GLAUCOMA 54 EWAP SEPTEMBER 2022 ClearPath also goes under both muscles, he said. But the 250 ClearPath does not require this, and the Molteno3 can also be put in without isolating a muscle. “In my mind, what’s revolutionary about the 250 ClearPath is it does not require you to touch the muscles,” Dr. Grover said. You can slide it in the superior temporal quadrant, which is the most common location, and it doesn’t require any muscle isolation. Dr. Grover added that this is beneficial in terms of patient recovery and comfort. Double vision is one of the most debilitating and annoying side effects of tube shunts, he said. “You take someone who is young and functional and give them double vision, and it is miserable.” Dr. Grover noted that he sees a role for all of the tubes, but recently he’s found the 250 ClearPath to be his preferred choice because of its yeÝibility and ease of implantation. Comparing the devices Dr. Grover said it’s important to collect data and compare the newer devices to the more tried and true options. He recently published 6-month data and is in the process of looking at his 1-year data with the ClearPath.1 “It is extremely promising and consistent with my clinical impression that the safety is there, there is less risk of hypotony, and we still have yet to see, with the 250 ClearPath, any cases of double vision in more than 200 cases at our practice.” Dr. Herndon is currently involved in a study comparing the 350 Baerveldt and the 350 ClearPath. While the study is ongoing, he said that early data suggests that there is no difference between the two products. “We have a handful of patients who have reached the 1-year mark, and we’re looking at the interim data,” he said. While it’s still early, Dr. Herndon noted the similar success and complication rates between the two. There had been no previous head-to-head comparison. Dr. Herndon noted that some thought the newer ClearPath has features that are more beneficial to patients, causing less diplopia, less pain, quicker recovery, and less surgical time, so the study is a way to look at this. Dr. Herndon has experience using both devices. ClearPath came to market about 2 years ago, and he had extensive experience with the 250 and 350 before starting the trial. Dr. Herndon said he thinks it may be surprising the way the 250 has taken off. “Traditionally, with tube surgery, we do think that bigger is better,” he said. There is more data on the 350, and for his more advanced patients, Dr. Herndon is using a 350. The ClearPath is similar in theory to traditional tubes, but with a different design, Dr. Herndon said. “We wonder if there are some factors with design that will make it better,” he added. Dr. Patrianakos uses both the ClearPath and Baerveldt devices in his practice, noting that he has been using the ClearPath for about a year and a half. For the most part, he thinks they’re similar in terms of efficacy. He said there are certain advantages of the ClearPath in patients who have a deep-set orbit where it’s hard to implant or tie down the device through the ostium holes. With the ClearPath, the holes are a little more anterior, and in eyes where it may be a more difficult angle to tie those down, the ClearPath can be a good option, he said. Dr. Patrianakos also uses the ClearPath over the Baerveldt in eyes with a lot of conjunctival scarring, particularly in those patients who have had previous surgeries, retinal surgeries, etc., because the ClearPath material is more yeÝible, and it can be “rolled up like a taco” and inserted and unrolled, he said. He stressed, however, that the ClearPath and Baerveldt are similar. “If you talk to some other doctors, they might say that they prefer the Baerveldt, but in my experience, I’ve had similar results with the two.” Another thing to consider when comparing the options are the different sizes. Dr. Grover has moved away from the larger implants. “There’s more and more data showing that there’s not a significant difference in outcomes when you compare the 250 and 350 Baerveldt implants,” he said. Given the Intraoperative photo of the 250 ClearPath prior to insertion into the superior temporal quadrant. Source (all): Davinder Grover, MD
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