Use of the Single-Plate Molteno Implant in Refractory Glaucoma

During a 5-year period, 60 patients with uncontrolled glaucoma in one eye, who were considered to have a poor surgical prognosis with conventional drainage surgery, were treated with a single-plate Molteno implant. The surgery was performed in one operation and the tube tied with an absorbable suture in all cases. The overall follow-up was 20.3 +/- 11 months (range 3-60). A successful outcome (defined as an intra-ocular pressure < or = 21 mm Hg with or without treatment) was achieved in 56% of the 16 eyes with either aphakic or pseudophakic glaucoma, in 71% of the 14 eyes with uncontrolled glaucoma despite a previous filtering procedure, in 46% of the 13 eyes with traumatic glaucoma and in 64% of the 17 eyes with traumatic glaucoma and lens involvement. The visual acuity remained the same or better in 70% (42/60). Early complications of the surgery were transient and easily treated. Late complications included tube exposure in 3 (5%), tube retraction in 2 (3.3%), bleb encapsulation in 5 (8.3%) and corneal decompensation in 1 (1.65%). This study suggests that the single-plate Molteno implant is a useful drainage device with satisfactory results when used for the treatment of refractory secondary glaucoma.