Molteno implantation for secondary glaucoma in juvenile rheumatoid arthritis
J. Valimaki, P. J. Airaksinen and A. Tuulonen
Department of Ophthalmology, University of Oulu, Finland.
OBJECTIVE: To evaluate the outcome of Molteno implantation in secondary
glaucoma associated with juvenile rheumatoid arthritis. METHODS: Between
January 1, 1986, and December 1, 1996, 27 eyes of 19 consecutive patients
with secondary glaucoma due to juvenile rheumatoid arthritis received a
Molteno implant. The diagnosis of juvenile rheumatoid arthritis was made
according to the American Rheumatism Association criteria. RESULTS: At the
end of the follow-up (mean, 40 months; range, 6-116 months), the mean
(+/-SD) postoperative intraocular pressure (IOP) (14.4+/-4.3 mm Hg) was
statistically significantly lower than the preoperative IOP (38.3+/-5.6 mm
Hg) (P<.001). The Snellen visual acuity remained within 1 line of the
preoperative level or improved in 23 (85%) of 27 eyes. A successful outcome
(defined as a final IOP of > or =6 mm Hg and < or =22 mm Hg, with
fewer than or an equal number of antiglaucoma medications as
preoperatively) was achieved in 24 (89%) of 27 eyes. Life-table analysis
success rates were 95% after 27 months and 90% after 52 months of
follow-up. Postoperative complications included flat anterior chamber (3
eyes), tube block by iris or vitreous (3 eyes), cataract (3 eyes),
cornea-tube touch (2 eyes), choroidal detachment (1 eye), corneal edema (1
eye), and corneal abrasion (1 eye). CONCLUSION: The Molteno implant is
useful and well tolerated in controlling IOP in patients with glaucoma
secondary to juvenile rheumatoid arthritis.
