GLAUCOMA EWAP SEPTEMBER 2022 53 Tube shunts still have important applications for glaucoma patients today and are often used for more severe disease. When categorizing tubes shunts, there are valved or non-valved options. Davinder Grover, MD, Leon Herndon Jr., MD, and Thomas Patrianakos, DO, discussed the available non-valved tube implants, particularly how the newer Ahmed ClearPath (New World Medical) compares to older options. The non-valved options include the ClearPath, Baerveldt (Johnson & Johnson Vision), and Molteno3 (Nova Eye), Dr. Patrianakos said, noting that he uses the non-valved option when he wants IOP to be a bit lower. He also said he uses this option more in end-stage disease where pressure of 16 or 17 mmHg might not be enough for the patient. He added that the profile of the non-valved option is a bit lower because valved devices are slightly thicker. Dr. Grover said that the Baerveldt is the most commonly used of the three, with the Molteno3 being the oldest and the ClearPath being the newest. They have different size options—the Molteno3 has 245 mm2 and 185 mm2, while Baerveldt and ClearPath have 250 mm2 and 350 mm2 options. The reason for the introduction of the new ClearPath, Dr. Grover said, was the hope that it would have a lower profile and would be easier to put in. Ideally, it could be put in farther away from the muscles, so there would theoretically be a lower risk of double vision and other problems. Dr. Grover has observed this improved safety and efficiency in his eÝperience with the implant over the past 2 years. The 250 and 350 Baerveldt are put underneath the rectus muscles, typically the superior rectus, Dr. Grover said, and with the 350, the lateral rectus as well because it’s bigger. The 350 Non-valved tube implants: Comparison of different devices and size options by Ellen Stodola Editorial Co-Director This article originally appeared in the June 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Grover: dgrover@glaucomaassociates.com Herndon: leon.herndon@duke.edu Patrianakos: tpatrianakos@yahoo.com The Clear2ath after being tied off on the bacM table Yith a 2rolene suture Meeping the Yings long so they lay flat along the sclera) with a 4-0 nylon rip cord that will be tucked in the subconjunctival space in the inferior temporal quadrant. The rip cord can be pulled 1–6 months later at the slit lamp in order to open the tube.
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