Molteno implantation for secondary glaucoma in juvenile rheumatoid arthritis

To evaluate the outcome of Molteno implantation in secondary glaucoma associated with juvenile rheumatoid arthritis.

Between January 1, 1986, and December 1, 1996, 27 eyes of 19 consecutive patients with secondary glaucoma due to juvenile rheumatoid arthritis received a Molteno implant. The diagnosis of juvenile rheumatoid arthritis was made according to the American Rheumatism Association criteria.

At the end of the follow-up (mean, 40 months; range, 6-116 months), the mean (+/-SD) postoperative intraocular pressure (IOP) (14.4+/-4.3 mm Hg) was statistically significantly lower than the preoperative IOP (38.3+/-5.6 mm Hg) (P<.001). The Snellen visual acuity remained within 1 line of the preoperative level or improved in 23 (85%) of 27 eyes. A successful outcome (defined as a final IOP of > or =6 mm Hg and < or =22 mm Hg, with fewer than or an equal number of antiglaucoma medications as preoperatively) was achieved in 24 (89%) of 27 eyes. Life-table analysis success rates were 95% after 27 months and 90% after 52 months of follow-up. Postoperative complications included flat anterior chamber (3 eyes), tube block by iris or vitreous (3 eyes), cataract (3 eyes), cornea-tube touch (2 eyes), choroidal detachment (1 eye), corneal edema (1 eye), and corneal abrasion (1 eye).

The Molteno implant is useful and well tolerated in controlling IOP in patients with glaucoma secondary to juvenile rheumatoid arthritis.