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Molteno implant surgery in refractory glaucoma.
1Glaucoma Consultation Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
Survey of Ophthalmology
|May 1, 1990
Summary
Modified Molteno implants improve outcomes for refractory glaucomas. Surgical techniques and device enhancements reduce complications like hypotony and tube-corneal touch, enhancing aqueous humor drainage.
Area of Science:
- Ophthalmology
- Surgical Devices
Background:
- Refractory glaucomas require advanced treatment options.
- Aqueous drainage implants are crucial for managing complex glaucoma cases.
- The Molteno implant is a widely used device for aqueous humor diversion.
Purpose of the Study:
- To describe the rationale, indications, and techniques for Molteno implant use.
- To detail recent modifications enhancing the Molteno implant's success rate.
- To review the results and complications associated with the modified Molteno implant.
Main Methods:
- Surgical modifications include hyaluronic acid injection, needle track insertion, two-stage procedures, double plates, temporary tube ligation, scleral patches, and antifibrotic therapy.
- The Molteno implant creates a permanent channel for aqueous flow.
- Techniques focus on optimizing aqueous humor drainage and minimizing complications.
Main Results:
- Modifications have enhanced the success rate of the Molteno implant.
- Complications such as prolonged hypotony, anterior chamber flattening, and tube-corneal touch are reduced.
- Improved aqueous humor drainage is achieved with enhanced surgical techniques.
Conclusions:
- Modified Molteno implants offer improved efficacy in treating refractory glaucomas.
- Surgical technique refinements and device modifications are key to better patient outcomes.
- The Molteno implant remains a valuable tool for managing complex glaucoma.