Effect Of Low-Cost Aqueous Drainage Device And Trabeculectomy On Corneal Endothelium And Anterior Chamber Flare: A Prospective Randomized Study

The Aurolab Aqueous Drainage Implant (AADI) (Aurolab, Madurai, India) is a cost-effective substitute to the
other commonly used non-valved shunts worldwide and has gained attention in developing countries. Though there have
been multiple studies which explored the corneal endothelial changes associated with trabeculectomy, with other
glaucoma drainage devices, there is minimal literature available on AADI.

Keywords: corneal endothelium, Anterior Chamber Flare, Glaucoma, Arvind Aqueous Drainage Implant, Intraocular pressure

STUDY DESIGN: This was a prospective, randomized, open-label blinded end point study, which included patients enrolled and   managed at Glaucoma Clinic of Advanced Eye Centre, PGIMER, Chandigarh.. Informed consent was taken from all participants, and the study complied with the principles of the Declaration of Helsinki. Ethical clearance was taken from the Institute Ethics Committee of the Postgraduate Institute of Medical Education and Research.

Study period- July 2020 to December 2021.

 Every participant underwent ophthalmic examination, Noncontact specular microscopy (TOMEY EM 4000)
(readings taken from 5 corneal quadrants) and LFM (FM-600, Kowa). A total of 42 eyes were randomly allocated into
AADI and Trabeculectomy groups. Postoperatively, readings were repeated on day 1, 7, 1st month and 3rd month.

The mean cell density values measured in the AADI group significantly decreased till postoperative day 1 in all
the quadrants from their respective baselines apart from the inferotemporal group (p < 0.03 in all quadrants). The mean
LFM variation was statistically significant (0.00 p-value POD 30 and 0.013 p-value POD 3m). There was hexagonality
loss in the AADI group superotemporal quadrant which persisted even at POD90.In the AADI group,Corneal cell count
reading in the central quadrant correlated with the age. (p value:0.014) and the tube corneal endothelial distance (p value
0.003).

There was no significant variation in the CECD loss, IOP reduction, anterior chamber flare and
complication rate between the two groups. The IOP reduction, failure rate, rise in flare from baseline, secondary
procedure requirement and the requirement of antiglaucoma medication were significantly more in the trabeculectomy
group. Thus, this low cost shunt device is a safe option.