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Editor,—We report a series of four infant patients who underwent insertion of Molteno implants for control of buphthalmos and congenital glaucoma. In addition to long term control of their glaucoma, they each demonstrated a return to emmetropia from myopia. We are unaware of any similar case reports in the literature.
All refractions discussed in cases were measured under cycloplegia (cyclopentolate 1% × 3) using a streak retinoscope and trial lenses.
A male patient presented at 6 months of age with bilateral congenital glaucoma. Bilateral Molteno implants were inserted without complications and long term intraocular pressure (IOP) control was achieved. Refraction 6 months postoperatively revealed myopia of −10.5 D in both eyes. Subsequent refraction at age 2 (18 months postoperatively) revealed reduced myopia of −4.5D in both eyes. Refraction at age 6 (66 months postoperatively) revealed essentially emmetropic refraction (plano/−1DC × 180 in both eyes).
A male patient first presented to our department at age 6 months. He was diagnosed with Sturge-Weber syndrome with bilateral trigeminal nerve distribution naevus flammeus involving both upper and lower lids. He was noted to have bilateral buphthalmos, but with clear corneas and normal discs. He showed no evidence of visual attention at presentation. Examination under anaesthetic (EUA) revealed IOP of 32 mm Hg right and 37 mm Hg left and horizontal corneal diameters of 14 mm in both eyes. A one plate Molteno implant with Vicryl tie, Sherwood slit, and donor sclera was inserted in the left eye at 8 months of age and the right eye at 9 months of age. EUA at 11 months of age (2 months postoperatively) revealed −6.5D (myopia) in both eyes and normal IOP. Horizontal corneal diameters were 14 mm right and 13 mm …
Disclaimer: One of the authors (ACBM) has a financial interest in Molteno implants.