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  • AADI Placement in Children: Which Quadrant Is Best?

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, April 2021

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    In eyes with refractory glaucoma, glaucoma drainage devices typically are placed in the superotemporal (ST) or inferonasal (IN) quadrant. Place­ment in either location appears equally safe and effective in adults, but little is known of the relationship between shunt location and outcomes in chil­dren. Puthuran et al. studied placement of an Aurolab aqueous drainage implant (AADI) in pediatric eyes with refracto­ry glaucoma. They found that proce­dures in the ST quadrant led to lower intraocular pressure (IOP), reduced need for IOP-lowering medications postoperatively, and were safer overall than were IN-quadrant procedures.

    Patients eligible for inclusion were under 19 years of age and had received an AADI at Aravind Eye Hospital (Madurai, India) during a six-year period. Placement location was de­termined by the amount of scarring and conjunctival mobility. Cumulative success was defined as IOP ≤21 mm Hg or IOP reduction of ≥20% below base­line at two consecutive visits occurring more than three months postoperative­ly. Failure was considered inadequate IOP reduction, persistent hypotony, loss of light perception, or reoperation for glaucoma or a complication of the procedure.

    Overall, the medical records of 144 eyes were reviewed (144 patients; mean age, 10.1 years). Shunts were placed in the IN quadrant in 33% and the ST quadrant in 67%. Baseline IOP and corneal diameter were higher for the IN group (p = .04 and p = .004, respectively); no other differences were noted. Two years after surgery, IOP was consistently lower in the ST group (13.7 ± 6.2 mm Hg vs. 17.5 ± 7.4 mm Hg; p = .005), as was the number of IOP-low­ering medications (0.8 ± 0.9 vs. 1.5 ± 1.0; p = .001). ST placement was linked to substantially less tube exposure (0% vs. 12%; p = .05) and greater cumula­tive success (65.6% vs. 50.7%; p = .15). Higher IOP at baseline was the sole factor significantly affecting failure, which occurred at a higher rate with IN placement, but the difference between groups was not significant.

    The authors cautioned that their findings may not necessarily apply to other patient populations or drainage devices, but they suggest avoiding IN placement of AADIs in children unless there are contraindications to using the ST quadrant.

    The original article can be found here.