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Long-term Results of Molteno Implant Insertion in Cases of Neovascular Glaucoma
Sean G. Every, FRANZCO;
Anthony C. B. Molteno, FRCS;
Tui H. Bevin, MPH;
Peter Herbison, MSc
Arch Ophthalmol. 2006;124:355-360.
Objective To describe the long-term outcomes of cases of neovascular glaucoma drained by Molteno implants.
Methods A prospective study of 145 eyes (130 patients) followed up for a mean of 3.3 years (range, 0.02 year [5 days] to 18.1 years) in the province of Otago, New Zealand, from 1979 to 2002.
Results Insertion of a Molteno implant controlled the intraocular pressure at 21 mm Hg or less with a probability (95% confidence interval) of 0.72 (0.64-0.80), 0.60 (0.51-0.69), and 0.40 (0.29-0.50) at 1, 2, and 5 years, respectively. Failure to control intraocular pressure at 1, 2, and 5 years was significantly correlated with persistent iris neovascularization (P<.001, P<.001, and P = .01, respectively). Visual acuity at final follow-up in nonenucleated eyes was maintained or improved in 56 eyes (39%) and deteriorated to light perception or better in 25 (17%) or no light perception in 47 (32%). Seventeen eyes (12%) were enucleated.
Conclusions The insertion of Molteno implants for neovascular glaucoma maintained or improved vision in 39% of eyes, whereas 12% were eventually enucleated (all of which initially had visual acuity <20/1200). The outcome depended mainly on progression of the underlying vascular disease.
Author Affiliations: Section of Ophthalmology, Department of Medical and Surgical Sciences (Drs Every and Molteno and Ms Bevin), and Department of Preventive and Social Medicine (Mr Herbison), Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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