Molteno Glaucoma Drainage Devices

Molteno continue to produce the single plate, double plate and microphthalmic implants, however the best implant available now is the Molteno3 which has a greatly improved pressure ridge, larger drainage area and lower profile. It is best used with a Vicryl-tie ligature to delay drainage except when draining cases of neovascular glaucoma or silicone oil induced glaucoma and a few cases where inflammatory exudate or blood is present in the eye.

Professor Molteno now uses the Molteno3 for most cases.  It is the easiest to insert and is held snugly in place by the adjacent extraocular muscles. The design of the subsidiary ridge reduces the risk of postoperative hypotony and the larger plate gives a thinner more permeable bleb with excellent long term control of IOP.  He uses the smaller Molteno3-175 in about 90% of cases and the Molteno3-230 for very severe glaucoma in younger patients and for neovascular glaucomas.
           
Where price is important the simple single plate Molteno (S1) is still a useful implant especially when used with a Vicryl tie.
           
The double plate Pressure Ridge Molteno (DL and DR) is also still a useful and versatile implant.  It has the advantage that the onset of drainage can be managed by either a Vicryl-tie on the translimbal tube or by a Vicryl-tie on the connecting tube.  But it is more difficult to insert especially for doctors who are not familiar with strabismus surgery.

Hypotensive medication after Molteno^® Implant surgery. “Keep the Pressure Down”

When the IOP is kept within normal limits there is a thinning of the bleb lining with a gradual and progressive fall in IOP. If the IOP is well controlled after Molteno^® Implant surgery (by hypotensive agents if necessary), there is a long term tendency for the IOP to fall and the need for hypotensive medication to decrease. On average, about 50% of cases need some hypotensive medication in the first year after Molteno^® Implant surgery. This proportion falls progressively to less than 20% after 5 years. Carbonic anhydrase inhibitors, beta-blockers and adrenergic agents are highly effective hypotensive agents after Molteno^® Implant surgery.

CAUTION: Miotics, prostaglandin analogues and other local vasodilating agents may cause elevation of IOP after implant surgery and should be avoided.

Further Information

• Surgical guides and videos available here or from your distributor.
• Frequently Asked Questions