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Maxwell William Dixon, Joel Palko, Arsham Sheybani; Comparing the Baerveldt and Molteno Shunts for Treatment of Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2076. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effectiveness of two different non-valved glaucoma drainage devices (GDDs) in controlling intraocular pressure (IOP) and compare differences in the intraoperative times required to implant each device.
Eligible patients who underwent implantation of a Baerveldt or Molteno GDD in a large tertiary care medical center were identified through retrospective chart review. Data between January 1, 2015 and June 30, 2017 was collected on sixteen sequential patients receiving either device (Baerveldt [n=8] and Molteno [n=8]). Data collection for more than two-hundred other patients is currently underway. Pre-operative and post-operative data was collected to determine differences in IOP, visual acuity, and number of glaucoma medications used. Our primary outcome was failure to control IOP post-operatively. Complete success was defined as 20% reduction from pre-operative IOP and IOP <= 18 mmHg without drops. Qualified success was the same reduction in IOP with the use of drops. Secondary outcomes included total surgical case length, number of drops after GDD placement, average IOP, and visual acuity.
The average surgical case length of the Baerveldt GDD was 13 minutes longer than the Molteno GDD (p = 0.0349). Based on preliminary data, there were no statistically significant differences in primary or secondary outcome measures. The Baerveldt GDD's average reduction in IOP of 11.6 mmHg was greater than the Molteno GDD's 4.8 mmHg, though this was not statistically significant.
On average, both the Baerveldt and Molteno GDDs were similarly successful in lowering IOPs and all sixteen patients were determined to be, at minimum, qualified successes based on reduction in IOP to <= 18 mmHg with or without IOP-lowering drops. Importantly, the Molteno GDD required statistically significantly less time to implant. Further analysis of the remaining patients is currently underway and will help better delineate the differences between these two devices.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Breakdown of surgical case lengths of the Baerveldt and Molteno GDDs.
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