAC/PACG diagnosis, uncontrolled intraocular pressure (IOP), and visible pigmented trabecular-meshwork (TM) at least 180° on gonioscopy following a LPI were recruited. Following a detailed baseline ophthalmic evaluation, all eligible eyes underwent SLT, and the patients were examined on day1, at 1 week, 1-, 3-, and 6-months, and 1-, 2-, 3-, 4-, and 5-year subsequently. The main outcomes measured were IOP, number of IOP-lowering agents, and complications. RESULTS: The mean age of the cohort was 57.80 ± 6.44 years, the male-female ratio was 8:26, and 17 eyes were PACG, and 28 were PAC. The baseline IOP was 23.81 ± 1.78 mm Hg, and was significantly declined at all follow-ups (p < .0001). The cumulative probability of overall success was 91% and 84% at 2-, and 5-year, respectively. At 5-year SLT provided drug-freedom in 80% of PAC and 23% of PACG eyes. Six eyes had IOP spike at 1-week and two patients underwent repeat SLT after 1-year. No other complications, such as pain/discomfort, inflammation, an increase in peripheral anterior synechiae and cystoid-macular-edema, were noted. CONCLUSIONS: SLT appears a safe and cost-effective procedure in PAC/mild- moderate PACG eyes with uncontrolled IOP after laser iridotomy. The long-term effectiveness of SLT as adjuvant treatment was good, but need large sized randomized studies for more validation.

CYP1B1 and MYOC variants in neonatal-onset versus infantile-onset primary congenital glaucoma.

OBJECTIVE: To compare CYP1B1 and MYOC variants in a cohort of neonatal-onset (NO) and infantile-onset (IO) primary congenital glaucoma (PCG). METHODS: This prospective observational study included 43 infants with PCG (14 NO and 29 IO) presenting between January 2017 and January 2019 with a minimum 1-year follow-up. CYP1B1 and MYOC genes were screened using Sanger sequencing with in-silico analysis of the variants using Polymorphism Phenotyping v.2 and Protein Variation Effect Analyser platforms. Allelic frequency was estimated using Genome Aggregation Database (gnomAd). Disease presentation and outcome were correlated to the genetic variants in both groups. RESULTS: Babies with CYP1B1 mutations had more severe disease at presentation and worse outcomes. Six of 14 (42.8%) NO glaucoma and 5 of 29 (17.2%) IO harboured CYP1B1 mutations. Five of six babies in the NO group and three of five in the IO group harboured the variant c.1169G>A, [p.R390H]. They required more surgeries and had a poorer outcome. On in-silico analysis c.1169G>A, [p.R390H] scored very likely pathogenic. Two patients in the IO group who had the c.1294C>G, [p.L432V] variant had a good outcome. Five of 14 NO-PCG and 8 of 29 IO-PCG harboured the variant c.227G>A, [p.R76K] in the MYOC gene, which was scored benign by in-silico analysis, and was also found in 2 of 15 normal controls. CONCLUSIONS: Patients with CYP1B1 pathogenic variants had a poorer outcome than those without. We found more NO PCG babies with CYP1B1 mutations compared with IO PCG. This may be one of the reasons for NO PCG having a poorer prognosis compared with IO PCG.

Primary aphakia: clinical recognition is the key to diagnosis.

PURPOSE: To describe the presentation and treatment outcomes of a cohort of children with primary aphakia (PA). METHODS: Clinical photographs and ultrasound biomicroscopy (UBM) images of children presenting with sclerocornea and undetermined anterior segment dysgenesis between July 2017 and December 2020 were reviewed retrospectively. Children who had no crystalline lens visible on UBM were included. RESULTS: A total of 124 UBM images were captured for 124 children with cloudy corneas. Twelve children were identified with congenital primary aphakia: 5 had bilateral buphthalmos, 2 had buphthalmos in one eye and microphthalmos in the other, and 5 had bilateral sclerocornea-microphthalmia complex. All patients had a peculiar silvery-blue corneal appearance, with fine vascularization on the corneal surface. The overall corneal thickness was 409.1 ± 8.7 µm. The intraocular pressure (IOP) in eyes with glaucoma was 24.5 ± 7.3 mm Hg; in microphthalmic eyes, 11.4 ± 3.4 mm Hg (P <0.001). The raised IOP was treated with limited trans-scleral cyclophotocoagulation under transillumination and topical antiglaucoma medications. Children with glaucoma gained ambulatory vision with spectacles. CONCLUSIONS: Congenital primary aphakia has a characteristic clinical appearance and may present as buphthalmos or microphthalmos, depending on the extent of dysgenesis. Incisional surgery may result in phthisis because of ciliary body dysgenesis and unpredictable aqueous production.

A modified model of glaucoma filtering surgery in Sprague-Dawley rats.

Animal models are useful in glaucoma research to study tissue response to wound healing. Smaller animals such as rats offer additional advantages in terms of availability of detection antibodies and microarrays with cheaper maintenance costs. In this study, we describe a glaucoma filtering surgery (GFS) model in adult Sprague-Dawley rats by performing a sclerostomy using a 26-G needle and additionally placing a silicone tube (27 G) connecting the anterior chamber to the subconjunctival space to maintain a patent fistula for the flow of aqueous humor, thus providing a more definitive bleb. This technique will be useful in identifying and modifying newer targets in the wound healing process in order to improve surgical outcomes following GFS.

Newborn Glaucoma: A Neglected Manifestation of Congenital Rubella Syndrome.

PURPOSE: To study the frequency of intrauterine rubella infection in a cohort of neonatal-onset glaucoma (NOG) and its effect on the treatment outcomes. DESIGN: Prospective cohort study. PARTICIPANTS: Infants with NOG presenting to the pediatric glaucoma service at a tertiary care center in northern India at Chandigarh between January 1, and September 30, 2018, with a minimum postoperative follow-up of 1 year were included in this study. METHODS: Rubella immunoglobulin-M (IgM) antibodies were tested in all patients. Surgery for intraocular pressure (IOP) control comprised combined trabeculotomy with trabeculectomy or goniotomy. Presenting features and treatment outcomes at 1 year were compared among infants with and without rubella-IgM antibodies. RESULTS: Of 27 eligible infants, 7 (25.9%) were rubella-IgM positive, and all had bilateral glaucoma. One eye in a rubella-positive baby was an unsightly blind eye and required a prosthesis. A total of 13 eyes of 7 patients were compared with 34 eyes of 20 rubella-negative patients. There was no significant difference in mean age and IOP at presentation. Rubella-positive infants had significantly more opaque corneas (P < 0.001), shorter eyes (P < 0.001), and smaller corneal diameters (P = 0.007) at presentation. Two patients in the rubella group had bilateral cataracts, 3 patients had heart disease, and 1 patient had sensorineural deafness. Salt-and-pepper retinopathy was noted in both rubella-positive infants where fundus evaluation was possible. Despite comparable IOP control (P = 0.51), the corneal clarity remained significantly worse in the rubella-positive patients (P = 0.02). CONCLUSIONS: Twenty-five percent of those with newborn glaucoma had underlying intrauterine rubella infection, thus making them susceptible for development of congenital rubella syndrome (CRS). Neonatal-onset glaucoma is an important component of CRS, which may present without buphthalmos and persistent corneal clouding despite good IOP control.

Tube-in-tube: A Solution for Retracted Tube.

Tube retraction after Ahmed glaucoma valve (AGV) implantation is an infrequent but known complication. The management option includes the use of a commercially available AGV tube extender, 22 G angiocatheter, resisting the existing glaucoma drainage device (GDD), or insertion of a new GDD. Each of the methods described in the literature has its limitations. We describe the successful management of this complication by using a cost-effective technique of connecting the silicone tube segment to the existing tube to lengthen the tube, so that it could be inserted in the anterior chamber again. The silicone tubes used for the technique were the extra length of the GDD tube, which was cut short and leftover during other GDD implantation surgeries. CLINICAL SIGNIFICANCE: During any GDD implantation, the tube is cut short before entering the anterior chamber. We retrieved the short segments of the tube immediately after the GDD was opened on the table and sterilized them again using plasma technology, available in our operating room. Hence, it provides a cost-effective alternative since the tube is usually trimmed to the desired length in all cases of GDD implantation (valved/non-valved), which can be subsequently sterilized and reused for lengthening the short tube in cases with tube retraction or inadvertently cut tube. HOW TO CITE THIS ARTICLE: Pandav SS, Gautam N, Thattaruthody F. Tube-in-tube: A Solution for Retracted Tube. J Curr Glaucoma Pract 2021;15(1):44-46.

Goniotomy for initial and re-surgery for childhood glaucoma in Northern India.

Purpose: The aim of this study was to describe the effectiveness of goniotomy for childhood glaucoma in Indian eyes. Methods: Consecutive patients with pediatric glaucoma who underwent goniotomy between July 2017 and June 2020, in a single center in Northwest India were prospectively analyzed. Goniotomy was done as a primary procedure or a re-do surgery of the untreated angle in failed filtering surgery. Success was defined as intraocular pressure (IOP) ≦18 mm Hg with or without 2 topical medications. Results: A total of 172 eyes of 126 children underwent goniotomy during this period (37.9% of all pediatric glaucoma surgeries). Goniotomy comprised 132 of 211 (62.5%) primary pediatric glaucoma surgeries and 40 of 243 (16.5%) re-do surgeries. 145, 112, and 54 eyes had a six months, 1-year and 2-year follow-up, respectively. At 1 year, success rates in Primary Congenital Glaucoma (PCG) were 79.7% for primary surgery and 68.4% for re-do surgery. For non-PCG eyes, the success rate was 62% at 1 year. Among PCG subgroups, infantile and newborn glaucoma had 87.5% and 57.1% success rates, respectively. On logistic regression analysis, lower baseline IOP and lesser axial length at presentation were significantly predictive of successful outcomes (P = 0.03 and P = 0.02, respectively). At 1 year, in the primary surgery group, 50% had good vision (better than logMAR 0.5), 28.9% had moderate (better than LOGMAR 1.0) and 20% had severe visual impairment. There were no significant intraoperative or post-operative complications. Conclusion: Goniotomy appears to be an effective surgery for childhood glaucoma in Indian eyes. Being minimally invasive, it obviates the need for conjunctival and scleral dissection and antifibrotic agents.

Reworking protocols of ophthalmic resident surgical training in the COVID-19 era - Experiences of a tertiary care institute in northern India.

PURPOSE: Coronavirus Disease 2019 (COVID-19) pandemic has negatively impacted medical professionals in all fields of medicine and surgery in their academic, clinical and surgical training. The impact of surgical training has been described as 'severe' by most ophthalmology residents worldwide due to their duties in COVID-19 wards, disruption of outpatient and camp services. METHODS: Ophthalmic surgery demands utmost accuracy and meticulousness. Fine motor proficiencies, stereoscopic skills and hand-eye coordination required can only be achieved by practice. So, a multileveled structured wet-lab teaching schedule was prepared for the residents and implemented to bridge this gap between theory and practice at our tertiary care institute. A semester-wise training schedule was made with the proper distribution of wet-lab and simulator training. Surgeries like phacoemulsification, scleral buckling, pars plana lensectomy and vitrectomy, trabeculectomy and intravitreal injections were practised by the residents on the goat eyes. Simulator training was provided for phacoemulsification and vitrectomy to increase the hand-eye coordination of the residents. RESULTS: Residents noticed improvement in their surgical skills and ambidexterity post wet-lab and simulator training . It also increased their confidence and provided essential surgical skills required to be used in the operation theater later. CONCLUSION: It is imperative that wet-lab training be included in the residency training programme in this COVID-19 era.

Treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma.

AIM: To study the treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma. METHOD: A retrospective case series study of patients treated for malignant glaucoma between 2005 and 2017. The treatment included medical management as first-line in the form of cycloplegic with anti-glaucoma medications (AGM) or pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy as second-line therapy. The resolution was defined as 'deepening of central anterior chamber' with intraocular pressure of ⩽ 21 mm Hg (minimum on two consecutive visits 1 week apart) with or without topical anti-glaucoma medications in the absence (complete success) or presence (qualified success) of systemic medications. RESULTS: Twenty-three eyes of 22 patients were included. At the time of diagnosis of malignant glaucoma preceding surgeries were cataract surgery (13 eyes) and trabeculectomy (4 eyes). One eye each had phacotrabeculectomy, Yag capsulotomy and optical keratoplasty. Eighteen eyes were pseudophakic and two eyes were phakic. At presentation, mean intraocular pressure was 26.25 ± 14.78 mmHg which was decreased to 15.90 ± 8.12 mmHg (p < 0.0001) at final follow-up (median follow-up was 15.50 months). Fifteen (75%) eyes had complete success, 3 (15%) eyes had qualified success and 2 (10%) eyes had treatment failure. Of 15 eyes that had achieved complete success, 3 eyes had undergone medical management and 12 eyes undergone second-line procedure. There was no significant difference in visual acuity or number of anti-glaucoma medication at presentation and final follow-up (p > 0.05). CONCLUSIONS: Though malignant glaucoma is highly refractory to treatment, appropriate management in the form of medical or vitrectomy-hyaloidotomy-zonulectomy-iridotomy could achieve 90% success in this series.

Neonatal-Onset Congenital Ectropion Uveae: A Distinct Phenotype of Newborn Glaucoma.

PURPOSE: To describe neonatal-onset congenital ectropion uveae (N-CEU) as a distinct clinical entity of newborn glaucoma (NG) and to study its significance toward the severity and outcome of NG. DESIGN: Prospective clinical cohort study. METHODS: The study took place at a tertiary care postgraduate teaching institute. It included consecutive patients with NG who presented between July 1, 2016 and September 30, 2017, with a minimum postoperative follow-up of 1 year. Infants with any ocular anomaly apart from CEU were excluded. Patients with N-CEU were compared with those with neonatal-onset primary congenital glaucoma (N-PCG). All infants underwent goniotomy or trabeculotomy, with trabeculectomy depending on corneal clarity. Clinical features at presentation and outcome 1 year after surgery were defined as good or satisfactory if intraocular pressure was ≤16.0 mm Hg under anesthesia without or with topical medications, respectively, and poor if the infant required additional surgery. RESULTS: Twenty eyes of 10 patients with N-CEU were compared with 16 eyes of 9 patients with N-PCG. Infants with N-CEU had significantly worse corneal clarity (mean grade 2.0 ± 0.7 vs 1.4 ± 0.8; P = .026) and poorer outcomes compared with those with N-PCG. Seven of 16 (43.7%) eyes with N-PCG had a cornea clear enough at presentation for a goniotomy compared with only 2 of the 20 (10%) eyes with N-CEU (P = .026). Thirteen of 16 (81.2%) eyes with N-PCG had a good or satisfactory outcome compared with 6 of 20 (30%) eyes with N-CEU (P = .001). CONCLUSIONS: N-CEU appears to be distinct from the unilateral CEU in older patients described in the literature and may be considered a poorer prognosis phenotype of neonatal-onset glaucoma.

Acute Hydrops in the Fellow Eye of Infants with Primary Congenital Glaucoma after Intraocular Pressure Reduction in 1 Eye.

PURPOSE: To demonstrate the occurrence of acute hydrops in the fellow eye of infants with primary congenital glaucoma (PCG) treated for glaucoma in 1 eye. DESIGN: Small, observational case series. PARTICIPANTS: Three infants with PCG who demonstrated acute hydrops in the fellow eye after treatment of the worse eye. METHODS: Intraocular pressure (IOP) was lowered surgically in 2 infants and medically in 1 infant with PCG. Two infants underwent combined trabeculotomy with trabeculectomy, and goniotomy was possible in 1 infant. MAIN OUTCOME MEASURES: Observation of the fellow eye after lowering IOP in an eye with acute hydrops. RESULTS: Two infants underwent glaucoma surgery in 1 eye and demonstrated acute hydrops in the fellow eye within 1 week. The third infant demonstrated acute hydrops after medically controlling IOP in 1 eye before the scheduled surgery. After surgical treatment, the stromal edema cleared completely in all 3 infants, leaving behind a small area of opacity where the Descemet's tear had healed. CONCLUSIONS: Our report demonstrates that the fellow eye of a patient with PCG may be at risk of sudden raised IOP resulting in acute hydrops, and early treatment may help to prevent this phenomenon in the fellow eye.

Mirtazapine-induced bilateral secondary angle closure in a female.

Purpose: To report a case of bilateral secondary angle closure in a female using mirtazapine for 6 months. Patient and method: A 55-year-old female was diagnosed with secondary angle closure in both eyes with raised intraocular pressure, and ultrasound biomicroscopic findings suggestive of ciliary body effusion. It was associated with adjoining cyst presumably because of the use of mirtazapine for depression and sleep disturbances. Results: After the planned discontinuation of mirtazapine, the ocular angle opened, the ciliary body edema decreased, and the cyst regressed in size. The intraocular pressure was controlled with topical timolol (0.5%). Conclusion: Patients with risk factors for angle closure should be prescribed antipsychotic drugs with caution. The peripheral laser iridotomy is not indicated in secondary angle closure due to ciliary body effusion.

Predictors of visual impairment in primary and secondary glaucoma in a tertiary institute in North India.

AIM: To find out and compare various predictors of glaucoma-related visual impairments in primary and secondary glaucoma. METHODS: A prospective observational study of patients, who were above 30 years of age. They were diagnosed as primary/secondary glaucoma with visual acuity <20/200 Snellen's/visual field showing less than 20° isopter in at least one eye, with a minimum follow-up of one year at a tertiary center. Patients were classified into advanced and end-stage glaucoma and outcome was assessed according to visual acuity and visual fields to see predictors of visual impairments. RESULTS: There were 169 (99 primary/70 secondary) glaucoma patients with mean age of 62.67 ± 11.9 and 54.65 ± 15.26 years, respectively. Trauma (21.4%), complicated cataract surgery (15.7%), and silicon oil tamponade (14.3%) were common causes of secondary glaucoma. There was significant delay in diagnosis in primary compared to secondary glaucoma (57.57% vs 32.85%) and non-compliance was significantly higher in primary glaucoma (34.3% vs 17.1%, p = 0.01). In univariate analysis, literacy, income status, locality, and delayed or missed diagnosis were found to be significant (p < 0.05) according to visual acuity criteria. Out of the 33 patients who had undergone glaucoma filtration surgery, 18 (54.5%) were in the end-stage group. While 105 (77.2%) of 136 patients who were not subjected to any glaucoma filtration surgery reached end-stage glaucoma as per visual fields criteria (p = 0.011). CONCLUSION: Lack of awareness, delayed diagnosis, low literacy, and income were associated with poor visual outcome. Patients who underwent glaucoma filtration surgery had significantly better visual outcome in comparison to patients managed medically.

Long-term outcome of low-cost glaucoma drainage device (Aurolab aqueous drainage implant) compared with Ahmed glaucoma valve.

PURPOSE: To compare the long-term outcome of Aurolab aqueous drainage device (AADI) and Ahmed glaucoma valve (AGV). METHOD: Retrospective analysis of patients with refractory glaucoma who underwent AGV (AGV-FP7) and AADI (AADI Model 350) implantation. The outcome measures were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs) and re-surgery for IOP control. The postoperative complications were classified as early (≤3 months), intermediate (>3 months to ≤1 year) or late (>1 year). RESULTS: 173 patients (189 eyes) underwent AGV implantation (AGV Group) while 201 patients (206 eyes) underwent AADI implantation (AADI group). The IOP in AADI group was significantly lower than AGV group at all time points till 2 years and comparable at 3 years. AADI group had significantly higher number of AGM in preoperative period and significantly lower number in postoperative period till 3 years compared with AGV group. AADI group had more hypotony-related complications but statistically insignificant (p = 0.07). The surgical interventions were significantly higher in AGV (n = 18) compared with AADI group (n = 5) in late postoperative period (p = 0.01). At 3 years, overall success was seen in 58.18% in AGV and 73.08% in AADI group (p = 0.15). Complete success was seen in 7.27% patients in AGV and 25.00% patients in AADI group (p = 0.02). CONCLUSION: Both AADI and AGV implant had comparable mean IOP at 3 years with lesser requirement of AGM in the AADI group. Both procedures appear to be safe with slight preponderance of hypotony-related complications in AADI group.

Intraocular pressure reduction in a spectrum of angle closure disease following cataract extraction.

Purpose: The purpose is to study the effect of cataract extraction on intraocular pressure (IOP) in patients with angle closure disease (ACD). Methods: In this retrospective study, patients with ACD including medically uncontrolled and advanced primary angle closure glaucoma (PACG) who underwent only cataract surgery were included. The IOP trend was analyzed at postoperative day 1, day 7, 1 month, 3 months, 6 months, 1 year, and final follow-up along with requirement of antiglaucoma medication (AGM)/surgery. Results: A total of 110 eyes of 79 patients [primary angle closure suspect (PACS): 21, PAC: 34, PACG: 55 eyes] were analyzed. Of these patients, 31 eyes had advanced PACG and 20 eyes had medically uncontrolled glaucoma. Best-corrected visual acuity >6/12 was seen in 51 eyes at baseline and 87 eyes at final follow-up. After cataract surgery alone, there was significant reduction (median) in IOP [19.1 ± 18.00% (18.8) in PACS (P < 0.01), 8.55 ± 17.9% (10) in PAC (P = 0.04), 22.82 ± 15.45%(14.3) in PACG (P < 0.01), 18.27 ± 15.99% (14.5) in advanced PACG (P = 0.01) and 36.56 ± 14.58% (28.57) in medically uncontrolled glaucoma (P < 0.01)] and AGM [51.85% (1) in PAC, 32.35% (2) in PACG, 17.71% (2) in advanced PACG, and 40.74% (1.5) in medically uncontrolled PACD] at median follow-up of 1, 2.5, 1, 1.3, and 1 year. Eleven PACG patients, who were on systemic medication preoperatively, were off systemic therapy at final follow-up, while six other PACG eyes (10.9%) required glaucoma surgery. Conclusion: Cataract surgery leads to significant drop in IOP across the spectrum of ACD with visually significant cataract. Cataract surgery may be considered initially for IOP control even in advanced or medically uncontrolled PACG followed by glaucoma surgery later if required.

Glaucoma Secondary to Uveitis in Children in a Tertiary Care Referral Center.

Purpose: To study outcome of secondary glaucoma in pediatric uveitis patients. Methods: Retrospective analysis of records of uveitis patients ≤16 years. Results: Of 182 pediatric uveitis patients, secondary glaucoma was seen in 48 patients (75 eyes, 26.23%) with female preponderance (F:M-29:19) . JIA was the most common etiology (35.71%). BCVA of ≥20/40 was seen in 22 eyes at presentation and in 38 eyes at final follow up (p<0.001). Twenty eight children (66.67%) received systemic antiglaucoma therapy while 17 children (21 eyes) required surgery (60.71%). Logistic regression showed pseudophakia could predict the higher use of oral antiglaucoma medication (p=0.03) while anatomical site of involvement was predictive of higher chances of surgery (p=0.003). Overall success was seen in 82.10% and 71.64% using IOP limit of 21 and 18 mmHg respectively at mean follow-up of 3.9 years. Conclusion: Pediatric uveitic glaucoma though require multitude of therapies, can be managed effectively with appropriate therapy.

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.

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.

A prospective randomized controlled study of Aurolab aqueous drainage implant versus Ahmed glaucoma valve in refractory glaucoma: A pilot study.

PURPOSE: To study the efficacy of the Aurolab aqueous drainage implant (AADI) compared to Ahmed glaucoma valve (AGV) in patients with refractory glaucoma. METHODS: This was a prospective, randomized controlled trial. Thirty-eight adult patients (>18 years) scheduled for a glaucoma drainage device (GDD) were randomized into two groups to receive either AGV or AADI. Primary outcome measures: intraocular pressure (IOP) control and requirement of antiglaucoma medications; secondary outcome measures: final best correct visual acuity (log MAR), visual field (Visual field index [VFI], mean deviation [MD] and pattern standard deviation [PSD]), postoperative complications and additional interventions. Complete success was defined as IOP ≥5-≤18 mmHg without antiglaucoma medications/laser/additional glaucoma surgery or any vision threatening complications. RESULTS: There were 19 age and sex-matched patients in each group. Both groups had comparable IOP before surgery (P = 0.61). The AGV group had significantly lower IOP compared to AADI group (7.05 ± 4.22 mmHg vs 17.90 ± 10.32 mmHg, P = <0.001) at 1 week. The mean postoperative IOP at 6 months was not significantly different in the two groups (13.3 ± 4.2 and 11.4 ± 6.8 mmHg respectively; P = 0.48). At 6 months, complete success rate according to antiglaucoma medication criteria was 78.94% in AADI and 47.36% in AGV groups. AGV group required 1.83 times more number of topical medications than AADI group. There was no significant difference in early (P = 0.75) and late (P = 0.71) postoperative complications in the AADI and AGV group. The complete success rate was higher in AADI group (68.42%) than AGV group (26.31%) (P = 0.034). CONCLUSION: In this study, AADI appears to have comparable efficacy versus AGV implant with higher complete success rate at 6 months follow-up.