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Comparison of the Baerveldt Glaucoma Implant With the Double-Plate Molteno Drainage Implant

Comparison of the Baerveldt Glaucoma Implant With the Double-Plate Molteno Drainage Implant Abstract Objective: To compare the 350-mm2 Baerveldt implant with the double-plate Molteno implant in the treatment of eyes with complicated glaucoma. Design: Retrospective chart review of a consecutive series of drainage implants. Setting: University-based referral practice. Patients: Thirty-four consecutive patients (37 eyes) undergoing glaucoma drainage device implantation because of uncontrolled, complicated glaucoma. Intervention: Eighteen eyes underwent 350-mm2 Baerveldt implantation and 19 eyes underwent double-plate Molteno implantation. Main Outcome Measures: Intraocular pressure (IOP) control, visual acuity outcome, and complication rate. Results: Mean preoperative IOP was 30.2 mm Hg in the Baerveldt group, with an average of 2.7 antiglaucoma medications, and 28.4 mm Hg in the Molteno group, with an average of 2.4 antiglaucoma medications. With an average follow-up of 11.3 months (range, 5 to 16 months), mean IOP at the final visit was 13.1 mm Hg (range, 7 to 21 mm Hg) in the Baerveldt group, with an average of 1.3 medications, and 13.4 mm Hg (range, 8 to 25 mm Hg) in the Molteno group, with an average of 0.8 medications. Final IOP was between 7 and 19 mm Hg in 16 of 18 Baerveldt eyes and in 17 of 19 Molteno eyes. Visual acuity (when it could be checked) remained stable (±2 Snellen lines) in 17 of 17 eyes in the Baerveldt group and in 17 of 19 eyes in the Molteno group. Complications in the Baerveldt group included two cases (11%) of flat anterior chamber after stent removal, one case (6%) of intermittently symptomatic diplopia, and one case (6%) of endophthalmitis. In the Molteno group there were two graft failures (11%) and one eye (5%) with loss of central field. Conclusions: Both types of drainage implants provide excellent postoperative IOP control. Early stent removal should be avoided if possible in eyes with Baerveldt implants. References 1. Heuer DK, Gressel MG, Parrish RK II, Anderson DR, Hodapp E, Palmberg PF. Trabeculectomy in aphakic eyes . Ophthalmology . 1984;91:1045-1051.Crossref 2. Herschler J, Agness D. A modified filtering operation for neovascular glaucoma . Arch Ophthalmol . 1979;97:2339-2341.Crossref 3. Schwartz AL, Anderson DR. Trabecular surgery . Arch Ophthalmol . 1974;92:134-138.Crossref 4. Insler MS, Cooper HD, Kasti PR, Caldwell DR. Penetrating keratoplasty with trabeculectomy . Am J Ophthalmol . 1985;100:593-595. 5. Shields MB. Glaucomas associated with ocular inflammation . In: Textbook of Glaucoma . 2nd ed. Baltimore, Md: Williams & Wilkins; 1987:298-311. 6. The Fluorouracil Filtering Surgery Study Group. Fluorouracil Filtering Surgery Study one-year follow-up . Am J Ophthalmol . 1989;108:625-635. 7. Ruderman J, Welch D, Smith MF, Shoch D. A randomized study of 5-fluorouracil and filtration surgery . Am J Ophthalmol . 1987;104:218-224. 8. Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy . Ophthalmology . 1991;98:317-321.Crossref 9. Kitazawa Y, Kawase K, Matsushita H, Minobe M. Trabeculectomy with mitomycin: a comparative study with fluorouracil . Arch Ophthalmol . 1991;109:1693-1698.Crossref 10. Molteno ACB, Straughan JL, Ancker E. Long tube implants in the management of glaucoma . S Afr Med J . 1976;50:1062-1066. 11. Lloyd MA, Baerveldt G, Heuer DK, et al. The Baerveldt glaucoma implant: long term histologic studies in rabbits and clinical experience in humans . Invest Ophthalmol Vis Sci . 1991;32:746. Abstract. 12. Smith MF, Sherwood MB, McGorray SP. Comparison of the double-plate Molteno drainage implant with the Schocket procedure . Arch Ophthalmol . 1992;110:1246-1250.Crossref 13. Heuer DK, Lloyd MA, Abrams DA, et al. Which is better? one or two? a randomized clinical trial of single-plate versus double-plate Molteno implantation for glaucomas in aphakia and pseudophakia . Ophthalmology . 1992;99:1512-1519.Crossref 14. Netland PA, Walton DS. Glaucoma drainage implants in pediatric patients . Ophthalmic Surg . 1993;24:723-729. 15. Lloyd MA, Baerveldt G, Heuer DK, Minckler DS, Martone JF. Initial clinical experience with the Baerveldt implant in complicated glaucomas . Ophthalmology . 1994;101:640-650.Crossref 16. Smith SL, Starita RJ, Fellman RL, Lynn JR. Early clinical experience with the Baerveldt 350 mm2 glaucoma implant and associated extraocular muscle imbalance . Ophthalmology . 1993;100:914-918.Crossref 17. Sherwood MB, Smith MF. Prevention of early hypotony with Molteno implants . Ophthalmology . 1993;100:85-90.Crossref 18. Kirkness CM, Ling Y, Rice NSC. The use of silicone drainage tubing to control post-keratoplasty glaucoma . Eye . 1988;2:583-590.Crossref 19. McDonnell, Robin JB, Schanzlin DJ, et al. Molteno implant for control of glaucoma in eyes after penetrating keratoplasty . Ophthalmology . 1988;95:364-369.Crossref 20. Beebe WE, Starita RJ, Fellman RL, Lynn JR, Gelander H. The use of Molteno implant and anterior chamber tube shunt to encircling band for the treatment of glaucoma in keratoplasty patients . Ophthalmology . 1990;97:1414-1422.Crossref 21. Sherwood MB, Smith MF, Driebe WT, Stern GA, Beneke JA, Zam ZS. Drainage tube implants in the treatment of glaucoma following penetrating keratoplasty . Ophthalmic Surg . 1993;24:185-189. 22. Christmann LM, Wilson ME. Motility disturbances after Molteno implants . J Pediatr Ophthalmol Strabismus . 1992;29:44-48. 23. Munoz M, Parrish R. Hypertropia after implantation of a Molteno drainage device . Am J Ophthalmol . 1992;113:98-100. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Comparison of the Baerveldt Glaucoma Implant With the Double-Plate Molteno Drainage Implant

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1995.01100040060027
Publisher site
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Abstract

Abstract Objective: To compare the 350-mm2 Baerveldt implant with the double-plate Molteno implant in the treatment of eyes with complicated glaucoma. Design: Retrospective chart review of a consecutive series of drainage implants. Setting: University-based referral practice. Patients: Thirty-four consecutive patients (37 eyes) undergoing glaucoma drainage device implantation because of uncontrolled, complicated glaucoma. Intervention: Eighteen eyes underwent 350-mm2 Baerveldt implantation and 19 eyes underwent double-plate Molteno implantation. Main Outcome Measures: Intraocular pressure (IOP) control, visual acuity outcome, and complication rate. Results: Mean preoperative IOP was 30.2 mm Hg in the Baerveldt group, with an average of 2.7 antiglaucoma medications, and 28.4 mm Hg in the Molteno group, with an average of 2.4 antiglaucoma medications. With an average follow-up of 11.3 months (range, 5 to 16 months), mean IOP at the final visit was 13.1 mm Hg (range, 7 to 21 mm Hg) in the Baerveldt group, with an average of 1.3 medications, and 13.4 mm Hg (range, 8 to 25 mm Hg) in the Molteno group, with an average of 0.8 medications. Final IOP was between 7 and 19 mm Hg in 16 of 18 Baerveldt eyes and in 17 of 19 Molteno eyes. Visual acuity (when it could be checked) remained stable (±2 Snellen lines) in 17 of 17 eyes in the Baerveldt group and in 17 of 19 eyes in the Molteno group. Complications in the Baerveldt group included two cases (11%) of flat anterior chamber after stent removal, one case (6%) of intermittently symptomatic diplopia, and one case (6%) of endophthalmitis. In the Molteno group there were two graft failures (11%) and one eye (5%) with loss of central field. Conclusions: Both types of drainage implants provide excellent postoperative IOP control. Early stent removal should be avoided if possible in eyes with Baerveldt implants. References 1. Heuer DK, Gressel MG, Parrish RK II, Anderson DR, Hodapp E, Palmberg PF. Trabeculectomy in aphakic eyes . Ophthalmology . 1984;91:1045-1051.Crossref 2. Herschler J, Agness D. A modified filtering operation for neovascular glaucoma . Arch Ophthalmol . 1979;97:2339-2341.Crossref 3. Schwartz AL, Anderson DR. Trabecular surgery . Arch Ophthalmol . 1974;92:134-138.Crossref 4. Insler MS, Cooper HD, Kasti PR, Caldwell DR. Penetrating keratoplasty with trabeculectomy . Am J Ophthalmol . 1985;100:593-595. 5. Shields MB. Glaucomas associated with ocular inflammation . In: Textbook of Glaucoma . 2nd ed. Baltimore, Md: Williams & Wilkins; 1987:298-311. 6. The Fluorouracil Filtering Surgery Study Group. Fluorouracil Filtering Surgery Study one-year follow-up . Am J Ophthalmol . 1989;108:625-635. 7. Ruderman J, Welch D, Smith MF, Shoch D. A randomized study of 5-fluorouracil and filtration surgery . Am J Ophthalmol . 1987;104:218-224. 8. Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy . Ophthalmology . 1991;98:317-321.Crossref 9. Kitazawa Y, Kawase K, Matsushita H, Minobe M. Trabeculectomy with mitomycin: a comparative study with fluorouracil . Arch Ophthalmol . 1991;109:1693-1698.Crossref 10. Molteno ACB, Straughan JL, Ancker E. Long tube implants in the management of glaucoma . S Afr Med J . 1976;50:1062-1066. 11. Lloyd MA, Baerveldt G, Heuer DK, et al. The Baerveldt glaucoma implant: long term histologic studies in rabbits and clinical experience in humans . Invest Ophthalmol Vis Sci . 1991;32:746. Abstract. 12. Smith MF, Sherwood MB, McGorray SP. Comparison of the double-plate Molteno drainage implant with the Schocket procedure . Arch Ophthalmol . 1992;110:1246-1250.Crossref 13. Heuer DK, Lloyd MA, Abrams DA, et al. Which is better? one or two? a randomized clinical trial of single-plate versus double-plate Molteno implantation for glaucomas in aphakia and pseudophakia . Ophthalmology . 1992;99:1512-1519.Crossref 14. Netland PA, Walton DS. Glaucoma drainage implants in pediatric patients . Ophthalmic Surg . 1993;24:723-729. 15. Lloyd MA, Baerveldt G, Heuer DK, Minckler DS, Martone JF. Initial clinical experience with the Baerveldt implant in complicated glaucomas . Ophthalmology . 1994;101:640-650.Crossref 16. Smith SL, Starita RJ, Fellman RL, Lynn JR. Early clinical experience with the Baerveldt 350 mm2 glaucoma implant and associated extraocular muscle imbalance . Ophthalmology . 1993;100:914-918.Crossref 17. Sherwood MB, Smith MF. Prevention of early hypotony with Molteno implants . Ophthalmology . 1993;100:85-90.Crossref 18. Kirkness CM, Ling Y, Rice NSC. The use of silicone drainage tubing to control post-keratoplasty glaucoma . Eye . 1988;2:583-590.Crossref 19. McDonnell, Robin JB, Schanzlin DJ, et al. Molteno implant for control of glaucoma in eyes after penetrating keratoplasty . Ophthalmology . 1988;95:364-369.Crossref 20. Beebe WE, Starita RJ, Fellman RL, Lynn JR, Gelander H. The use of Molteno implant and anterior chamber tube shunt to encircling band for the treatment of glaucoma in keratoplasty patients . Ophthalmology . 1990;97:1414-1422.Crossref 21. Sherwood MB, Smith MF, Driebe WT, Stern GA, Beneke JA, Zam ZS. Drainage tube implants in the treatment of glaucoma following penetrating keratoplasty . Ophthalmic Surg . 1993;24:185-189. 22. Christmann LM, Wilson ME. Motility disturbances after Molteno implants . J Pediatr Ophthalmol Strabismus . 1992;29:44-48. 23. Munoz M, Parrish R. Hypertropia after implantation of a Molteno drainage device . Am J Ophthalmol . 1992;113:98-100.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Apr 1, 1995

References