Acb. Molteno et al., Otago glaucoma surgery outcome study - Long-term results of uveitis with secondary glaucoma drained by Molteno implants, OPHTHALMOL, 108(3), 2001, pp. 605-613
Objective: This study was undertaken in Otago, New Zealand, to provide data
on the long-term results of cases of uveitis with secondary glaucoma drain
ed by Molteno implants.
Design: A prospective, noncomparative case series of all cases of chronic u
veitis with secondary glaucoma drained by Molteno implants from 1978 throug
h 1998.
Participants: Forty eyes of 35 patients.
Intervention; Insertion of Molteno implant.
Main Outcome Measures: Intraocular pressure, visual acuity, and progressive
visual field loss.
Results: Insertion of a Molteno implant was effective in controlling the in
traocular pressure at 21 mmHg or less with a probability of 0.87 (95% confi
dence interval [CI], 0.76, 0.98) and 0.77 (95% CI, 0.60, 0.93) at 5 and 10
or more years after surgery. The mean visual acuity improved from 20/100 to
20/70 immediately after operation. This value declined to 20/130 at 5 and
10 years after surgery and then improved slightly to 20/120 at 15 years aft
er surgery. In these eyes, the Kaplan Meier estimated probability of retain
ing useful vision (visual acuity >20/400; visual field >5 degrees radius) w
as 0.75 (95% CI, 0.61, 0.89) and 0.71 (95% Cl, 0.55, 0.87) at 5 and 7 or mo
re years after surgery.
Conclusions: The insertion of a Molteno implant controlled the intraocular
pressure in 76% of cases over the follow-up period. Patients in whom the uv
eitis was well controlled maintained their visual acuity and visual fields,
whereas the proportion of cases requiring steroids and the doses required
fell progressively over the period of follow-up. Failures were related to c
omplications of advanced disease, previous intraocular surgery, and failure
to control the uveitis, The drainage system provided by the Molteno implan
t proved robust, continuing to function well despite continuous activity of
the uveitis, acute exacerbations of the uveitis, and all subsequent intrao
cular surgery including cataract extraction, keratoplasty, and vitrectomy.