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Supra-Tenon’s capsule placement of a single-plate Molteno implant

Department of Ophthalmology, SUNY Health Science Center at Downstate, Brooklyn, NY, USA

Correspondence to:
Professor J Freedman, Department of Ophthalmology, SUNY Health Science Center at Downstate, 161 Atlantic Avenue, Brooklyn, NY 11201, USA; jfreedman50{at}hotmail.com

Aim: To describe clinical results of a new technique for inserting Molteno implants in a supra-Tenon’s capsule location.

Design: Prospective interventional case study.

Participants: 19 patients, 18 of whom had suffered previous filter or glaucoma implant failure. Seventeen had open-angle glaucoma, and two had neovascular glaucoma. Seventeen patients were black and two were Asian.

Intervention: All patients underwent supra-Tenon’s capsule placement of a single-plate Molteno implant. Goldmann applanation tensions and Snellen visual acuities were determined before the operation and at the last follow-up visit. The numbers of preoperative and postoperative adjunctive drugs were compared before and after surgery.

Main outcome measures: Success was defined as intraocular pressure 18 mm Hg with or without anti-glaucoma drugs.

Results: Mean age was 62 years. Mean pressure before and after surgery was 31 and 16 mm Hg, respectively. Mean follow-up was 22 months (range 12–48). Vision returned to within 2 lines of preoperative vision, except in one patient who lost light perception. Surgery was regarded as a failure in four patients, including both patients with neovascular glaucoma. The difference between the median number of drugs used before (three) and after (one) the operation was significant (p<0.001). Complications were minimal, characterised by small choroidal effusions in three patients; all resolved spontaneously.

Conclusion: Supra-Tenon’s capsule placement of Molteno implants in eyes with previously failed glaucoma surgery is an effective method for controlling intraocular pressure.

Ethics approval: Ethics approval was obtained.