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Molteno Implants as a Treatment for Refractory Glaucoma in Black Patients

Molteno Implants as a Treatment for Refractory Glaucoma in Black Patients Abstract • Eighty-two black patients with refractory glaucoma were treated with a single-plate Molteno implant inserted in a single-stage procedure. A successful outcome (intraocular pressure 21 mm Hg with or without adjunctive medical therapy) was achieved in 72% of the patients with a mean follow-up of 30 months. Success was achieved in 23 (73%) of the 31 patients with open angle glaucoma, 20 (83%) of the 24 patients with either aphakic or pseudophakic glaucoma, 12 (67%) of the 18 patients with neovascular glaucoma, four (80%) of the five patients with uveitic glaucoma, and two (50%) of the four patients with congenital glaucoma. All but four patients required additional medical therapy. Visual acuities remained the same or improved in 21 (68%) of the 31 patients with open angle glaucoma, 11 (61%) of the 18 with neovascular glaucoma, 19 (79%) of the 24 patients with aphakic/pseudophakic glaucoma, three (75%) of the four patients with congenital glaucoma, and four (80%) of the five patients with uveitic glaucoma. Complications included hyphema (18%), "kissing" choroidal effusion (6%), blocked tube (8%), flat anterior chamber (12%), cataracts (5%), Tenon's cyst (encapsulated bleb) (17%), uveitis (7%), phthisis bulbi (5%), and erosion of the silicone tube (1%). References 1. Molteno ACB, Straughen L, Anker E. Long tube implants in the management of glaucoma . S Afr Med J . 1976;50:1062-1066. 2. Molteno ACB. Use of Molteno implants to treat secondary glaucoma . In: Cairns JE, ed. Glaucoma . New York, NY: Grune & Stratton; 1986;1:211-238. 3. Freedman J. Scleral patch grafts with Molteno setons . Ophthalmic Surg . 1987;18:532-534. 4. Minckler DS, Heuer DK, Hasty B, Baerveldt G, Cutting RC, Barlow WE. Clinical experience with the single plate Molteno in complicated glaucomas . Ophthalmology . 1988;95:1181-1188.Crossref 5. Freedman J, Shen E, Ahrens M. Trabeculectomy in Black American glaucoma population . Br J Ophthalmol . 1976;60:573-574.Crossref 6. Ferguson JG, MacDonald R, Jr. Trabeculectomy in blacks: a two-year follow up . Ophthalmic Surg . 1977;8:41-43. 7. Merrit JC. Filtering procedure in American blacks . Ophthalmic Surg . 1980;11:91-94. 8. Freedman J, Kopelowitz W. Long term results of trabeculectomy in a black population . Glaucoma . 1982;4:123-124. 9. Shingleton BJ, Distler JA, Baker BH. Filtration surgery in black patients: early results in a West Indian population . Ophthalmic Surg . 1987;18:195-199. 10. Melamed S, Cahane M, Gutman I, Blumenthal M. Postoperative complications after Molteno implant surgery . Am J Ophthalmol . 1991;11:319-322. 11. Traverso CE, Tomey KF, al-Kaff A. The long-tube single plate Molteno implant for the treatment of recalcitrant glaucoma . Int Ophthalmol . 1989;1:159-162.Crossref 12. Krupin T, Ritch R, Camras CB, et al. A long Krupin-Denver valve implant attached to a 180 scleral explant for glaucoma surgery . Ophthalmology . 1988;95:1174-1180.Crossref 13. Schocket SS, Lakhanpal V, Richards RD. Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma . Ophthalmology . 1982;89:1188-1194.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Molteno Implants as a Treatment for Refractory Glaucoma in Black Patients

Archives of Ophthalmology , Volume 109 (10) – Oct 1, 1991

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1991.01080100097051
Publisher site
See Article on Publisher Site

Abstract

Abstract • Eighty-two black patients with refractory glaucoma were treated with a single-plate Molteno implant inserted in a single-stage procedure. A successful outcome (intraocular pressure 21 mm Hg with or without adjunctive medical therapy) was achieved in 72% of the patients with a mean follow-up of 30 months. Success was achieved in 23 (73%) of the 31 patients with open angle glaucoma, 20 (83%) of the 24 patients with either aphakic or pseudophakic glaucoma, 12 (67%) of the 18 patients with neovascular glaucoma, four (80%) of the five patients with uveitic glaucoma, and two (50%) of the four patients with congenital glaucoma. All but four patients required additional medical therapy. Visual acuities remained the same or improved in 21 (68%) of the 31 patients with open angle glaucoma, 11 (61%) of the 18 with neovascular glaucoma, 19 (79%) of the 24 patients with aphakic/pseudophakic glaucoma, three (75%) of the four patients with congenital glaucoma, and four (80%) of the five patients with uveitic glaucoma. Complications included hyphema (18%), "kissing" choroidal effusion (6%), blocked tube (8%), flat anterior chamber (12%), cataracts (5%), Tenon's cyst (encapsulated bleb) (17%), uveitis (7%), phthisis bulbi (5%), and erosion of the silicone tube (1%). References 1. Molteno ACB, Straughen L, Anker E. Long tube implants in the management of glaucoma . S Afr Med J . 1976;50:1062-1066. 2. Molteno ACB. Use of Molteno implants to treat secondary glaucoma . In: Cairns JE, ed. Glaucoma . New York, NY: Grune & Stratton; 1986;1:211-238. 3. Freedman J. Scleral patch grafts with Molteno setons . Ophthalmic Surg . 1987;18:532-534. 4. Minckler DS, Heuer DK, Hasty B, Baerveldt G, Cutting RC, Barlow WE. Clinical experience with the single plate Molteno in complicated glaucomas . Ophthalmology . 1988;95:1181-1188.Crossref 5. Freedman J, Shen E, Ahrens M. Trabeculectomy in Black American glaucoma population . Br J Ophthalmol . 1976;60:573-574.Crossref 6. Ferguson JG, MacDonald R, Jr. Trabeculectomy in blacks: a two-year follow up . Ophthalmic Surg . 1977;8:41-43. 7. Merrit JC. Filtering procedure in American blacks . Ophthalmic Surg . 1980;11:91-94. 8. Freedman J, Kopelowitz W. Long term results of trabeculectomy in a black population . Glaucoma . 1982;4:123-124. 9. Shingleton BJ, Distler JA, Baker BH. Filtration surgery in black patients: early results in a West Indian population . Ophthalmic Surg . 1987;18:195-199. 10. Melamed S, Cahane M, Gutman I, Blumenthal M. Postoperative complications after Molteno implant surgery . Am J Ophthalmol . 1991;11:319-322. 11. Traverso CE, Tomey KF, al-Kaff A. The long-tube single plate Molteno implant for the treatment of recalcitrant glaucoma . Int Ophthalmol . 1989;1:159-162.Crossref 12. Krupin T, Ritch R, Camras CB, et al. A long Krupin-Denver valve implant attached to a 180 scleral explant for glaucoma surgery . Ophthalmology . 1988;95:1174-1180.Crossref 13. Schocket SS, Lakhanpal V, Richards RD. Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma . Ophthalmology . 1982;89:1188-1194.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Oct 1, 1991

References

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