Outcomes of single-plate molteno implants in refractory glaucoma

ABSTRACT

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