Outcomes of aqueous shunt surgery in glaucoma secondary to congenital aniridia

Purpose

To evaluate the safety and efficacy outcomes of aqueous shunt implant with/without intraoperative mitomycin-C (MMC) in glaucoma secondary to congenital Aniridia and risk factors associated with its success.

Design

Retrospective study

Subjects

Patients with congenital Aniridia who underwent aqueous shunt implantation with/without intraoperative MMC for glaucoma at Moorfields Eye Hospital London between 2012 and 2021 with at least 3 years follow-up.

Methods

The primary outcome was success at 3 years defined by intraocular pressure (IOP) reduction ≥ 20 % from baseline and final IOP between 6 and 21 mmHg with/without (overall) or without (complete) medications, without further glaucoma surgery or loss of light perception.

Results

Altogether 28 eyes of 23 patients were included, with a mean age of 33.1 (SD 18.3) years. The baseline IOP, medications and visual acuity were 23.4 (SD 8.3), 3.0 (SD 0.9) and 1.6 (SD 0.7) logMAR respectively. Intraoperative MMC was used in 15 (53.6 %) cases. At 3 years the proportion of complete and overall success was 44.0 % and 92.0 % respectively, with a significant reduction in IOP (-11.0, CI -14.0 to -8.0, p < 0.001) and medication use (-1.7, CI -2.3 to -1.2, p < 0.001), and no significant change in VA. There was no significant association between baseline IOP, number of medications and VA, lens status, MMC use, removal of stent suture and surgical success.

Conclusions

Aqueous shunt implant is effective at reducing IOP and medication use at 3 years in glaucoma secondary to congenital Aniridia, with no significant change in visual acuity observed post-operatively.