title: Which is better? One or two? A randomized clinical trial of single-plate versus double-plate Molteno implantation for glaucomas in aphakia and pseudophakia.
abstract: OBJECTIVE
  Previous studies have suggested that primary double-plate Molteno implantation may be beneficial. Therefore, the authors performed a randomized clinical trial to evaluate the relative effectiveness and safety of single- versus double-plate Molteno implantation.
  
  
  METHODS
  From March 1988 to February 1990, 132 patients who underwent Molteno implantation for medically uncontrollable non-neovascular glaucomas in aphakia or pseudophakia were randomly assigned to receive either single- or double-plate implants.
  
  
  RESULTS
  The 1- and 2-year life-table success rates (success [survival] defined as 6 mmHg < or = final intraocular pressure [IOP] < or = 21 mmHg without additional glaucoma surgery or devastating complication) were 55% and 46% with single-plate implantation and 86% and 71% with double-plate implantation, respectively. The final postoperative visual acuities were within one line of the preoperative visual acuities or had improved in 73% and 80% of patients, respectively. Choroidal hemorrhages and/or effusions, corneal decompensation, flat anterior chambers, and phthisis bulbi were more common in the patients who had undergone double-plate Molteno implantation; however, transient elevations of IOP during the first few postoperative months were more common in the patients who had undergone single-plate Molteno implantation.
  
  
  CONCLUSIONS
  Double-plate Molteno implantation more frequently affords IOP control than single-plate Molteno implantation; however, double plates are associated with greater risks of choroidal hemorrhages and/or effusions, corneal decompensation, flat anterior chambers, and phthisis bulbi.
authors.affiliation: Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles.
authors.forename: D K
authors.initials: DK
authors.lastname: Heuer
authors.forename: M A
authors.initials: MA
authors.lastname: Lloyd
authors.forename: D A
authors.initials: DA
authors.lastname: Abrams
authors.forename: G
authors.initials: G
authors.lastname: Baerveldt
authors.forename: D S
authors.initials: DS
authors.lastname: Minckler
authors.forename: M B
authors.initials: MB
authors.lastname: Lee
authors.forename: J F
authors.initials: JF
authors.lastname: Martone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001035:Aphakia / Q000601:surgery*; D002648:Child; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007910:Lenses, Intraocular; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012826:Silicone Elastomers; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D012826:Silicone Elastomers