Outcome of Molteno implantation surgery in refractory glaucoma and the effect of total and partial tube ligation on the success rate

PURPOSE: To analyze the results of 87 consecutive one-stage Molteno implantations in 87 patients and evaluate the factors influencing the surgical outcome, especially the effect of intraoperative partial and total occlusion of the tube. METHODS: Successful outcome was defined as final intraocular pressure (IOP) between 6 and 22 mmHg with less or equal amount of glaucoma medication than preoperatively without loss of light perception. RESULTS: After a mean (+/-SD) follow-up of 24+/-17 months, the mean IOP was 18.1+/-16.0 mmHg compared to the preoperative mean of 42.4+/-11.1 mmHg (p<.0001). One-, 2- and 4.5-year life-table success rates were 90%, 75% and 50%, respectively. There was no statistically significant difference in the success rate between the eyes with total and partial tube occlusion (p=0.703). Postoperative hyphema, suprachoroidal hemorrhage and the number of systemic medications were the only factors significantly associated with failure. CONCLUSIONS: Molteno implantation is warranted in patients with refractory glaucoma who have undergone numerous previous surgical procedures.