J R Fuller1, T H Bevin, A C Molteno. 1. Department of Ophthalmology, University of Otago Medical School, Dunedin, New Zealand.
Abstract
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.
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.