Safety and Efficacy of an Affordable Glaucoma Drainage Device Implantation (AADI) in Refractory Glaucoma

Abstract

Aims: This study aimed to assess the safety and efficacy of implanting an affordable glaucoma drainage device in patients with refractory glaucoma. Methodology: A prospective longitudinal study was conducted involving 30 patients diagnosed with refractory glaucoma who underwent implantation of the Aurolab Aqueous Drainage Implant (AADI) at Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh between November 2021 and April 2022. All surgeries were performed by a single surgeon using a consistent technique. Patients were followed up for three months postoperatively. Outcome measures included postoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA), the number of anti-glaucoma medications, and post-surgery complications. Complete success was defined as an IOP between ≥5 and ≤21 mm Hg, without the need for additional glaucoma medications. Results: The majority of the patients were male (56.7%), while females comprised 43.3%. The mean age was 24.97 (±16.5). A significant decrease in the mean preoperative IOP from 31.67 (±9.8) mmHg to 12.7 (±4.0) mmHg was observed at the three-month follow-up, with a mean percentage reduction of 59.9% (P value <0.001). The mean number of preoperative topical anti-glaucoma medications (AGM) decreased from 3.17 (±0.59) to 0.17 (±0.53) at the three-month follow-up. Visual acuity remained stable in 10 (33.3%) eyes, improved in 9 (30%) eyes, and deteriorated in 11 (36.7%) eyes. Complications occurred in 4 patients (13.3%), including hyphema in 1 (3.3%) patient, choroidal detachment (CD) in 1 (3.3%) patient, and choroidal detachment with retinal detachment in 2 (6.6%) patients. The overall success rate was 96.6%. Conclusion: The non-valved affordable glaucoma drainage device (AADI) demonstrated safety and efficacy in patients with refractory glaucoma, exhibiting good intraocular pressure control. Further follow-up is recommended to assess sustainability over time.