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Molteno implant surgery in refractory glaucoma.

S Melamed¹, P M Fiore

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.

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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.

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