Outcomes of Single-Plate Molteno Implants in Refractory Glaucoma

Abstract

<p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 9]><xml> Normal 0 false false false MicrosoftInternetExplorer4 </xml><![endif]--><!--[if gte mso 9]><xml> </xml><![endif]--> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--></p><!--[if gte mso 9]><xml> Normal 0 false false false MicrosoftInternetExplorer4 </xml><![endif]--><!--[if gte mso 9]><xml> </xml><![endif]--> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p>PURPOSE: To evaluate the success rate and complications of single-plate Molteno tube implantation in patients with intractable glaucoma. METHODS: We reviewed the records of patients who had undergone single-plate Molteno tube implantation from 1995 to 2000 with at least 18 months of follow up. RESULTS: Thirty-six eyes of 35 (20 male and 15 female) patients with mean age of 29.7±25.3 (range 3-77) years were enrolled in the study. Preoperative intraocular pressure (IOP) was 34.5±10.4 mmHg with a mean of 2.3±0.8 medications which decreased to 18.0±7.6 mmHg with 1.9±1.2 medications after 32.8±16.1 months of follow up (P < 0.0001). Complete success (IOP: 7-21 mmHg without medications), incomplete success (IOP: 7-21 mmHg with medication) and total success (sum of complete and incomplete success) rates were 19.5%, 55.6%, and 75%, respectively. At final follow up, visual acuity improved 1 line or more in 10 (27.8%), decreased 1 line or more in 8 (22.2%) and remained unchanged in 18 (50%) eyes. Postoperative complications occurred in 20 eyes (55.6%) including encapsulated bleb in 10 eyes (27.8%), tube-iris touch in 4 (11%), flat anterior chamber in 3 (8.4%), tube-cornea touch in 2 (5.6%), and retinal detachment, tube-lens touch, and tube blockage, each in 1 (2.8%). IOP dropped to zero in one eye resulting in visual loss. CONCLUSION: In eyes at high risk for trabeculectomy failure, implantation of the Molteno tube can be considered as a procedure with acceptable success for control of IOP and preservation of vision. Long term follow-up is recommended to ensure timely management of the frequent complications of this procedure.</p>