Clinical experience with the Molteno implant in advanced infantile glaucoma

The alternatives in the management of infantile glaucoma refractory to conventional treatment are quite limited and unrewarding. We did a retrospective study of 49 patients (53 eyes) under 12 years of age with advanced, uncontrolled glaucoma who each underwent implantation of a single-plate Molteno implant in one stage. Over the follow-up period ranging from 6 months to 3 years (mean 18 months), 36 of the 53 eyes (68%) had an intraocular pressure less than or equal to 21 mm Hg and were considered a success. Fourteen eyes (26%) required further glaucoma surgery, 2 eyes developed severe chronic hypotony, and 1 eye lost light perception following endophthalmitis. The number of anti-glaucoma medications was decreased from a mean of 2 (+/- 1) to 1 (+/- 1). The probability for success of the Molteno implant in controlling glaucoma increased with the age of the patient. Six eyes (11%) were late failures, most probably due to fibrous encapsulation of the bleb. Complications observed were: prolonged hypotony and flat anterior chamber, retinal detachment, migration of the tube, erosion of the tube through the conjunctiva, and an ingrowth of fibrous tissue in the anterior chamber. We consider the Molteno implant to be a reasonable option in the management of difficult cases of infantile glaucoma.