Eyeworld

JUNE 2022 | EYEWORLD | 97 G be a lower risk of double vision and other prob- lems. Dr. Grover has observed this improved safety and efficiency in his experience with the implant over the past 2 years. The 250 and 350 Baerveldt are put under- neath 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 ClearPath also goes under both muscles, he said. But the 250 ClearPath does not require this, and the Molteno3 can also be put in with- out 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 debilitat- ing 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 flexibility 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 differ- ence 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 de- vices. 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 sur- prising the way the 250 has taken off. "Tradi- tionally, 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. This is an intraoperative photo of the 250 ClearPath prior to inserting the implant in the superior temporal quadrant. Again, this implant was tied off on the back table with a 7-0 Prolene suture and a 4-0 nylon rip cord. Source (all): Davinder Grover, MD continued on page 98

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