New nonvalved GDD (AADI) surgery is effective in reducing IOP and need for AGM with a safety profile similar to published reports of prevailing GDDs. It thus has the ability to breach the cost barrier in low-to-middle income countries; further follow-up is required to determine sustainability over time.

Lensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy.

Purpose: This study aimed to report the 2-year surgical outcomes in terms of efficacy and safety of the relatively new, indigenously manufactured, low-cost nonvalved drainage device Aurolab Aqueous Drainage Implant (AADI) in the management of refractory glaucomas in the Indian population. Methods: A retrospective review of consecutive patients older than 12 years, who underwent nonvalved glaucoma drainage device surgery via AADI, was performed by a single fellowship-trained surgeon, between January 2014 and January 2018, who had at least 12 months of documented postoperative follow-up. Outcome Measures: Primary—intraocular pressure (IOP). Secondary—number of antiglaucoma medication (AGM), LogMAR best-corrected visual acuity and complications. Complete success was defined as IOP ≥5 and ≤21 mm Hg; qualified success was defined as fulfilling the above criteria with the use of AGM. Failure was defined as the inability to fulfill the IOP criteria, loss of perception of light, explantation, or any additional glaucoma surgery. Results: A total of 48 eyes of 46 patients were included with a median follow-up of 24 months (quartile 1=16, quartile 3=31.25; interquartile range=15.25) (mean=24.9 mo; SD=10.1). The IOP and number of AGM required was significantly lower at every timepoint postoperatively (P<0.001). The median LogMAR best-corrected visual acuity remained unchanged (P=0.307). Complications occurred in 21 patients (43.7%); some eyes had >1 complication. Complete success was seen in 56.3%; overall success was 87.5%. Conclusions: The safety and efficacy of the new nonvalved glaucoma drainage device, AADI, remain in its second year after implantation. Still further follow-up is recommended, as it has the ability to breach the cost barrier in newly industrialized nations worldwide

Both procedures were effective in reduction of IOP and need for AGM. Nevertheless, overall success rate was higher in the AADI group and IOP and number of AGM required was significantly lower in the AADI group; this affordable GDD could have a tremendous impact in the management of refractory glaucomas in low-income to middle-income countries.

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