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Comparison of outcomes between Aurolab aqueous drainage implant placed in the superotemporal versus inferonasal quadrant
  1. George Varghese Puthuran1,
  2. Paul Frederic Palmberg2,
  3. Hiruni Kaushalya Wijesinghe1,
  4. Thandra Sai Shreya1,
  5. S R Krishnadas1,
  6. Steven J Gedde3,
  7. Alan L Robin4
  1. 1Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu, India
  2. 2Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
  3. 3Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
  4. 4Glaucoma, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr George Varghese Puthuran, Glaucoma, Aravind Eye Hospital, Madurai, Tamil nadu, India; georgeputhuran{at}


Aim To determine the outcomes of Aurolab aqueous drainage implant (AADI) placed in the superotemporal versus the inferonasal quadrant in adult eyes with refractory glaucoma.

Methods This was a retrospective study of eyes that had AADI placement and completed a minimum of 2-year follow-up. The choice of the quadrant was at the surgeon’s discretion and mainly depended on the amount of scarring and conjunctival mobility. The cumulative failure rate of the AADI was defined as intraocular pressure (IOP) >21 mm Hg or not reduced by 20% below baseline on two consecutive follow-up visits after 3 months, IOP ≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for glaucoma or a complication, or loss of light perception vision.

Results We included 84 eyes with AADI in the inferonasal quadrant versus 69 eyes in the superotemporal quadrant. A significant drop in IOP was seen in both groups (18.4±10.4 mm Hg in the inferonasal group vs 17.7±11.1 mm Hg in the superotemporal group; p=0.63) at 3-month follow-up and this was maintained until last follow-up. Best-corrected visual acuity, IOP, number of IOP-lowering medications and complications were similar between the two groups at all time points. The cumulative success rate at 2-year follow-up without IOP-lowering medications was 57.1% (47.1%–68.1%) in the inferonasal group and 50.7% (39.8%–63.1%) in the superotemporal group (p=0.47).

Conclusions Inferonasal AADI placement appears to be an equally safe and effective surgical option compared with superotemporal AADI placement and may be helpful in certain clinical situations.

  • glaucoma
  • treatment surgery
  • intraocular pressure
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  • Contributors All authors made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work. GVP: concept and design of the work, critical revision of the content, final approval of the version to be published, accountable for all aspects of work in ensuring questions related to the accuracy or integrity of any part of work are appropriately investigated and resolved. PFP, SRK, SJG, ALR: concept and design of the work, critical revision of the content, final approval of the version to be published. HKW, TSS: data acquisition, analysis, preparation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institutional ethics committee of Aravind Eye Hospital, Madurai and was conducted as per the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information and are available upon request.

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