Early-onset pseudoexfoliation syndrome following multiple intraocular procedures

To present early-onset ocular manifestations of pseudoexfoliation syndrome in young patients who had undergone multiple intraocular procedures. This is an observational case series, introducing four cases with histories of multiple intraocular procedures for glaucoma. All reported cases demonstrated typical manifestations of pseudoexfoliation unilaterally in the eye that had undergone multiple surgeries. The diagnosis of pseudoexfoliation was made prior to the age of 50 in all subjects and the earliest manifestation was at the age of 18 in a case with primary congenital glaucoma. The role of multiple surgical procedures, in addition to genetic predisposition, should be further investigated as a possible inciting factor predisposing to pseudoexfoliation in younger individuals.

Outcomes of single-plate molteno implants in refractory glaucoma

To evaluate the success rate and complications of single-plate Molteno tube implantation in patients with intractable glaucoma. 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. 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 [LOP] 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 +/- 161 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 in 10 [27.8%], decreased >/= 1 line 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. 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