The long-term surgical outcomes of the Aurolab aqueous drainage implant versus the Ahmed glaucoma valve for refractory pediatric glaucoma in Saudi children

Abstract

Introduction: Glaucoma drainage devices (GDDs) play a crucial role in managing refractory pediatric glaucoma. The Aurolab aqueous drainage implant (AADI) is a promising option, especially in regions where cost-effective interventions are essential. We aimed to assess the long-term outcomes of AADI compared to the Ahmed glaucoma valve (AGV) in Saudi children. Methods: A cohort study was conducted at a tertiary eye care center in Riyadh, including patients ≤18 years who underwent AADI or AGV implantation between July 2014 and November 2019. Primary outcomes were intraocular pressure (IOP) control, anti-glaucoma medication (AGM) usage, the need for additional glaucoma surgery, and complications. Factors associated with treatment failure were examined using Cox proportion hazard modeling. Results: Among 126 eyes (AADI = 56, AGV = 70), the mean follow-up was 55.52 ± 14.47 and 53.02 ± 21.85 months for AADI and AGV, respectively. AADI demonstrated comparable IOP control and AGM reduction to AGV over five years. The AADI group exhibited higher success rates than AGV (76.8% vs. 47%). AGV showed a significantly higher risk of failure compared to AADI (adjusted hazard ratio 2.75, P = 0.041). Conclusion: AADI proves to be a safe and effective option for refractory pediatric glaucoma. The long-term outcomes of AADI were not inferior to AGV. Despite consistently lower IOP and AGM usage in the AADI group from the 3 rd to the 60 th month, statistical significance was not achieved.