Modifications of the Molteno implant and implant procedure

I have modified the Molteno implant and standard implantation procedure as follows with the idea of achieving the benefits noted: (1) using a 5-0 nylon suture to temporarily reduce the inner diameter of the Molteno tube in order to prevent flat anterior chamber and high IOP in the immediate postoperative period, as well as to permit early perfusion of the modified Molteno plate, likely resulting in less fibrosis and better filtration; (2) placing a 4-0 steel suture guide inside the silicone tube to ensure accurate positioning, especially crucial in some cases when a pars plana approach is used to introduce the tube; (3) placing 10 holes in the platform of the implant to increase drainage; (4) placing three holes to allow conversion of a one-plate into a two-plate implant, thus reducing the risk of complications and making reoperation easier and safer.