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At least 19 recordsLinked to original sources
PubMed1997

A comparison of postoperative complications from pressure-ridge Molteno implants versus Molteno implants with suture ligation.

BACKGROUND AND OBJECTIVES: The pressure-ridge Molteno implant incorporates a ridge on the proximal episcleral plate to limit aqueous outflow during the immediate postoperative period. This modification is intended to decrease the high incidence of postoperative hypotony and flat anterior chambers following Molteno tube implantation, while avoiding the pressure spikes that can occur with suture ligation of the Molteno tube. This study was devised to compare postoperative intraocular pressure control and complications associated with pressure-ridge Molteno implantation versus a standard Molteno implantation with suture ligation of the tube. PATIENTS AND METHODS: Thirty eyes were prospectively randomized to receive either a pressure-ridge, double-plate Molteno implant or a standard, double-plate Molteno Molteno implant with suture ligation of the tube. RESULTS: Postoperative intraocular pressure was significantly higher at day 1 and week 2 in the suture-ligation implant group, although the final pressure at 12 weeks was not different between the two groups. Six of 15 eyes from the pressure-ridge implant group experienced shallow or flat anterior chambers with hypotony, whereas 5 of 15 eyes from the suture-ligation implant group had significant postoperative pressure spikes. CONCLUSION: Because the ridge effect is unpredictable, further modifications are necessary to prevent postoperative hypotony.

Female↗
PubMedDate not supplied

Motility disturbances after Molteno implants.

Molteno implants are gaining wide acceptance for refractory glaucoma in both children and adults. Such surgery led to vertical strabismus in three patients. Two children developed an inability to elevate the globe after Molteno implants were placed superiorly. One adult, whose Molteno implant was placed inferiorly, could not fully depress the globe postoperatively, and experienced vertical diplopia. This complication of Molteno implants was explored using forced duction testing and surgery. We feel a likely explanation for this is a Faden or posterior fixation suture effect induced by scarring under the rectus muscle. Patients undergoing this surgery should be counseled about possible postoperative diplopia, an especially devastating complication when the implant is placed inferiorly.

Aged↗
PubMed2000

[Shunt tube implantation combining amniotic membrane transplantation and implantation of Molteno implant for glaucoma after penetrating keratoplasty].

PURPOSE: To investigate the therapeutic effect of aqueous humor shunt implants with amniotic membrane transplantation on intractable glaucoma. METHODS: Glaucoma was induced in rabbits by the injection of alpha-chymotrypsin into the posterior chamber of the eyes. The rabbits were divided into four groups. Group A: control group, Group B: single shunt tube group, Group C: shunt tube with amniotic membrane transplantation group, Group D: shunt tube with amniotic supporter and amniotic membrane transplantation group. The intraocular pressure(IOP), histology and filterable ability of the tissue around the tubes were studied. The therapeutic effect of the three methods for the glaucoma was compared. From 1998 to 1999, 42 eyes of 41 patients with uncontrolled glacoma after penetrating keratoplasty were randomly assigned into two groups. One group (12 eyes) underwent implantation of shunt tube combining transplantation of amniotic membrane. The other group underwent implantation of a single plate Molteno implant. Clinical records were reviewed to ascertain postoperative IOP, visual acuities, number of medications. RESULTS: The IOP elevated after the operation and reached at the peak on the third day for all groups and then dropped slowly. The IOP was 33.34 +/- 5.54 mmHg (1 mmHg = 0.133 kPa) for Group A and 27.88 +/- 8.86 mmHg for Group B three months after the operation. There was no statistical difference between the two groups (P = 0.274). The IOP was 22.33 +/- 3.73 mmHg for Group C and there was statistical significant difference between Group C and Group A (P = 0.02) and no difference between Group C and Group B (P = 0.113). The IOP was 15.74 +/- 2.94 mmHg for Group D and there was statistical significant difference between Group D and Group A (P = 0.001) and Group B (P = 0.036). There was no difference between Group D and Group C (P = 0.09). The study of horseradish peroxidase penetrability indicated that there was peroxidase in the tissues around the tube with amniotic membrane transplantation and no peroxidase for simple shunt tube. The fibrous tissue near the tube was denser in simple shunt tube group than that in containing amnion groups. In clinic, the basic data existed no statistical difference between the two groups before surgery. The IOP was 54.42 +/- 9.65 mmHg in shunt tube with amnion group and 43.28 +/- 10.57 mmHg in simple plate Molteno implant group (P = 0.535) before operation. There was significant relativity of the visual acuity before and after the operation in two groups (r = 0.916, P = 0.002 and r = 0.962, P = 0.000). Most patients of the two groups had to use one or two anti glaucoma drugs. The overall success rates were 58.3% for shunt tube with amnion group and 66.7% for Molteno implant group (P = 0.73) within the follow-up period. Kaplan-Meier success analysis indicated one year cumulative success rates of 52.25% for shunt tube with amnion group and of 65.3% for Molteno implant group (P = 0.42). CONCLUSION: Amniotic membrane can inhibit proliferation of the scar around the shunt tube. Shunt tube implantation conbining amniotic membrane transplantation can significantly lowered the IOP of glaucoma. Combined using amnion supporter can expend shunt area and significantly reduce IOP of glaucoma. The effect of shunt tube implantation combining amniotic membrane transplantation has the similar result of single plate Molteno implant for the glaucoma after penetrating keratoplasty.

Adult↗
PubMed1991

Paralimbal compression suture for Molteno implants.

When a Molteno implant is being inserted, the silicone tube occasionally can be misdirected anteriorly, bringing the end of the tube dangerously close to the corneal endothelium. A paralimbal compression suture of 8-0 nylon may redirect the tube more posteriorly, preventing such contact.

Anterior Chamber↗
PubMed1988

Molteno implant for control of glaucoma in eyes after penetrating keratoplasty.

Seventeen patients (17 eyes) underwent implantation of a single plate Molteno implant for medically uncontrollable intraocular pressures after penetrating keratoplasty. Most of the eyes had extensive peripheral anterior synechiae, and 16 of 17 (94%) were pseudophakic or aphakic following keratoplasty. Other glaucoma procedures had been performed previously on 13 eyes: argon laser trabeculoplasty (one eye), trabeculectomy (seven eyes), transpupillary argon laser cyclophotocoagulation (three eyes), and cyclocryotherapy (three eyes). Follow-up ranged from 5 to 28 months (mean, 13 months). Three eyes underwent repeat Molteno implantation when intraocular pressure (IOP) was not satisfactorily reduced after the first procedure. Considering one eye with chronic hypotony as a failure, 12 of 17 eyes (71%) had IOPs of less than 21 mmHg at the time of the three most recent postoperative examinations after a single Molteno implant. Repeat implants in three eyes increased the number of eyes with IOPs of less than 21 mmHg to 14 (82%). Corneal allograft rejection after Molteno implantation occurred in seven eyes; two of these were successfully reversed with corticosteroid therapy. Three of the five eyes with irreversible graft rejection were regrafted, and two of these grafts have remained clear. Including the regrafted eyes, 13 eyes had clear grafts and controlled IOPs at the most recent postoperative examination. The Molteno implant may prove useful in the management of medically uncontrollable glaucoma following penetrating keratoplasty; however, there appears to be a substantial risk of postoperative graft rejection.

Adult↗
PubMed1996

[The Molteno implant].

The authors describe their experience with Molteno implants in 21 patients. The most frequent types of glaucoma were congenital glaucoma--5 times--and glaucoma associated with pseudophakia--5 times. Before the implant as many as four operations of one eye were performed, in the whole group with Molteno implants 28 operations had preceded, mostly trabeculectomies and cyclocryocoagulations. As to postoperative complications, expulsive haemorrhage on the first night after operation was most serious. The follow-up period is 1-15 months, on average 7.7 months. The intraocular pressure before operation was on average 35.8 mm Hg, on discharge 9.7 mm Hg and during the last check-up examination (19 eyes) 19.1 mm Hg. It was under 21 mm Hg in 10 eyes, i.e. 52.6%, during the last check-up examination. Re-operations were made five times (26.3%). As compared with values before surgery, vision deteriorated in three eyes, incl. two because of complications of diabetes. The Molteno implant is an effective procedure in the treatment of complicated and refractory cases of glaucoma in high-risk eyes.

Adult↗
PubMed2002

Comparison of the Ahmed Glaucoma Valve, the Krupin Eye Valve with Disk, and the double-plate Molteno implant.

OBJECTIVE: To compare the efficacy of the nonvalved double-plate Molteno implant with two valved implants, the Krupin Eye Valve with Disc and the Ahmed Glaucoma Valve, in the treatment of recalcitrant glaucoma. PATIENTS AND METHODS: The authors performed a nonrandomized retrospective review of patients who received the Molteno implant (n = 27), Krupin Eye Valve with Disc (n = 13), or Ahmed Glaucoma Valve (n = 13), with adjunctive mitomycin C. RESULTS: Kaplan-Meier life-table analysis showed that the Molteno implant patients were more likely to maintain an intraocular pressure between 5 and 15 mm Hg than Ahmed Glaucoma Valve patients (P = 0.03). Success rates at 1 year were 80% (95% CI, 66-97%) for the Molteno implant, 39% (19-77%) for the Krupin Eye Valve with Disc, and 35% (15-82%) for the Ahmed Glaucoma Valve. However, Ahmed Glaucoma Valve patients were less likely to experience complications requiring reoperation or loss of two or more lines of visual acuity (P < 0.01) than Molteno implant or Krupin Eye Valve with Disc patients. CONCLUSIONS: This nonrandomized study suggests that the Molteno implant with mitomycin C is more likely to result in intraocular pressures in the lower teens than the Ahmed Glaucoma Valve with mitomycin C. The findings suggest that the Ahmed implant is less likely to create problems leading to reoperations or visual acuity loss than the Molteno or Krupin implants.

Adult↗
PubMed2003

Otago Glaucoma Surgery Outcome Study: factors controlling capsule fibrosis around Molteno implants with histopathological correlation.

OBJECTIVE: To describe the histopathology of Molteno implant capsules in cases of primary and secondary glaucoma and to correlate them with surgical technique and clinical outcomes in quiet eyes. DESIGN: Human tissue study with clinicopathological correlation. MATERIALS: Seventy-five autopsy eyes or surgical pathology specimens obtained between 4 days and 23 years after insertion of Molteno implants were studied. Basic histologic features common to all bleb capsules were described, and the thickness was measured in 28 specimens from quiet eyes. MAIN OUTCOME MEASURES: Histologic features of capsules, including wall thickness, distribution of inflammatory cells, and presence or absence of fibrodegeneration, were assessed by light microscopy. RESULTS: Without aqueous flow (first stage of 2-stage insertion), the episcleral plates of Molteno implants were encapsulated by a very thin (20-60 micro m) avascular collagenous layer. The second stage of 2-stage insertion, with delayed drainage of aqueous and early temporary postoperative intraocular pressure (IOP) increase to 25 to 35 mmHg, produced thin (190-250 micro m) permeable capsules with fewer fibrovascular than fibrodegenerative components. Insertion of nonligatured implants with immediate aqueous flow produced thicker capsules (300-600 micro m) composed of an outer fibrovascular layer and an inner fibrodegenerative layer of approximately equal thickness. Three-stage insertion of modified Molteno implants with temporary externalization of aqueous flow onto the conjunctival surface and postoperative IOP not exceeding 12 mmHg produced the thickest (375-700 micro m) heavily fibrosed and impermeable capsules composed entirely of dense fibrovascular tissue without a fibrodegenerative layer. CONCLUSIONS: Capsules around functioning Molteno implants evolved through a series of histologic stages. Without aqueous flow, the episcleral plate of the implant stimulated encapsulation by a thin avascular collagenous layer. With aqueous flow, an immediate inflammatory reaction developed in the episcleral connective tissues that included collagenous and vascular components. After a variable delay, a fibrodegenerative process developed in the deeper layers of the capsule. The fibrodegenerative process may depend on sufficient increases of IOP for aqueous to displace interstitial tissue fluid from the deeper layers of the capsule. The final thickness and permeability of the capsule probably depend on the relative intensity and timing of these opposing processes, which were influenced by surgical technique and postoperative management.

Adult↗
PubMed2001

Long-term follow-up of traumatic glaucoma treated with Molteno implants.

PURPOSE: To determine the long-term outcomes of patients with traumatic glaucoma treated with Molteno implants at Dunedin Hospital, New Zealand. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-eight patients with traumatic glaucoma and with a mean follow-up of 10.9 years. INTERVENTION: Insertion of Molteno implant. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) and intraocular pressure-related surgical interventions after Molteno implant insertion. RESULTS: Insertion of a Molteno implant controlled the IOP at 21 mmHg or less (with or without hypotensive medication) with a probability of 0.80 (95% confidence interval [CI], 0.66, 0.93) at 5 years and 0.72 (95% CI, 0.56, 0.88) at 10 years. At final follow-up, intraocular pressure was controlled solely with the implant in 26 cases and controlled with the addition of hypotensive medication in three cases, whereas nine eyes were failures. Eleven patients (29%) underwent intervention for implant repositioning or tube orifice blockage. Thirty-four double- and six single-plate Molteno implants were inserted. Two patients had implants replaced. Seventy-nine percent became aphakic or pseudophakic from their trauma before or at the time of Molteno implant insertion. There were no exclusions resulting from extensive ocular damage. CONCLUSIONS: Insertion of Molteno implants in traumatic glaucoma produced intraocular pressure control at long-term follow-up in 76% of cases.

Adolescent↗
PubMed1992

Which is better? One or two? A randomized clinical trial of single-plate versus double-plate Molteno implantation for glaucomas in aphakia and pseudophakia.

PURPOSE: 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.

Adolescent↗
PubMed1995

Molteno implant surgery for advanced glaucoma.

PURPOSE: The use of adjunctive antimitotics with conventional filtering surgery appears to have decreased the need for Molteno implants in glaucomas with a poor prognosis. We review the current status, results and complications of Molteno implants. METHODS: Review of the literature and practical experience from two university departments of ophthalmology. RESULTS: Improvements in the design and surgical techniques for Molteno implants have decreased the incidence of over filtration, but this and other complications continue to pose problems. Increased success rates may be possible if antimitotics are used with Molteno implants. CONCLUSION: Molteno implants continue to be an option when conventional filtration with or without antimitotics has failed; they continue to be regarded as a last resort for filtration. The use of antimitotics to increase the success rate of Molteno implants is not proven, but merits further investigation.

Conjunctiva↗
PubMed1991

Postoperative complications after Molteno implant surgery.

We performed Molteno implant surgery in one eye each of 41 patients with uncontrolled glaucoma. Intraocular pressure was controlled (intraocular pressure less than or equal to 18 mm Hg) in 32 eyes (78%). The mean preoperative intraocular pressure was 40 +/- 13.2 mm Hg, whereas the mean postoperative intraocular pressure was 16 +/- 6.6 mm Hg. Patients were followed up for an average of 16 months after the operation. Visual acuity was unchanged in 23 eyes (56%), improved in nine eyes (22%), and poorer in nine eyes (22%). The major complications included shallow anterior chamber and hypotony in six eyes (14.6%), vitreous hemorrhage in two eyes (4.9%), retinal detachment in one eye (2.4%), and malignant glaucoma in two eyes (4.9%). Less grave complications included hyphema in four eyes (9.8%), peripheral choroidal effusion in 15 eyes (36.6%), obstruction of the tube in six eyes (14.6%), recession of the tube into the angle in two eyes (4.9%), erosion of the tube in one eye (2.4%), and Tenon's cyst formation in three eyes (7.3%).

Adolescent↗
PubMed1990

[Histologic comparison of a functioning and non-functioning filtration membrane with the Molteno implant].

In two patients with a Molteno implant, the filtration membrane was excised 2 and 21 months postoperatively because of uncontrolled elevation of intraocular pressure. This tissue was examined by light and electron microscopy and the findings compared with those of a third functioning Molteno filtration membrane obtained from an enucleation specimen. The most conspicuous differences were the high density and cellularity of the connective tissue of the non-functioning membranes and the frequent cell pyknosis and necrosis in the functioning membrane. In addition, one of the non-functioning membranes showed a condensed cellular layer on the inner surface. There were no inflammatory cell infiltrates in any of the three specimens. We conclude that the variable results of Molteno implants are related to the quantities of tissue components of the filtration membrane.

Adult↗
PubMed2005

Otago Glaucoma Surgery Outcome Study: follow-up of young patients who underwent Molteno implant surgery.

OBJECTIVE: To provide data on the results of patients with nonneovascular juvenile glaucoma who had Molteno implant surgery in the province of Otago, New Zealand. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Fifty-five operations in 52 eyes of 45 patients with nonneovascular juvenile glaucoma who had Molteno implant surgery between the ages of 9 and 49 years from 1976 to 2003 at Dunedin Hospital and were observed for a mean of 12.2 years (range, 0.1-25). INTERVENTION: Insertion of a Molteno implant. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) and visual acuity (VA). RESULTS: Insertion of a Molteno implant controlled IOP at < or =21 mmHg with probabilities of 0.89 (95% confidence interval [CI], 0.81-0.97) at both 1 and 2 years and 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.66-0.90), and 0.71 (95% CI, 0.58-0.85) at 5, 10, and 15 years, respectively. Mean VA was 20/100 preoperatively; improved to 20/60 at 1 year; and stabilized at 20/120 at 5, 10, and 15 years postoperatively. Twenty-nine eyes had their preoperative VA maintained or improved at final follow-up, and the VAs of 17 eyes deteriorated but were at least light perception at final follow-up. CONCLUSION: The use of Molteno implants in cases of nonneovascular juvenile glaucoma controlled IOP with a probability of 0.71 15 years postoperatively, whereas 53% maintained or improved their vision from their preoperative VA at final follow-up.

Adolescent↗
PubMed2001

Otago glaucoma surgery outcome study : long-term results of uveitis with secondary glaucoma drained by Molteno implants.

OBJECTIVE: This study was undertaken in Otago, New Zealand, to provide data on the long-term results of cases of uveitis with secondary glaucoma drained by Molteno implants. DESIGN: A prospective, noncomparative case series of all cases of chronic uveitis with secondary glaucoma drained by Molteno implants from 1978 through 1998. PARTICIPANTS: Forty eyes of 35 patients. INTERVENTION: Insertion of Molteno implant. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, and progressive visual field loss. RESULTS: Insertion of a Molteno implant was effective in controlling the intraocular pressure at 21 mmHg or less with a probability of 0.87 (95% confidence interval [CI], 0.76, 0.98) and 0.77 (95% CI, 0.60, 0.93) at 5 and 10 or more years after surgery. The mean visual acuity improved from 20/100 to 20/70 immediately after operation. This value declined to 20/130 at 5 and 10 years after surgery and then improved slightly to 20/120 at 15 years after surgery. In these eyes, the Kaplan-Meier estimated probability of retaining useful vision (visual acuity >20/400; visual field >5 degrees radius) was 0.75 (95% CI, 0.61, 0.89) and 0.71 (95% CI, 0.55, 0.87) at 5 and 7 or more years after surgery. CONCLUSIONS: The insertion of a Molteno implant controlled the intraocular pressure in 76% of cases over the follow-up period. Patients in whom the uveitis was well controlled maintained their visual acuity and visual fields, whereas the proportion of cases requiring steroids and the doses required fell progressively over the period of follow-up. Failures were related to complications of advanced disease, previous intraocular surgery, and failure to control the uveitis. The drainage system provided by the Molteno implant proved robust, continuing to function well despite continuous activity of the uveitis, acute exacerbations of the uveitis, and all subsequent intraocular surgery including cataract extraction, keratoplasty, and vitrectomy.

Adolescent↗
PubMedDate not supplied

Clinical experience with the Molteno implant in advanced infantile glaucoma.

The alternatives in the management of infantile glaucoma refractory to conventional treatment are quite limited and unrewarding. We did a retrospective study of 49 patients (53 eyes) under 12 years of age with advanced, uncontrolled glaucoma who each underwent implantation of a single-plate Molteno implant in one stage. Over the follow-up period ranging from 6 months to 3 years (mean 18 months), 36 of the 53 eyes (68%) had an intraocular pressure less than or equal to 21 mm Hg and were considered a success. Fourteen eyes (26%) required further glaucoma surgery, 2 eyes developed severe chronic hypotony, and 1 eye lost light perception following endophthalmitis. The number of anti-glaucoma medications was decreased from a mean of 2 (+/- 1) to 1 (+/- 1). The probability for success of the Molteno implant in controlling glaucoma increased with the age of the patient. Six eyes (11%) were late failures, most probably due to fibrous encapsulation of the bleb. Complications observed were: prolonged hypotony and flat anterior chamber, retinal detachment, migration of the tube, erosion of the tube through the conjunctiva, and an ingrowth of fibrous tissue in the anterior chamber. We consider the Molteno implant to be a reasonable option in the management of difficult cases of infantile glaucoma.

Child↗
PubMedDate not supplied

Long-term results of Molteno implants.

We retrospectively reviewed 76 Molteno implants in 72 eyes, with a minimum of 18 months' follow up. Double-plate implants were used initially in 64 of these eyes. After a mean follow up of 33.27 months, the mean intraocular pressure (IOP) was 14.0 mm Hg, as compared with 35.31 mm Hg preoperatively. With success defined as an IOP greater than 5 mm Hg but no greater than 21 mm Hg at the last visit, the success rate was 74%. If the four cases of chronic hypotony without loss of best-corrected vision are included, the success rate was 79%. The most frequent complications included corneal graft failure, filtration tube blockage, choroidal effusion, and hyphema/vitreous hemorrhage.

Adolescent↗
PubMed1993

Various indications for artificial aqueous drainage systems (Molteno implant).

In reoperations the draining effect of a Molteno Implant can be enhanced by a "sandwich" arrangement or a "bleb to bleb" anastomosis. Molteno implants can also be inserted via a pars plana trepanation and can control juvenile glaucoma. They are also compatible with anterior chamber lenses and corneal transplants.

Anterior Chamber↗