Single stage Molteno implant with combination internal occlusion and external ligature

A variety of techniques have been devised to reduce postoperative hypotony following a single-stage Molteno implant procedure. Although they effectively reduce hypotony, these techniques may result in a prolonged increase of intraocular pressure (IOP). I present a technique, consisting of placement of a 5-0 nylon internal occlusion suture combined with an external polyglactin (Vicryl) ligature around the Molteno tube, to prevent both hypotony and elevated IOP after implantation.