Nonvalved aqueous drainage implant reduces IOP, glaucoma medications
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A low-cost nonvalved aqueous drainage implant significantly reduced IOP and glaucoma medication use in patients with refractory glaucoma, according to a retrospective review.
“The design inspiration of this cost-effective indigenously manufactured nonvalved device is the Baerveldt glaucoma implant (Johnson & Johnson Vision), which is not available in India. Its performance appears to be rather similar, and at 2 years, it has a low failure rate with achievement of low target intraocular pressure at substantially reduced number of medications,” study co-author Vanita Pathak Ray, FRCS (Ed), FRCOphth, told Healio/OSN.
The study included 48 eyes of 46 patients with refractory glaucoma who received an Aurolab aqueous drainage implant with at least 12 months of postoperative follow-up. Complete success was defined as IOP of 5 mm Hg or greater and 21 mm Hg or less, and qualified success was defined as reaching the IOP criteria with the use of glaucoma medications.
The median preoperative IOP was 33 mm Hg, and the median preoperative number of glaucoma medications was four.
At postoperative day 1, week 1, week 6, month 3, month 6, month 12, month 24 and final follow-up, median IOP was 25.5 mm Hg, 18 mm Hg, 8 mm Hg, 14 mm Hg, 12 mm Hg, 14 mm Hg, 14.5 mm Hg and 14 mm Hg, respectively. The IOP was significantly lower at each time point compared with the median baseline IOP (P < .001), and patients experienced an overall IOP reduction of 57.6%.
The number of glaucoma medications was zero at the last follow-up visit (P < .001).
Complete success was seen in 56.3% of eyes, and overall success was 87.5%. However, 21 complications occurred, and some eyes had more than one complication.
“This has tremendous implications in the management of refractory glaucoma in newly industrialized nations worldwide, as it has the ability to breach the cost barrier,” Ray said.
Perspective
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Savak "Sev" Teymoorian, MD, MBA
Economic concerns for our patients influence how we practice. Other types of glaucoma drainage devices work well with this subset of high-risk patients, but access to care can be a problem. Finding some kind of alternative that gives us comparable results similar to other drainage devices, but in an economically friendly way, is important for us to investigate.
This is a study that reviews one specific type of drainage device, the Aurolab aqueous drainage implant, to see if it would be comparable. There is no specific comparison between this device and a Baerveldt (Johnson & Johnson Vision), but it does compare it overall in terms of its efficiency in reducing IOP and its complication rates. If you look at the data over 2 years, it does an effective job of bringing the pressures down. In terms of complications, it is not going to be superior to other devices, but when you are taking into account economic factors, it does a good job of doing what it needs to do, especially in these high-risk patients who have refractory glaucoma.
I am excited to see longer studies following outcomes in this particular subset of patients. It is worthwhile to explore technology to consider if we are able to treat these patients with some type of coverage that will work well for them.
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