TRABECULECTOMY AND MOLTENO IMPLANTATION FOR GLAUCOMAS ASSOCIATED WITHUVEITIS

Purpose: This study compares the outcomes of trabeculectomy and Molten o implantation in the treatment of glaucomas associated with uveitis. Methods: Forty-five patients with uveitis, who had undergone filtering surgery for glaucomas associated with uveitis, were reviewed retrospe ctively. Successful outcome was defined as final intraocular pressure (IOP) of 6 to 21 mmHg, with a minimum follow-up of 6 months without vi sually devastating complications or loss of light perception. Results: One- and two-year life-table success rates, respectively, were 81% an d 73% with trabeculectomy (16 patients); 53% and 31% with combined tra beculectomy and first-stage (reserve) Molteno implantation (19 patient s); and 79% and 79% with one-stage Molteno implantation (10 patients). In 11 patients who underwent second-stage Molteno implantation after trabeculectomy failure, 1- and 2-year life-table success rates were 79 % and 79%, respectively. Complications included surgically treated cho roidal effusions (1/45; 2%), choroidal hemorrhages (3/45; 7%), and chr onic hypotony (3/45; 7%). Follow-up in all groups ranged from 5 to 70 months (mean +/- standard deviation, 28 +/- 17 months). Conclusions: T rabeculectomy provides surprisingly good results in glaucomas associat ed with uveitis (modulation of wound healing with antimetabolites prob ably would afford an even higher success rate). However, when signific ant, immediate postoperative and/or moderate chronic postoperative inf lammation is likely, aqueous drainage devices appear more likely to co ntrol IOP.