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Outcomes of the Aurolab aqueous drainage implant and trabeculectomy with mitomycin C in iridocorneal endothelial syndrome

  • Glaucoma
  • Published:
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Abstract

Purpose

To compare the surgical outcomes of the Aurolab aqueous drainage implant (AADI) and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome.

Materials and methods

This retrospective comparative case series included 41 eyes of 41 patients with ICE syndrome and glaucoma who underwent either a trabeculectomy with MMC (n = 20) or AADI surgery (n = 21) with a minimum of 2 years follow-up. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, additional surgical interventions, and surgical complications. Surgical failure was defined as IOP > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma or a complication, or loss of light perception vision.

Results

The cumulative probability of failure at 2 years was 50% in the trabeculectomy group (95%CI = 31–83%) and 24% in the AADI group (95%CI = 11–48%) (p = 0.09). The IOP was consistently lower in the AADI group compared with the trabeculectomy group at 6 months and thereafter. Surgical complications occurred in 13 eyes (65%) in the trabeculectomy group and 12 eyes (57%) in the AADI group (p = 0.71). Reoperations for glaucoma or complications were performed in 12 eyes (60%) in the trabeculectomy group and 5 patients (24%) in the tube group (p = 0.06). Cox proportional hazards showed that AADI had a 53% lower risk of failure at 2 years (p = 0.18; HR = 0.47; 95%CI = 0.16–1.40).

Conclusion

AADI surgery achieved lower mean IOPs than trabeculectomy with MMC in managing glaucoma secondary to ICE syndrome. A trend toward lower rates of surgical failure and reoperations for glaucoma and complications was observed following AADI placement compared with trabeculectomy with MMC in eyes with ICE syndrome.

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Acknowledgements

The authors acknowledge the inputs from Ms R Kumaragurupari, Chief Librarian, Aravind Eye Care System for literature search.

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Author notes

  1. Techi Dodum Tara

    Present address: Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Tirunelveli, India

Authors and Affiliations

  1. Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India

    Vijayalakshmi A. Senthilkumar, George Varghese Puthuran, Techi Dodum Tara, Nimrita Nagdev, Sujitha Ramesh, Iswarya Mani & Subbaiah Ramasamy Krishnadas

  2. Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, USA

    Steven Jon Gedde

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Correspondence to George Varghese Puthuran.

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Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Ethics Committee of the Aravind Eye Hospital, Madurai, India (RET202000246), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Senthilkumar, V.A., Puthuran, G.V., Tara, T.D. et al. Outcomes of the Aurolab aqueous drainage implant and trabeculectomy with mitomycin C in iridocorneal endothelial syndrome. Graefes Arch Clin Exp Ophthalmol 261, 545–554 (2023). https://doi.org/10.1007/s00417-022-05811-6

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