Molteno implant helpful in controlling IOP in younger patients

Young patients who underwent a Molteno implant for the treatment of glaucoma were able to maintain or improve their visual outcomes over the long term, according to a group of researchers.

John J. Ah-Chan, BMedSci, MBChB, and colleagues in New Zealand reviewed the charts of 45 patients (52 eyes) with non-neovascular juvenile glaucoma who had Molteno implant surgery when they were between 9 and 49 years old. Patients were treated between 1977 and 2003.

A total of 55 operations were included in the analysis. The average follow-up was 12.2 years. Mean visual acuity preoperatively was 20/100. The mean IOP preoperatively was 29.7 mm Hg. The main outcome measures were IOP and visual acuity.

Inserting the Molteno implant controlled IOP (defined as less than 21 mm Hg) in 40 of the 55 cases at final follow-up, the authors said. The mean visual acuity improved to 20/60 at year 1, and stabilized at 20/120 at the 5-, 10- and 15-year follow-ups.

Preoperative visual acuity was maintained or improved in 29 of the 52 eyes at final follow-up; the acuity of 17 eyes deteriorated by final follow-up, but had at least light perception.

One or more intraocular procedures were carried out in 29 cases; the implant was removed in two cases.

The authors said this study represents the longest follow-up to date. Most other studies have reported follow-ups of less than 1 year to 3.7 years, they said.

The study is published in the December issue of Ophthalmology.