Long-term Results of Molteno Implant Insertion in Cases of Neovascular Glaucoma

Abstract

To describe the long-term outcomes of cases of neovascular glaucoma drained by Molteno implants. Methods: A prospective study of 145 eyes (130 patients) followed up for a mean of 3.3 years (range, 0.02 year [5 days] to 18.1 years) in the province of Otago, New Zealand, from 1979 to 2002. Results: Insertion of a Molteno implant controlled the intraocular pressure at 21 mm Hg or less with a probability (95% confidence interval) of 0.72 (0.64-0.80), 0.60 (0.51-0.69), and 0.40 (0.29-0.50) at 1, 2, and 5 years, respectively. Failure to control intraocular pressure at 1, 2, and 5 years was significantly correlated with persistent iris neovascularization (PϽ.001, PϽ.001, and P=.01, respectively). Visual acuity at final follow-up in nonenucleated eyes was maintained or improved in 56 eyes (39%) and deteriorated to light perception or better in 25 (17%) or no light perception in 47 (32%). Seventeen eyes (12%) were enucleated. Conclusions: The insertion of Molteno implants for neovascular glaucoma maintained or improved vision in 39% of eyes, whereas 12% were eventually enucleated (all of which initially had visual acuity Ͻ20/1200). The outcome depended mainly on progression of the underlying vascular disease.

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

“…One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 . However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] .…”

“…However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] . It delivers both retina and glaucoma treatment in a single surgical session and reduces the patient and health care system burden by simplifying postoperative care and follow-up.…”

“…Our success rate of 65%, defined as an IOP <22 mmHg, with or without glaucoma medication and without vision loss after a oneyear follow-up, is similar to success rates reported for glaucoma drainage devices, which range from 62% to 66.7% 24,[48][49][50] . One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 .…”

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

“…One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 . However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] .…”

“…However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] . It delivers both retina and glaucoma treatment in a single surgical session and reduces the patient and health care system burden by simplifying postoperative care and follow-up.…”

“…Our success rate of 65%, defined as an IOP <22 mmHg, with or without glaucoma medication and without vision loss after a oneyear follow-up, is similar to success rates reported for glaucoma drainage devices, which range from 62% to 66.7% 24,[48][49][50] . One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 .…”

Neovascular Glaucoma: An Update

“…A relevant study showed success rates of 20.6% in NVG patients and 81.8% for controls at the 5-year follow-up 79 . These results are similar to the postoperative results of other types of GDDs 80 . Shen et al 81 reported similar success rates with the Ahmed glaucoma valve compared to TRAB with MMC; success rates were 70 and 65% at 1 year and 60 and 55% at 2 years after Ahmed glaucoma valve and trabeculectomy with MMC, respectively.…”

Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma

“……”

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

“…One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 . However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] .…”

“…However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] . It delivers both retina and glaucoma treatment in a single surgical session and reduces the patient and health care system burden by simplifying postoperative care and follow-up.…”

“…Our success rate of 65%, defined as an IOP <22 mmHg, with or without glaucoma medication and without vision loss after a oneyear follow-up, is similar to success rates reported for glaucoma drainage devices, which range from 62% to 66.7% 24,[48][49][50] . One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 .…”

Neovascular Glaucoma: An Update

“…A relevant study showed success rates of 20.6% in NVG patients and 81.8% for controls at the 5-year follow-up 79 . These results are similar to the postoperative results of other types of GDDs 80 . Shen et al 81 reported similar success rates with the Ahmed glaucoma valve compared to TRAB with MMC; success rates were 70 and 65% at 1 year and 60 and 55% at 2 years after Ahmed glaucoma valve and trabeculectomy with MMC, respectively.…”

Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma

“……”

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

“…One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 . However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] .…”

“…However, this report is the exception as others have found 24,[48][49][50] . Our integrative surgical approach avoided tube-specific complications (e.g., tube exposure, retraction, corneal touch, obstruction), ranging from 13% to 26% in NVG over five years 24,[48][49][50][51] . It delivers both retina and glaucoma treatment in a single surgical session and reduces the patient and health care system burden by simplifying postoperative care and follow-up.…”

“…Our success rate of 65%, defined as an IOP <22 mmHg, with or without glaucoma medication and without vision loss after a oneyear follow-up, is similar to success rates reported for glaucoma drainage devices, which range from 62% to 66.7% 24,[48][49][50] . One study reported a 73% success rate in 38 eyes that received a glaucoma drainage device and had relatively few postoperative complications 51 .…”

Neovascular Glaucoma: An Update

“…A relevant study showed success rates of 20.6% in NVG patients and 81.8% for controls at the 5-year follow-up 79 . These results are similar to the postoperative results of other types of GDDs 80 . Shen et al 81 reported similar success rates with the Ahmed glaucoma valve compared to TRAB with MMC; success rates were 70 and 65% at 1 year and 60 and 55% at 2 years after Ahmed glaucoma valve and trabeculectomy with MMC, respectively.…”

Trabeculectomy versus Ahmed Glaucoma Valve implantation in neovascular glaucoma

“……”