title: Long-term results of primary trabeculectomies and Molteno implants for primary open-angle glaucoma.
abstract: OBJECTIVE
  To describe the long-term outcomes of primary trabeculectomies and primary Molteno implants performed in cases of primary open-angle glaucoma at Dunedin Hospital.
  
  
  METHODS
  Prospective comparative case series of 718 eyes (500 patients) and 260 eyes (195 patients) that had trabeculectomy and Molteno implants, respectively, at Dunedin Hospital as the first drainage operation for primary open-angle glaucoma between 1976 and 2007, and followed up for a mean of 7.7 (range, 0.0-28.0) and 5.0 (range, 0.0-27.4) years, respectively.
  
  
  RESULTS
  The probability of intraocular pressure (IOP) control at 21 mm Hg or less following trabeculectomy at 1, 2, 5, 10, 15, and 20 years was 0.95 (95% confidence interval [CI], 0.94-0.97), 0.93 (95% CI, 0.91-0.96), 0.89 (95% CI, 0.86-0.92), 0.82 (95% CI, 0.78-0.86), 0.74 (95% CI, 0.68-0.80), and 0.68 (95% CI, 0.59-0.77), respectively. There were 96 (13%) failures (using the >21-mm Hg definition of failure) in the trabeculectomy group by the final follow-up. The probability of IOP control at 21 mm Hg or less following Molteno implant insertion at 1, 2, 5, 10, 15, and 20 years was 0.98 (95% CI, 0.97-1.0), 0.97 (95% CI, 0.96-1.0), 0.96 (95% CI, 0.92-0.99), 0.96 (95% CI, 0.92-0.99), 0.91 (95% CI, 0.81-1.00), and 0.91 (95% CI, 0.81-1.00), respectively. In the Molteno implant group, there were 8 (3%) failures (using the >21-mm Hg definition of failure) by the final follow-up.
  
  
  CONCLUSIONS
  Insertion of a Molteno implant provided superior IOP control to trabeculectomy when carried out as a first operation in cases of primary glaucoma.
authors: Department of Medicine, University of Otago Dunedin School of Medicine, New Zealand. acb.molteno@otago.ac.nz
authors: Anthony C B
authors: AC
authors: Molteno
authors: Tui H
authors: TH
authors: Bevin
authors: Peter
authors: P
authors: Herbison
authors: Mohd Aziz
authors: MA
authors: Husni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D018465:Molteno Implants; D011183:Postoperative Complications; D011446:Prospective Studies; D019919:Prosthesis Implantation; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology