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    Glaucoma

    Review of: Comparative Outcomes of the Molteno3 and Baerveldt Glaucoma Implants

    Dixon M, Moulin T, Margolis M, et al. Ophthalmology Glaucoma, January–February 2020

    Investigators compared outcomes between 2 nonvalved glaucoma drainage devices (GDDs): Molteno 3 and the Baerveldt.

    Study design

    This retrospective, nonrandomized, multicenter comparative study comprised 117 eyes that underwent implantation of Baerveldt or Molteno3 glaucoma implant. The primary outcome was time until device failure, defined as IOP of 21 mm Hg or more or a reduction of less than 20%, hypotony, reoperation for glaucoma or loss of light perception. Secondary outcomes were intraoperative time, postoperative IOP, number of IOP-lowering medications and visual acuity.

    Outcomes

    The Molteno was noninferior to the Baerveldt in lowering IOP. The authors did not observe any meaningful differences in time until device failure, VA outcomes and medication use. The Molteno was linked to more secondary operative interventions but also required a shorter implantation time than the Baerveldt 350 mm2 implant.

    Limitations

    Limitations of this study include inter-surgeon variability, differences in surgical technique, variable follow-up, small sample size, and the biases inherent to a retrospective study

    Clinical significance

    There are few studies comparing only nonvalved GDDs. This study is unique because it uses noninferiority testing, a much more robust paradigm for testing similarity between devices as opposed to nonsignificant P value from standard/superiority testing where nonsignificance may emerge from low statistical power due to small sample size and/or high variance versus a true lack of difference. Overall, the use of either nonvalved glaucoma drainage device is justifiable to lower IOP when more conservative management has failed.