Graft-free Molteno tube insertion: 10-year outcomes

Aurolab Aqueous Drainage Implant With and Without Scleral Patch Graft in Refractory Adult and Pediatric Glaucomas: A Comparative Study

PURPOSE

To compare the 2-year outcomes of eyes that received the Aurolab aqueous drainage implant (AADI) with and without a scleral patch graft.

DESIGN

Retrospective comparative interventional case series.

METHODS

Eyes with AADI and a minimum of a 2-year follow-up were included. Eyes that underwent implantation before January 2016 had surgery with a scleral patch graft covering the distal end of the tube, whereas those that were implanted after this period underwent surgery using a needle-generated scleral tunnel without the patch graft. The cumulative failure of the AADI was defined as intraocular pressure (IOP) >18 mm Hg or not reduced by 30% below baseline on 2 consecutive follow-up visits after 3 months.

RESULTS

We included 215 adult eyes (n = 147 with patch graft, n = 68 without patch graft) and 111 pediatric eyes (n = 73 with patch graft, n = 38 without a patch graft). The mean IOP in eyes without the patch graft was higher at 1 month in adult eyes (before, 27.5 ± 14.1 vs after, 22.3 ± 11.1; P = .01) but not in pediatric eyes (14.3 ± before, 5.8 vs after, 17.8 ± 11.0; P = .39); there were no differences in IOP, vision, number of antiglaucoma medications, and complications between groups at all other time points. None of the eyes without the patch graft experienced tube exposure. Cumulative success rates at 2 years in adults (66.2% vs 63.9%, respectively; P = .85) were similar to those in children (77.2% vs 71.9%, respectively; P = .83) with both techniques.

CONCLUSIONS

AADI placed without a scleral patch graft is as safe and effective as AADI placed with a patch graft in pediatric and adult refractory glaucomas.

Postoperative management of trabeculectomy and glaucoma drainage implant surgery

PURPOSE OF REVIEW

This article describes important aspects of postoperative management after trabeculectomy and glaucoma drainage implant surgery.

RECENT FINDINGS

Postoperative management of glaucoma drainage implant surgery includes stabilization of intraocular pressure, possible ligature release, and management of complications such as corneal edema, and tube/plate exposure. Postoperative management of trabeculectomy includes evaluation of bleb encapsulation, management of hypotony, and assessment of need for adjuvant therapy. Recent advances in surgical techniques, device/tissue availability, and imaging continue to shape the postoperative course.

SUMMARY

Careful preoperative planning and postoperative care may decrease the likelihood of complications in tube surgery or trabeculectomy.

Update on aqueous shunts

Medicare claims data and surveys of the American Glaucoma Society membership show that aqueous shunts are being increasingly utilized in the surgical management of glaucoma. New clinical trials data have identified differences in the efficacy and safety of shunts in common use. Recent studies have reported comparable results with trabeculectomy and aqueous shunts in similar patient groups. Intraoperative and postoperative complications may develop with aqueous shunt surgery related to the implantation of a foreign material. Several modifications in surgical technique have been directed toward improving surgical success, reducing complications, and optimizing efficiency and cost.