Otago glaucoma surgery outcome study - Long-term results of uveitis with secondary glaucoma drained by Molteno implants

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.