Molteno implant surgery in refractory glaucoma.
In recent years aqueous drainage implants have become a useful adjuvant in the treatment of refractory glaucomas. The Molteno implant is one of the most widely used devices for providing a permanent channel of aqueous flow from the anterior chamber to a collecting reservoir in the posterior subconjunctival space. Recently, modifications in design and surgical technique of the Molteno implant have enhanced its success rate, with a reduction in complications such as prolonged hypotony, anterior chamber flattening, and tube-corneal touch. These modifications include intracamerally injecting hyaluronic acid, using a needle track to provide an opening into the anterior chamber for the tube, performing the operation in two stages, using a double plate, temporarily ligating the tube, using a donor scleral patch, and giving adjunctive antifibrotic therapy. The rationale for application of the Molteno implant, the indications, techniques, results, and complications are described.
Melamed
S
S
Glaucoma Consultation Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
Fiore
P M
PM
D001082:Aqueous Humor / Q000378:metabolism*; D005355:Fibrosis / Q000209:etiology / Q000628:therapy; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D008722:Methods; D011379:Prognosis; D019736:Prostheses and Implants / Q000009:adverse effects; D011474:Prosthesis Design; D012826:Silicone Elastomers
D012826:Silicone Elastomers