Molteno3 Surgical Videos

Surgeons may modify the surgical technique recommended in the Molteno3 Glaucoma Implant Step-by-Step Surgical Guide to suit the individual case. Experienced surgeons demonstrate their Molteno3 implant surgical technique in a range of cases through links on this page. 
Warning: All these videos contain surgical images.

1) The Molteno3 G-series glaucoma implant with Vicryl tie for delayed drainage. A case with primary glaucoma. Surgery and commentary by Prof Anthony C.B. Molteno.
 

2) Molteno3 implantation with cataract extraction & IOL. Prof Bill Morgan demonstrates his surgical technique for Molteno3 implantation combined with phacoemulsification (cataract extraction) and insertion of IOL (intraocular lens). Techniques for success include: tube occlusion with 5.0 Vicryl® tie, test of occlusion, large (5mm) limbus-based scleral flap and trimming the tube with bevel facing forward. 



3) Molteno3 implant for uveitic glaucoma 2° to Juvenile Rheumatoid Arthritis, surgery by Prof Bill Morgan.
Case history: IOP had been well controlled for many years on Latanoprost and Timolol. IOP recently rose to 30. Alphagan and Brinzolamide were added with no significant or sustained effect. Supero-temporal disk rim loss was noted on serial confocal scanning laser tomography (Heidelberg HRT). Visual field was still normal. Due to the elevated IOP and disk change, Molteno3 GL (230mm2) implant surgery with scleral graft was performed. A complicating factor was the presence of peripheral anterior synechiae (PAS): when the 23g needle entered the anterior chamber some iris was engaged. The tube was inserted bevel down to ride over the PAS then rotated to the correct orientation. The rest of the procedure was routine: tube occlusion with Vicryl tie, Sherwood venting slit and limbus-based scleral flap with interposed scleral graft.



4) Pars plana placement of a Molteno3 implant in traumatic glaucoma with failed Ex-PRESS shunt. Surgery by Dr Gian Luca Laffi. 
Case history: Fifteen years after R eye trauma with angle recession the patient underwent a posterior vitrectomy for IOL luxation into the vitreous cavity and developed a uveitic reaction. The IOP became uncontrolled. After scleral fixation and pupilloplasty an Ex-PRESS shunt was placed in the supero-nasal quadrant, but failed within a year. The patient, now 57 years old, proceeded to pars plana implantation of a Molteno3 GS (175mm2) glaucoma drainage device with the implant plate in the supero-temporal quadrant.
A pars plana tube is safer for the cornea compared to placing the tube in the AC. Pars plana tube position requires an anterior vitrectomy.
Additional information about pars plana insertion can be found in the Molteno3 Glaucoma Implant Step-by-Step Surgical Guide, pages 22-35. A summary of the pars plana technique appears on pages 39-40.
 



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New Zealand

Phone: +64 3 479 2744
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