Molteno Implantation for Neovascular Glaucoma with a Laser-Releasable Intracameral Ligature to Limit Postoperative Pressure Fluctuations

ABSTRACT

We incorporated a 9-0 nylon ligature on the intracameral portion of the Molteno tube to limit postoperative hypotony in 15 eyes of 14 neovascular glaucoma patients. Postoperative hypotony, less than 5mmHg occured in 2 eyes at 1 week, and none thereafter. Argon laser release of the ligature, performed an average of 29 +/- 24 days after surgery, resulted in intraocular pressure reduction in all cases. After 7.3 +/- 3.3 months, the intraocular pressure was significantly lower(47.3 +/- 11.5 vs 18.7 +/- 7.7mmHg, p=0.0007) on less medications(2.2 +/- 1.0 vs 0.3 +/- 0.6, p=0.0008). Thirteen eyes(87%) achieved an intraocular pressure less than 21mmHg and twelve eyes(80%) maintained or improved their preoperative visual acuity. The releasable internal ligature is effective in limiting hypotony and intraocular pressure contral.