Eyeworld

96 | EYEWORLD | JUNE 2022 G UCOMA by Ellen Stodola Editorial Co-Director About the physicians Davinder Grover, MD Attending Surgeon and Clinician Glaucoma Associates of Texas Dallas, Texas Leon Herndon Jr., MD Director of the Glaucoma Service Duke Eye Center Durham, North, Carolina Thomas Patrianakos, DO Chair of Ophthalmology Cook County Health Chicago, Illinois T ube shunts still have important appli- cations 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, partic- ularly how the newer Ahmed ClearPath (New World Medical) compares to older options. The non-valved options include the Clear- Path, 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 mm Hg 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 a 245 mm 2 and 185 mm 2 , while Baerveldt and ClearPath have 250 mm 2 and 350 mm 2 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 Non-valved tube implants: Comparison of different devices and size options This is the 250 ClearPath after being tied off on the back table with a 7-0 Prolene suture (keeping the wings 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 the clinic in order to open the tube.

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