Eyeworld

98 | EYEWORLD | JUNE 2022 G UCOMA Reference 1. Grover DS, et al. Clinical outcomes of Ahmed ClearPath implantation in glaucomatous eyes: A novel valveless glaucoma drainage device. J Glaucoma. 2022;31:335–339. Relevant disclosures Grover: New World Medical, Nova Eye Herndon: New World Medical Patrianakos: None Contact Grover: dgrover@glaucomaassociates.com Herndon: leon.herndon@duke.edu Patrianakos: tpatrianakos@yahoo.com The ClearPath is similar in theory to tra- ditional 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 flexible, 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 similarity in out- comes, he tends to think that the smaller option is safer because it's taking up less room, it's less invasive, and there is a lower chance of tube-as- sociated hypotony. One additional reason he likes the 250 ClearPath option is because of patient com- fort. When you have to pull on muscles during surgery and put a plate under them, it's un- comfortable for the patient, and this requires a block, he said. "When you're not messing with the muscles, you don't need to do an extensive block, so I'm doing all of my 250 ClearPaths topical without having to block the patient at all, which is safer and more efficient, while still comfortable for the patient." He added that this may be potentially bene- ficial if a patient gets double vision and needs to be referred to a strabismus surgeon for muscle surgery, as that surgeon would have access to all muscles if needed. "While I have yet to ex- perience double vision with the 250 ClearPath, in the rare situation the patient has this, the strabismus surgeon has more flexibility in fixing the problem," he said. In terms of IOP lowering, Dr. Herndon said that both the Baerveldt and ClearPath can get to similar levels. In multicenter trials with the 350 Baerveldt out to 5 years, the pressures were 14 mm Hg, he said, adding that he's seeing 12–15 mm Hg in the ClearPath. For both devices, Dr. Patrianakos said you can get pressures in the low teens, sometimes high single digits, with the larger surface area options. The larger surface area of the 350 may get the pressure down lower, but there are tradeoffs too, he said. The larger the surface area of the plate, the more chance of compli- cations, so you have to take that into account. "I do think that the larger the surface area, the lower the intraocular pressure, and when I real- ly want to aim for low pressures, I usually will opt for the 350. It may not be that significant, but it does have some effect," Dr. Patrianakos said. Dr. Grover said he's typically seeing pres- sures in the mid-teens with one IOP-lowering drop. He also mentioned using a diode laser with CPC or ECP. "What's becoming more of a trend is if a patient has a tube shunt and pres- sures are not ideally controlled, I can supple- ment that tube with the low-energy CPC diode, and it allows me to dial down the pressure a bit," he said. "It's our responsibility, as a society of glau- coma specialists, any time a new implant comes out, to prove that it's safe and successful and look at our data. This is what we are currently doing with the ClearPath," Dr. Grover said. continued from page 97

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