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.
Glaucoma Consultation Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
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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