LONG-TERM SURVIVAL OF MOLTENO GLAUCOMA DRAINAGE DEVICES

Purpose: To evaluate the long-term outcome of the Molteno implant drai nage device using survival analysis. Methods: A retrospective chart re view was performed on 77 eyes of 71 patients that underwent Molteno im plantation for intractable glaucoma unresponsive to conventional manag ement from October 1984 to April 1990 at the University of Washington Eye Center and had at least 6 months of follow-up data. Success was de fined as a postoperative intraocular pressure of 22 mmHg or lower with (qualified success) or without (complete success) glaucoma medication s and no additional glaucoma surgery, phthisis, or loss of light perce ption. Results: The median follow-up was 44 months (range, 6-107 month s). Indications for Molteno implantation were aphakia/pseudophakia (n = 24), neovascular glaucoma (n = 20), uveitic glaucoma (n = 12), faile d trabeculectomy (n = 9), traumatic glaucoma (n = 8), and congenital g laucoma (n = 4). The total success was 57% (23% complete; 34% qualifie d) at the last follow-up. Kaplan-Meier survival curves demonstrated a continuous and relatively linear attrition of success over at least 5 1/2 postoperative years, The uveitic glaucoma group had the highest su ccess rate of 75%. Eyes with neovascular glaucoma failed significantly more frequently than those with uveitic glaucoma (P < 0.01). There wa s no significant difference in outcome based on sex, race, single vers us double plate, anterior chamber versus posterior chamber tube placem ent, or two-stage versus single-stage surgery, Younger age was associa ted with a significantly higher failure rate after controlling for gla ucoma category (P < 0.01). Conclusion: The Molteno implant drainage de vice offers a reasonable long-term outcome in eyes with intractable gl aucomas. However, an ongoing rate of failure, not unlike that seen aft er other filtration surgery, is to be expected.