[Success rate and complications of single-plate Molteno tube implantation in patients with glaucoma]

To evaluate the success rate and complications of single-plate Molteno tube implantation in patients with intractable glaucoma. This study was conducted on records of patients who underwent Molteno tube implantation from 1995 to 2000 and had at least 18 months of follow-up. Thirty six eyes of 35 patients including 20 male and 15 female subjects with mean age of 29.7 +/- 25.3 yr [range 3-77 yr] were enrolled in the study. Intraocular pressure [IOP] was 34.48 +/- 10.39 mmHg with use of 2.3 +/- 0.8 drugs which decreased to 17.97 +/- 7.63 mmHg with 1.9 +/- 1.2 drugs after 32.8 +/- 16.14 month of follow-up. [P<0.0001] Complete success [IOP /= 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 [27.8%], tube-iris touch in 4 [11%], flat anterior chamber in 3 [8.4%], tube-corneal touch in 2 [5.6%], and retinal detachment, tube-lens touch, and tube blockage each in 1 [2.8%]. Intraocular pressure dropped to zero in one eye and vision was lost. In eyes at high risk for trabeculectomy failure, implantation of the Molteno tube can be considered as a procedure with high success for controlling intraocular pressure and preservation of vision. Long term follow up is recommended to ensure adequate management of the frequent complications of this procedure

Preclinical trial of serafilm in preventing subconjunctival fibrosis

Objective: To assess the safety and incidence of subconjunctival fibrosis in rabbits eyes with and without intraoperative application of Seprafilm Bioresorbable Membrane (Genzyme Corp., Cambridge, MA) Methodology: A fornix based conjunctival peritomy was made on 20 eyes of10 rabbits. Ten eyes were randomly assigned to receive Seprafilm on the subconjunctival area while the opposite eye had no intraoperative application of the membrane. Two orbits (one rabbit) were exenterated each week for ten weeks and gross and histologic evaluation for signs of morbidity and scarring were performed Results: Seprafilm did not show any adverse effect on the rabbits eyes. All eyes with Seprafilm (100 percent) were a vascular while 5 eyes (50 percent) without Seprafilm showed the presence of conjunctival vascularity. Conjunctival mobility was normal in eyes with Seprafilm (100 percent) while the conjunctiva was immobile in 6 eyes (60 percent) without Seprafilm. Histologic sections on eyes without Seprafilm showed presence of fibrosis and inflammatory infiltrates in 7 eyes (70 percent) while only 2 (20 percent) and 3 eyes (30 percent) with Seprafilm showed the presence of fibrosis and inflammatory infiltrates, respectively. Failed "blebs" were evident in 6 eyes (60 percent) while only 4 eyes (40 percent) without Seprafilm were considered as functioning "blebs". All eyes with Seprafilm (100 percent) were considered as functioning "blebs" (p.005) and is statistically significant Conclusion: Pre-clinical evaluation has shown that Seprafilm is safe and effective in preventing postoperative subconjunctival fibrosis.

Implante de molteno e transplante penetrante de córnea / Molteno implant and penetrating keratoplasty

Objetivo: Relatar experiência clínico-cirúrgica inicial da associaçäo de cirurgia de transplante de córnea e implante de dispositivo de drenagem artificial de humor aquoso (Moleto) no tratamento do glaucoma refratário associado a doença da córnea. Métodos: Quinze olhos de 15 pacientes com glaucoma näo-controlado por medicaçäo máxima e/ou tratamento cirúrgico prévio associado a opacidade corneana foram submetidos à cirurgia combinada de TPC e implante de Moleto. Avaliamos acuidade visual melhor corrigida (AV), tonometria e biomicrospia, correlacionanso-as à efetividade do tratamento quanto à reduçäo da pressäo intra-ocular (PIO) e quanto à transparência do botäo doador durante o periódo de obeservaçäo. Resultados: Houve efetiva diminuiçäo da PIO em 14 (93,3 por cento) dos olhos tratados. AV melhorou em 12 casos (80 por cento), foi mantida em 2 (13,3 por cento) e piorou em 1 (6,6 por cento)...

Single-plate Molteno implants in complicated glaucomas: results, survival rates, and complications.

Sixty-two single-plate single-stage Molteno implantations for complicated glaucomas were performed between March 1991 and November 1992. The charts of all these patients were reviewed to determine the intraocular pressure (IOP) control success rate (< 21 mm Hg with or without medications), visual success rate (retention or improvement of visual acuity from preoperative level) and the rate of complications encountered. A Kaplan-Meier life-table (survival) analysis was also performed. IOP control was obtained in 74.2% of cases. Mean postoperative IOP was 16.97 +/- 8.07 mm Hg (Mean +/- SD). Visual success was obtained in 51.6% of the eyes. Eyes with aphakia/pseudophakic glaucomas showed the best response with 80% of them achieving IOP control and 60% achieving visual success. The survival plot for IOP control revealed 75.81% and 74.19% success rates at 48 and 72 weeks, respectively. Complications encountered were either due to the early postoperative hypotony or were tube-related. These results were gratifying considering the severity of the glaucoma in these cases and they reaffirm the usefulness of the Molteno implant in the management of difficult glaucomas.