Comparison of the Baerveldt glaucoma implant with the double-plate Molteno drainage implant
M. F. Smith, J. W. Doyle and M. B. Sherwood
Department of Ophthalmology, University of Florida College of Medicine, Gainesville, USA.
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.
