Postoperative complications and visual loss following Molteno implantation

A retrospective review of 16 initial, consecutive cases of Molteno implantation with at least 6 months of follow up showed that all eyes developed either or both early-onset (12 eyes) or late-onset (7 eyes) complications. The early-onset complications, which included choroidal effusions and flat anterior chambers, tended to resolve without difficulty. By contrast, the late-onset complications, which included 4 implant extrusions, 2 vitreous hemorrhages, 1 persistent hyphema, 1 cystoid macular edema, 1 opacified vitreous face, and 1 tractional detachment with fibrous ingrowth, tended to herald poor visual prognoses. Implant removal was required in three cases. Overall, vision improved in 3 eyes (18.8%), remained unchanged in 3 (18.8%), and deteriorated two or more lines in 10 (62.4%). In 3 eyes vision deteriorated to no light perception; 2 of them became phthisical. These complications often occurred despite successful control of intraocular pressure (less than 23 mm Hg). The relatively high complication rates in this series as compared with previously reported ones probably reflects a combination of factors not necessarily related to the Molteno surgery; primarily, the patients in this small series may have had more severe disease and more prior surgeries than those in other such series.