Otago Glaucoma Surgery Outcome Study

Abstract

To evaluate the efficacy of the 175-mm 2 Molteno3 implant in patients with nonneovascular glaucoma.Methods: A hospital-based, retrospective historical control comparative case series comparing results in the first 87 eyes to receive the 175-mm 2 Molteno3 implant with those in a control group of 115 eyes receiving the 274mm 2 double-plate Molteno implant.Results: Successwasdefinedasanintraocularpressure(IOP) of at least 6 mm Hg but not more than 21 mm Hg with or without hypotensive medication. The mean postoperative follow-up was 3.0 years (range, 13 days to 5.6 years) in the Molteno3 implant group and 6.2 years (range, 1 day to 13.9 years) in the double-plate Molteno implant group. The mean (SD) preoperative IOP was 25.6 (7.1) mm Hg in the Mol-teno3 implant group in eyes treated with a mean of 2.3 ocular hypotensive medications, and 25.7 (8.0) mm Hg in the double-plate Molteno implant group in eyes treated with a mean of 2.2 medications. The mean (SD) postoperative IOP at 36 months was 13.9 (3.2) mm Hg in the Molteno3 implant group in eyes treated with a mean of 0.9 ocular hypotensive medications, and 14.5 (3.4) mm Hg in the doubleplate group in eyes treated with a mean of 0.7 medications. The probability of IOP control at 3 years was 0.79 in both groups.Therewassignificantlymorepostoperativehypotony in eyes without a polyglactin 910 tie in the Molteno3 implant group (P=.04); however, significantly more eyes with flat anterior chambers in the double-plate group required anterior chamber reformation (P=.03). Conclusion:The 175-mm 2 Molteno3 implant provided intermediate-term successful treatment of nonneovascular glaucoma comparable to that provided by the double-plate Molteno implant.

Molteno3 Implantation as Primary Glaucoma Surgery

“…), but the differences cannot fully explain the difference in success rate. In the study of Thompson and coworkers, 17% of 87 eyes with Molteno3 implant had previously undergone trabeculectomy [11]. They reported successful IOP control in 79% at 3 years, which is, less than in our study with near same IOP criteria.…”

European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and optionsSupported by the EGS Foundation

“…The use of long-tube drainage devices such as those described by Molteno 256-263 , Krupin 264-266 , Baer veldt 267-272 , Ahmed 268 , 273-280 or Schocket 281-284 are generally reserved for patients with risk factors for a poor result with trabeculectomy with antimetabolite [II,D], although recent trials established their efficacy and safety as a primary surgical procedure 258 , 285 [II,B].…”

Glaucoma drainage devices

“…(95,96) The incidence of this complication ranges from 2% to 25.9%. (7,11,15,17,23,53,87,88,90,92,(97)(98)(99)(100)(101) Patients with NVG seem to face a higher risk of developing hyphema in the postoperative period. (23,87,92,97,100) tip of the tube may change its position over time, therefore, a tube-endothelial touch may occur.…”