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Molteno Glaucoma Implants: Case Studies
Case 1: Primary Open Angle Glaucoma with poor compliance
This 84 year old man developed primary open angle glaucoma with very advanced field loss close to fixation. He was started on medication but was unable to comply with the medication regime due to early dementia. Pre-op IOP was 21-30 mm Hg on Timolol and Xalatan. A 175mm2 Molteno3® with Vicryl tie was inserted. The postoperative course was smooth and 24 months after insertion the IOP is 10 mmHg on no treatment. The V/A is unchanged at 6/6.
Case 2: Bi-lateral Bupthalmos due to Sturge-Weber Syndrome
This child was referred at the age of 7 months with a history of poor vision since birth. Under anaesthesia, the IOP was 32 mmHg in the Right eye and 37 mmHg in the left eye. A Pressure Ridge Single Plate Molteno® Implant (D1) was inserted into each eye with the tube tied off with 5.0 Vicryl, combined with a Sherwood slit. At operation abnormal blood vessels covering the anterior one third of the sclera were treated with thermocautery. The postoperative course was uneventful and when last seen 5 years after the operation the IOP in both eyes was 15 mmHg on no treatment.
Case 3: Juvenile Glaucoma
This patient had a lens extraction for congenital cataract in early childhood. At the age of 34 he developed glaucoma. Preoperatively the IOP was 30 mmHg on acetazolamide and timolol. At operation a Double Plate Molteno® Implant (L2) was inserted, with Vicryl-tie for delayed drainage. There were no postoperative complications. The IOP has ranged between 12 and 16 mmHg on no treatment over the 17 years of follow up.
Case 4: Primary Open Angle Glaucoma
This patient underwent trabeculectomy for open angle glaucoma in the left eye. The trabeculectomy failed with progression of field loss and loss of central vision. Prior to Molteno® Implant surgery IOP was 28 mmHg on timolol and acetazolamide and the visual acuity was 6/24. A Pressure Ridge Double Plate Molteno Implant® (DL2) with Vicryl-tie and Sherwood slit was inserted. The postoperative course was smooth and uneventful. Currently, nine years after operation, the IOP is 12 mmHg on no treatment, while the visual acuity remains 6/24.
Case 5: Traumatic Glaucoma
This young man was struck in the right eye by a stone when he was 11 years old. He developed traumatic glaucoma which was drained by trabeculectomy at the age of 24 years. The trabeculectomy failed after 5 years. Prior to Molteno® Implant surgery his IOP was 45-50 mmHg on pilocarpine and timolol. At operation a Double Plate Molteno® Implant (R2) was inserted with delayed drainage by two-stage operation. (NOTE: This was before the introduction of and the Vicryl-tie procedure). The postoperative course was smooth and no hypotensive medication was required. When last seen 22 years later the IOP was controlled at between 13 and 17 mmHg on no treatment.
