Supra-Tenons' Placement of a Single Plate Molteno Implant versus Molteno3 Implant, in African American Patients with Refractory Glaucoma.

Abstract

Purpose: : To evaluate the efficacy of a single plate Molteno implant, versus a Molteno3 implant when placed in a supra-Tenons' pocket in African American patients with refractory glaucoma.

Methods: : In this retrospective series of 42 eyes, we compared the efficacy of supra-Tenons' placement of a single plate Molteno implant(130mm²) , to that of a Molteno3(170mm²).The single plate was placed into 17eyes, and the Molteno3 into 25 eyes. All the patients had previous glaucoma filtration procedures which failed.Seven patients in the Molteno group and and 5 in the Molteno3 group had previous Molteno implants which had failed due to bleb encapsulation. Success was defined as a pressure of 18mm.Hg. or less with or without adjunctive medical therapy.

Results: : Mean follow up was 22 months(range12-48) in the single plate Molteno eyes and19 momths(range 8-48) for the Molteno3. Mean pre-opertative IOP was 31 and 27mm.Hg for Molteno and Molteno3 respectively. Mean post-op.pressure was 16 and 14mm.Hg. for Molteno and Molteno3. Survival for Molteno3 using Kaplan Meier survival analysis was 88.7%, and that for the single plate Molteno, using the same analysis was 70.5%.Using Log-Rank or Mantel-Haensel Test for Comparison of Survival analysis p>0.25, and there was no significant difference between survival of the 2 groups.Complications consisted of small choroidal effusions in 5 eyes ,which resolved spontaneously. Two tube exposures and one tube blockage were resolved surgically.

Conclusions: : The results indicate that placement of a glaucoma implant in a supra-Tenons' pocket is effective in decreasing bleb encapsulation, by eliminating the effect of Tenons' capsule, and thereby controlling the intraocular pressure even in eyes with refractory glaucoma. Furthermore the results imply that if fibrosis is overcome that increasing the size of the implant does not add to its pressure lowering ability.

Keywords: intraocular pressure • wound healing • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials