Glaucoma drainage device and patch grafts - IOP Inc

G L A U CO M A
Glaucoma drainage device and patch grafts

New Molteno3 is the result of 40 years
of clinical expertise with the tube and
plate principle pioneered by Professor
Anthony Molteno. The newest, 2012
enhancements, have demonstrated
improved surgical utility.
Low-profile pressure ridge for
staged bleb management
Implantation of a new Molten 3 for long-term Glaucoma treatment
1
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.
Suture holes
repositioned 1.0mm
more anterior and
adjacent to the tube.
Pressure ridge is
set back 1.2mm for
improved closure and
capsule formation.
2
3
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.
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 is intended to
function like a drain with a small surface area.
This enables the short-term benefit of reduced
complications from excessive filtration.
Improved contour
Improved contour
and edge detail aids
insertion.
Profile reduced
.55mm from 1.5mm
to 0.95 total height.
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
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.
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.
For more information regarding
staged bleb management please visit:
www.iopinc.com/train

Patching glaucoma stent with
processed Tutoplast patch graft
Tutoplast Sclera used to patch a Molteno3.
1
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
Wesstcot 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.
2
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.
5mm x 8 mm
3
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.
• High profile collagen with a
nominal thickness of 1 mm.
• Multidirectional matrix for
superior surgical handling and
suture utility.
1 cm x 1 cm
4
Conjunctiva and tenons are grasped
together with non-toothed Pierce Hoskins
tissue forceps and pulled forward to
the limbus.
• 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 1cm 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