Purpose: The aim of this study was to report our experience with eyes that presented with an initial GDD exposure and their subsequent outcome in terms of re-exposure. Methods: A retrospective review of charts of 42 patients (43 eyes) who presented with a GDD exposure during the period 2008-2015 in a tertiary eye care center was performed. Demographic data, past ocular history, pre-operative and post-operative information including the surgical technique of GDD surgery and exposure repair were recorded. The patients were followed for further exposure to the date of the last follow-up clinic visit. For each type of repair technique, details were collected on risk and timing of GDD exposure. The baseline features of eyes that had further exposure after initial exposure were compared to eyes without further exposure. Results: Forty-three eyes were identified which had repair after an initial exposure. The mean +/- SD age was 54 +/- 27 years. Of the GDDs, Ahmed FP7 was performed in 31 eyes, Ahmed FP8 in two eyes, Ahmed S2 in five eyes, Krupin valve in two eyes and Baerveldt 350 GDD in three eyes. The methods of repair and the relative risk [95% CI] of re-exposure were: conjunctival closure only (n=4; RR=2.10 [0.84-5.23]); repair with patch graft and conjunctival repair (n=18), RR=1.24 [0.51-3.01]; tube repositioning, use of patch graft and conjunctival repair (n=14), RR=1.0; tube removal with replacement in a different quadrant, patch graft and conjunctival repair (n=3), RR=1.87 [0.64-5.48]. After the first exposure, 18 eyes had a second re-exposure, four eyes had a third re-exposure, and 1 eye had a fourth exposure. Conclusions: The GDD exposure rates at our institution are consistent with other reports. Lack of a patch graft for repair is associated with a two-fold risk of subsequent re-exposure.

Introduction: Glaucoma drainage devices (GDDs) play a crucial role in managing refractory pediatric glaucoma. The Aurolab aqueous drainage implant (AADI) is a promising option, especially in regions where cost-effective interventions are essential. We aimed to assess the long-term outcomes of AADI compared to the Ahmed glaucoma valve (AGV) in Saudi children. Methods: A cohort study was conducted at a tertiary eye care center in Riyadh, including patients ≤18 years who underwent AADI or AGV implantation between July 2014 and November 2019. Primary outcomes were intraocular pressure (IOP) control, anti-glaucoma medication (AGM) usage, the need for additional glaucoma surgery, and complications. Factors associated with treatment failure were examined using Cox proportion hazard modeling. Results: Among 126 eyes (AADI = 56, AGV = 70), the mean follow-up was 55.52 ± 14.47 and 53.02 ± 21.85 months for AADI and AGV, respectively. AADI demonstrated comparable IOP control and AGM reduction to AGV over five years. The AADI group exhibited higher success rates than AGV (76.8% vs. 47%). AGV showed a significantly higher risk of failure compared to AADI (adjusted hazard ratio 2.75, P = 0.041). Conclusion: AADI proves to be a safe and effective option for refractory pediatric glaucoma. The long-term outcomes of AADI were not inferior to AGV. Despite consistently lower IOP and AGM usage in the AADI group from the 3^rd to the 60^th month, statistical significance was not achieved.

Introduction Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear. Methods This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15 months. The secondary outcomes included surgical success and complications. Results The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14 mmHg in the perforation group and 35 to 12 mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications. Conclusions An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15 months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

Purpose: To compare the efficacy and safety of iStent versus Endocyclophotocoagulation (ECP) as an adjunct to cataract surgery by Phacoemulsification for treating glaucoma patients in a tertiary eye center. Methods: Retrospective study of 67 eyes of 61 patients with glaucoma and cataract who underwent either phaco-ECP or phaco-iStent. Primary efficacy endpoint is the Intraocular pressure (IOP) reduction, while reduction of glaucoma medications is the secondary outcome. In addition to IOP and number of glaucoma medications; visual acuity, degree of disc cupping, safety profiles were all assessed at different intervals up to 12 months. Results: A total of 40 eyes underwent phaco-ECP, and 27 eyes underwent phaco-iStent. Both groups were associated with a significant reduction in the number of glaucoma medications; however phaco-iStent group achieved slightly lower IOP levels than the phaco-ECP group. Furthermore, iStent inject had better control of IOP at the last follow-up compared to first-generation stents. Moreover; 2 or more stents significantly reduced IOP than single stent ( p = 0.009 vs. p = 0.618, respectively). Phaco-iStent achieved a better reduction in the number of glaucoma medications for primary open-angle glaucoma ( p = 0.007) compared to pseudoexfoliation glaucoma patients ( p = 0.084). Complications were seen in 12 eyes (18%), of which five eyes in phaco-ECP (7.4%) and 7 eyes in phaco-iStent (10.4%), majority were mild and treated conservatively. Conclusions: Both groups had equal efficacy in reducing the IOP. However, phaco-iStent seems superior in reducing the number of glaucoma medications after 1 year of follow-up compared to phaco-ECP, particularly when 2 or more stents are used. Both groups showed an overall good safety profile.

BACKGROUND The PreserFlo MicroShunt is a subconjunctival drainage device increasingly used to manage open-angle glaucoma. While its safety profile is considered favorable compared with that of trabeculectomy, rare postoperative complications, including corneal surface pathology, can still be encountered. To our knowledge, corneal dellen has not been previously reported following PreserFlo implantation. CASE REPORT A 15-year-old boy with pathological myopia and Stickler syndrome underwent PreserFlo MicroShunt implantation for refractory secondary open-angle glaucoma. Two weeks postoperatively, he developed a temporal area of corneal stromal thinning consistent with dellen, located adjacent to an elevated bleb in the horizontal plane. Conservative therapy, including a switch from prednisolone acetate to loteprednol etabonate, intensive preservative-free lubrication, autologous serum drops, and bandage contact lens placement, was initiated. Full corneal re-epithelialization and recovery were achieved within 1 week, without compromising bleb function or intraocular pressure control. CONCLUSIONS Corneal dellen is a potential, although previously undocumented, complication of PreserFlo MicroShunt surgery, particularly when bleb elevation is prominent in areas not protected by the eyelid. Prompt recognition and targeted conservative therapy may allow for complete recovery while preserving device function and visual outcomes. Surgeons should monitor the ocular surface for this complication and adjust postoperative management accordingly.