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SA Iyer, A Neelakantan, HD Vaishnav, JD Gross, MB Sherwood; Mid-Term Results of Double Plate Molteno Implants in the Treatment of Pediatric Glaucomas . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3366.
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Purpose:To study the mid to long-term survival rate of Double Plate Molteno implants used in the management of pediatric patients with refractory glaucoma. Methods:Retrospective chart review of all consecutive patients who received a Double-Plate Molteno Implant from January 1987 to December 1994, for management of primary congenital glaucoma, developmental glaucoma or pediatric aphakic glaucoma was performed. Intraocular pressure (IOP) and visual acuity (VA) change after Double-Plate Molteno implantation were the main outcome measures studied. IOP success was defined as a postoperative IOP of ≤18 mmHg at final follow-up, with or without antiglaucoma medication use, with no additional antiglaucoma surgical interventions and retaining visual acuity of at least light perception. VA success was defined as, visual acuity at final follow-up better than or within 2 Snellen lines of preoperative visual acuity. The effects of additional glaucoma procedures after the primary Double-Plate Molteno implantation were also studied. Kaplan-Meier survival curves were plotted.This same analysis was then repeated, to examine the effects of the additional glaucoma interventions on the survival time. Results:29 eyes of 24 patients with a mean age of 6 years (range, 6 weeks - 20 years) were followed for a mean of 85.248.6 months(SD).The Cumulative probability of achieving IOP success, with no further antiglaucoma interventions, was 57% at 5 years and 29% at 10 years. Preoperative VA data was available for 17 eyes. The cumulative probability of achieving VA success, with no further antiglaucoma interventions, was 100% at 5 years and 65% at 10 years. Nineteen of 29 eyes that had a Double-Plate Molteno Implant failed to achieve IOP success, of which 11(38%) eyes had further glaucoma surgery performed. Additional glaucoma procedures performed mainly included Glaucoma Drainage Devices. Other procedures included YAG laser cyclophotocoagulation and mitomycin trabeculectomy. When the effects of these additional glaucoma interventions were also considered in determining success, the cumulative probability of IOP survival significantly improved to 78% at 5 years and 56% at 10 years. However the cumulative probability of VA success was lowered to 94% at 5 years and 62% at 10 years. Conclusion:Double-Plate Molteno implants are useful in the management of refractory pediatric glaucomas with approximately one half to a third of the eyes remaining successful at 5 years. Additional glaucoma procedures when performed in eyes that fail, significantly increases the mid to long-term IOP survival rate.
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