Glaucoma

G L A U CO M A
Glaucoma drainage device and patch grafts
Low-profile pressure ridge for
staged bleb management
New Molteno3 is the result of 40 years
Implantation of a new Molteno3 for long-term Glaucoma treatment
of clinical expertise with the tube and
plate principle pioneered by Professor
Anthony Molteno. The newest, 2012
enhancements, have demonstrated
improved surgical utility.
1
2
Improved contour
Suture holes
repositioned 1.0 mm and edge detail aids
insertion.
more anterior and
adjacent to the tube.
Pressure ridge
is set back 1.2 mm for
improved closure and
capsule formation.
Profile reduced .
55 mm from 1.5 mm
to 0.95 total height.
An absorbable suture is used to ligate the tube.
Temporary drainage is achieved by venting
the tube with “Sherwood” slits. This allows
aqueous to drain under the patch graft and
facilitates the development of a preformed
tissue capsule forming around the implant.
In 5 to 6 weeks the absorbable ligating suture
dissolves or is released manually and the tube
opens. Aqueous releases into the preformed
bleb system.
3
The pressure ridge is designed to confine
aqueous to the primary drainage space.
This space has a volume approximately equal
to 10-15% of aqueous from the anterior chamber. The primary drainage area is intended to
function like a drain with a small surface area.
This enables the short-term benefit of reduced
complications from excessive filtration.
4
Aqueous begins filtering through the virgin
bleb lining in the area above the pressure
ridge until hypertensive resistance is induced
by inflammatory components of the aqueous.
The gradual increase in pressure elevates
the tissue over the ridge and allows the
aqueous to flow into the secondary bleb
system established by the remaining surface
area of the implant.
5
MEET OUR CONSULTANTS
Our surgical consultants are experts on the
latest ophthalmic techniques and related
technologies. They can guide you through
a series of educational resources and O.R.
support. Our consultants are certified
and trained to support you on every level.
The unique low-profile pressure ridge used
together with tube ligation is intended to
assist the process of bleb management. The
pressure ridge is positioned under posterior
Tenon’s capsule. The purpose is to establish
the bleb system in two stages, thus tempering
the effects of the subsequent hypotensive
and hypertensive stages of bleb formation.
For more information regarding
staged bleb management please visit:
www.iopinc.com/train
A fully functioning bleb will be visible over
the entire plate surface. The plate incorporates
two peripheral fenestrations. These fenestrations are intended to secure the implant in
place with fibrous tissue and limit the potential
for the bleb to effect rectus muscle function.
Patching glaucoma stent with
processed Tutoplast patch graft
Tutoplast Sclera used to patch a Molteno3.
1
2
A section of Tutoplast processed
sclera is soaked in antibiotic fluid and
laid over the tube. It is trimmed to an
appropriate size and shape with sharp
Westcott Scissors. The patch should
not extend to the Molteno3 plate
posteriorly or the limbus anteriorly.
• High profile collagen with a
nominal thickness of 1 mm.
•Multidirectional matrix for
superior surgical handling
and suture utility.
5 mm x 8 mm
The interior edge of the graft is beveled
to create a partial-thickness slope.
Trimming the anterior temporal
corner of the patch graft also reduces
the potential visibility of the patch,
improving cosmesis.
• High profile collagen with a
nominal thickness of .5 mm.
3
4
The two anterior corners of the patch
graft are secured with sutures. Don’t
suture the two posterior corners so the
tube remains uncompressed and the
effectiveness of the venting slits
is maintained.
Conjunctiva and tenons are grasped
together with non-toothed Pierce Hoskins
tissue forceps and pulled forward to
the limbus.
•Multidirectional matrix for
superior surgical handling and
suture utility.
1.5 cm x 1.5 cm
•Bioengineered lamellar patch
graft consists of submucosa
membrane that has been
decellurized and processed to
implantable device standards.
•Clear graft option retaining
strength & maximizing
translucency.
1 cm x 1.5 cm
Conjunctiva is closed with a running
9-0 Vicryl suture.
5
To view more techniques regarding
the application of our patch grafts please visit:
www.iopinc.com/train
Contact your local
surgical consultant.
www.iopinc.com/consult
Our tools. Your skills.
CODE
DESCRIPTION
DIMENSIONS
M3-185
Molteno3
185 sq. mm
M3-245
Molteno3
245 sq. mm
CODE
DESCRIPTION
DIMENSIONS
68333
Tutoplast Sclera
0.5 x 0.8 cm
68337
Tutoplast Sclera
0.6 x 1.0 cm
68334
Tutoplast Sclera
1 x 3 cm
CODE
DESCRIPTION
DIMENSIONS
68250
Tutoplast Pericardium
1.5 x 1.5 cm
68260
Tutoplast Pericardium
2 x 3 cm
68252
Tutoplast Pericardium
4 x 5 cm
68257
Tutoplast Pericardium
5 x 5 cm
68254
Tutoplast Pericardium
6 x 12 cm
68255
Tutoplast Pericardium
2 x 5 cm
68256
Tutoplast Pericardium
1.0 x 2.5 cm
CODE
DESCRIPTION
DIMENSIONS
TK-41015
keraSys Patch Graft
1 x 1.5cm
3184-B Airway Avenue
Costa Mesa, CA 92626 USA
Tel 714.549.1185
Fax 714.549.0557
molteno3@iopinc.com
Customer Service
800.535.3545
iopinc.com
Molteno3 is a registered trademark of Molteno Ophthalmic Ltd. and is used with permission. Tutoplast is a registered trademark or RTI Biologics
and is used with permission. IOPatch and keraSys are trademarks of IOP Ophthalmics. © 2012 IOP, Inc. IOP-1076.00