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Supra-Tenon's Capsule Placement of Single Plate Molteno Implant
  1. Jeffrey Freedman (jfreedman50{at}hotmail.com),
  2. Pirahatai Chamnongvongse (researchlich{at}yahoo.com)
  1. SUNY Downstate Medical Center, United States
  2. SUNY Downstate Medical Center, United States

    Abstract

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

    Design: Prospective interventional case study.

    Participants: Nineteen patients, 18 of whom had previous filter or glaucoma implant failure. Seventeen had open angle (OAG) 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 taken preoperatively and at the last follow-up visit. The numbers of preoperative and postoperative adjunctive medications were compared before and after surgery.

    Main Outcome Measures: Success was defined as IOP 18mmHg or less with or without anti-glaucoma medications.

    Results: Mean age was 62 years. Mean preoperative pressure was 31mmHg, and mean postoperative pressure was 16mmHg. Mean follow-up duration was 22 months (range 12 to 48 months). Vision returned to within 2 lines of preoperative vision, except in one patient who lost light perception. Four patients were regarded as failures, and this included both patients with neovascular glaucoma. The difference between the average number of preoperative medications used,3, and postoperative medications used,1, was statistically significant (p<0.001). The complications were minimal, characterized by small choroidal effusions in 3 patients, all resolving 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.

    • Molteno
    • bleb fibrosis
    • glaucoma
    • glaucoma implant
    • supra- Tenon's capsule

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