Glaucoma tubes and their blebs. A personal reflection on the south african connection to the development of glaucoma tube shunts and their blebs

The development of newer iterations of the tube shunt will show the link between the original scientist and the scientist involved with the development of a subsequent highly popular implant.
The original Molteno Shunt provided the basis for all the subsequent iterations of glaucoma implants that are used today.
Thus learning about the development of the original implant has led to the development of subsequent iterations of glaucoma implants, and their modifications.
The original glaucoma implant, the “Molteno Implant”, was developed in South Africa, by  Dr Anthony Molteno, during his ophthalmology residency. This implant  provided the solution to the failures related to the original glaucoma surgeries, and has also resulted in newer iterations of subsequent glaucoma implants.
Dr George Baerveldt, another South African Ophthalmologist, following Dr Molteno’s discovery, developed his own larger implant the “Baerveldt Implant”, possibly the most popular glaucoma implant in use currently.
The reasons for bleb failure namely cytokines, was discovered by the presenter, thus another Ex- South African.
The final iteration of the original Molteno implant has been the Ahmed Implant, which is a modified implant with a valve. (Dr Ahmed is not a South African).
Tube shunts, continue to remain  the ultimate surgical treatment for uncontrolled glaucoma, and two of the glaucoma implants used in the surgical  treatment for glaucoma, were developed in South Africa.

Audience Take Away Notes:

• The reasons leading to the development of glaucoma tube shunts, and the scientists involved in their discovery
• The early problems involved with the implants and their solutions
• Newer iterations of implants, to overcome early problems associated with the original implants. The physiological factors related to the efficacy of bleb formation