ABSTRACT
We have employed a single-plate Molteno implant in 62 eyes affected by secondary angle closure glaucoma [non-neovascular: n, 23; neovascular: n, 13] and congenital glaucoma [n, 26]. The median number of previously failed antiglaucoma surgical procedures was two non - neovascular secondary glaucomas [range, o-3] and three for congenital glaucomas [range, 1-6]. In 80% of the neovascular glaucoma cases filtration surgery was not attempted before implantation. The one-stage technique of implantation was used in all cases. To decrease early postoperative complications associated with prolonged hypotony, we used a tourniquet suture to occlude temporarily the tube of the implant. Results were analyzed in 46 cases with a minimum follow-up of four months [maximum 22 mo, median 12 mo]. Success was defined as an intraocular pressure of less than 20 mm Hg +/- medication. Mean intraocular pressure was 37 mm Hg [ +/- 10] preoperatively and 17 [ +/- 7] postoperatively. In three patients a revision of the implant was necessary because the tip of the tube was touching the corneal endothelium. One implant had to be exchanged because the tube was severed at the site of the tourniquet suture. Choroidal detachment was diagnosed in 15 cases [24%], requiring suprachoroidal drainage in two cases [13%]. Our study shows that the Molteno implant is a valid alternative for the treatment of complicated cases of glaucoma refractory to filtration surgery. Results on congenital glaucomas have so far been particularly rewarding, but a conservative approach is recommended