Molteno® and Molteno3® Glaucoma Drainage Devices

MOLTENO Ophthalmic Ltd manufactures the most versatile, safe and effective glaucoma drainage devices with the longest and most comprehensive follow-up of any glaucoma devices on the market (1-6,9-14). Glaucoma drainage devices are also known as glaucoma shunts, drains or implants.

Many leading glaucoma surgeons now prefer the Molteno3® S-series implants which feature:
  • New anterior suture hole position for fast, easy insertion
  • Two sizes (185 and 245mm2). The smaller SS implants are suitable for most cases
  • Translimbal, pars plana and 'piggy-back' insertion options with one implant
  • Rounded contours, gentle on vulnerable tissues: can be positioned supra-Tenon's if necessary
  • Lowest profile plate: best choice for highly myopic eyes with limited space in the orbit
  • Plate edge fits snugly between and slightly beneath the adjacent extraocular muscles
  • Immediate or delayed drainage (using absorbable suture +/- relieving slit (16))
  • Primary drainage area (<25mm2) to reduce the risk of hypotony and to produce a permeable bleb with excellent long term control of intraocular pressure (5,6,14)
  • MRI safe. 
  • Molteno3 glaucoma implants are also available in the standard profile G-series.



The Molteno3 implant range is usually used with an absorbable suture ligature (Vicryl® tie, (13)) to delay drainage, except when treating urgent cases of acutely raised intraocular pressure, neovascular glaucoma, silicone oil induced glaucoma and a few cases where inflammatory exudate or blood is present in the eye.

MOLTENO Ophthalmic also produce the original Single Plate (S1), the Double Plate range and the Paediatric / Microphthalmic (P1) implants to meet worldwide demand for these Molteno glaucoma drainage devices. 
 

Hypotensive medication before and after Molteno® Implant surgery:

Before surgery: control the intraocular pressure (IOP) optimally to minimise operative complications. 

From surgery until the onset of drainage: maintain the IOP in the mid-range, around 15mmHg is ideal in most cases.

Once drainage commences, and in all cases with immediate drainage: Control inflammation, if present, and allow the IOP to rise above 15mmHg (above the episcleral venous pressure). This triggers the process which leads to a more permeable bleb capsule and long-term control of IOP. 

From 3 months postoperatively: aim to keep the IOP in the low-normal range (8-12mmHg). When the IOP is well controlled in the months and years after Molteno Implant surgery, using hypotensive agents if necessary, there is a tendency for increasing permeability of the bleb lining to occur over the long term, reducing the IOP further and decreasing the need for hypotensive medication.  

CAUTION: Up to 3 months after Molteno implant surgery, miotics, prostaglandin analogues and other topical vasodilating agents should be used with caution as they may increase the episcleral venous pressure and thus increase fibrous tissue deposition and the likelihood of bleb failure.

Vicryl® is a trade mark of Ethicon Inc. 
© MOLTENO Ophthalmic Ltd 2016


 

Molteno3® S-series Single Plate Implant (SS & SL)

Molteno3® SL(left) and SS glaucoma implants

Molteno3® S-series implant diagrams

Molteno3® S-series implant showing the cleverly positioned anterior suture holes

Molteno3® S-Series implant demonstrating the clarity of the finely engineered plate

Molteno3® Glaucoma Drainage Device box detail

Molteno3® SS Glaucoma Implant box.

Recently launched in response to feedback from leading surgeons:
  • Easy access to anterior suture holes for fast and easy suturing
  • Ultra-low profile 0.4mm plate thickness and lower profile 0.95mm primary drainage area
  • Single plate simplicity with double plate performance (2)
  • Single quadrant surgery with a low profile implant that slips easily into place between and slightly beneath the adjacent extraocular muscles
  • Suited to cases with large eyes and little space in the orbit
  • Flexible and shaped to fit the eyeball
  • Primary drainage area reduces the risk of post-operative hypotony: restricts initial aqueous drainage to the small oval area until the IOP rises sufficiently to lift the tissues and allow drainage of aqueous over the entire plate
  • Self-cleaning patented 'biological valve' resists blockage by inflammatory exudate, blood clot or fibroblast ingrowth, unlike a mechanical valve (8)
  • MRI safe
The primary drainage area on the Molteno3 S-series implants has been lowered and rounded to reduce the risk of erosion when the implant is placed supra-Tenon's (7) or when the Tenon's tissue and conjunctiva are compromised or poor healing may be expected. 

Molteno3 Glaucoma Implant Step-by-Step Surgical Guide

Product Information Sheet Molteno Glaucoma Implants

Molteno3 S-series brochure
 

Molteno3® G-Series Single Plate Implant (GS & GL)

Molteno3® G-series implant oblique view

Molteno3® G-series implant diagrams

Molteno3® G-series implant demonstrating the clarity of the finely engineered plate

Molteno3® GS Single Plate 175mm2 Implant boxes

Molteno3® Glaucoma implant boxes being packed

Molteno3® GL Single plate 230mm2 Implant boxes

  • Single plate simplicity with double plate performance (2)
  • Single quadrant surgery
  • Low profile plate that slips easily into place between and slightly beneath the adjacent extraocular muscles
  • More flexible and shaped to fit the curvature of the eyeball
  • Self-cleaning 'biological valve' resists blockage, unlike a mechanic valve (8)
  • Excellent long-term control of IOP (2)
  • Primary drainage area reduces post-operative hypotony by acting as a 'biological valve'
  • The primary drainage area restricts initial aqueous drainage to the small oval area until the IOP rises sufficiently to lift the tissues and allow drainage of aqueous over the entire plate
  • MRI safe
*For supra-Tenon's placement, compromised or poorly healing tissues or large eyes with little space in the orbit, the Molteno3 S-series implants are recommended.



Molteno3 Glaucoma Implant Step-by-Step Surgical Guide

Product Information Sheet Molteno Glaucoma Implants
 

Molteno® Single Plate Implant (S1), the original Molteno® glaucoma implant

The original Molteno® Single plate Implant (S1), oblique view

The original Molteno® Single plate Implant boxes

Original Molteno® Single Plate Implant diagram

In cost-critical healthcare settings, the original Molteno S1 Implant, particularly when combined with delayed drainage using an absorbable suture such as 5.0 Vicryl®, gives very satisfactory results. Most surgeons now prefer the Molteno3 range of implants.

The original Molteno S1 Implant is suitable for elderly patients with reduced ciliary body function and for combined cataract and glaucoma operations. Plate area 133mm2.

The original Molteno Single Plate Implant (S1) may also be used to provide additional drainage to a previously implanted glaucoma device in the 'piggy-back' procedure (19, 21).


MRI safe.

Product Information Sheet Molteno Glaucoma Implants

Molteno® Paediatric / Microphthalmic Implant (P1)

Molteno® Paediatric / Microphthalmic Implant

Molteno® Paediatric / Microphthalmic Implant boxes

Molteno® Paediatric / Microphthalmic Implant diagram

The Molteno® Paediatric/ Microphthalmic Implant (P1) is a mini version (area 80mm2) of the original Molteno Single Plate (S1) Implant with a reduced radius of curvature suitable for microphthalmic eyes.

The Molteno Paediatric /Microphthalmic Implant is indicated for eyes with an axial length of less than 17mm. The newer design Molteno3 Single Plate SS (185mm2) implant can be used for eyes with an axial length of 17mm or greater (a normal eye has an axial length of approximately 22mm).

In a young patient, positioning the Molteno glaucoma implant in an anterior position, between the insertions of the extraocular muscles, reduces the impact of subsequent growth of the globe on the length of Molteno implant tubing in the anterior chamber (AC) and reduces the need for re-operation.


MRI safe.

Product Information Sheet Molteno Glaucoma Implants

Molteno® Double Plate Implant (L2 & R2)

Molteno® Double Plate Implant (right eye shown)

Molteno® Double Plate Implant (L2,R2) diagram

Molteno® Double Plate Implant boxes, left eye (L2)

Molteno® Double Plate Implant boxes, right eye (R2)

Molteno® Double (twin) Plate Implants provide twice the drainage area of an original Molteno Single Plate (S1) Implant without interfering with the action of the extraocular muscles. Total plate area 266mm2.

The Molteno Double Plate Implants are suitable for patients with very severe glaucoma, patients with especially vigorous fibrous tissue response, younger patients with good ciliary body function and patients who have glaucoma associated with uveitis or retinal detachment (3). Most surgeons now prefer a Molteno3® Implant where they would have used a Molteno Double Plate Implant in the past (2).

This implant is available in left eye (L2) and right eye (R2) configurations. All Molteno glaucoma implants are MRI safe.

Product Information Sheet Molteno Glaucoma Implants
 

Molteno® Pressure Ridge Single Plate Implant (D1)

Molteno® Pressure Ridge Single Plate Implant

Molteno® Pressure Ridge Single Plate (D1) Implant boxes

Molteno® Pressure Ridge Single Plate Implant diagram

The subsidiary ridge on the Molteno® Pressure Ridge Single Plate Implant (D1), when covered by Tenon's capsule, acts as a pressure-sensitive biological valve which limits the escape of aqueous from the eye and reduces postoperative hypotony.

The Molteno Pressure Ridge Single Plate Implant is suitable for patients with neovascular glaucoma, acute glaucoma in patients with reduced ciliary body function, elderly patients and patients who require a combined cataract and glaucoma procedure (4). Most surgeons now prefer the Molteno3® Implants. The Molteno Pressure Ridge Single Plate Implant may be preferred in extensively scarred eyes requiring an implant with a moderate drainage area. (For similarly scarred eyes requiring a large drainage area, the Molteno® Pressure Ridge Double Plate Implants (DR, DL) may be used).

The Molteno Pressure Ridge Single Plate Implant is also an option when adding drainage area to a previously inserted implant in the 'piggy-back' procedure (19, 21).

MRI safe.

Product Information Sheet Molteno Glaucoma Implants
 

Molteno® Pressure Ridge, Double Plate Implant (DL & DR)

Molteno® Pressure Ridge, Double Plate Implant, right eye configuration

Molteno® Pressure Ridge, Double Plate Implant boxes, right eye, DR

Molteno® Pressure Ridge, Double Plate Implant (DL,DR) diagrams

Molteno® Pressure Ridge, Double Plate Implant boxes, left eye, DL

Molteno® Glaucoma Implant boxes top view with silver logo

The Molteno® Pressure Ridge Double Plate Implant combines the large drainage area of the Molteno Double Plate Implant with the subsidiary ridge for controlling postoperative hypotony. This implant is suitable for patients with very severe glaucoma, younger patients with good ciliary body function, patients with especially vigorous fibrous tissue response and patients who have glaucoma associated with uveitis or retinal detachment (3). 

Most surgeons now prefer to use a Molteno3® implant where they would have used a Molteno Double Plate Implant in the past (2), however, the Molteno® Pressure Ridge Double Plate Implants may be preferred in extensively scarred eyes requiring an implant with a large drainage area. 

The Molteno Pressure Ridge Double Plate Implant is available in left eye (DL) and right eye (DR) configurations. All Molteno glaucoma implants are MRI safe.

Product Information Sheet Molteno Glaucoma Implants
 



Molteno® Ophthalmic Limited
PO Box 6322 Dunedin
New Zealand

Phone: +64 3 479 2744
Fax: +64 3 479 2444
Email: sales@molteno.com

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