The long-tube single plate Molteno implant for the treatment of recalcitrant glaucoma

One hundred cases of recalcitrant glaucoma were operated with a long tube single-plate Molteno implant (LSMI). At the median follow-up of 15 months an intraocular pressure of less than or equal to 19 mm Hg was obtained in 64 of the 87 eyes (73%) which have a minimum follow-up of 6 months (secondary non-neovascular glaucomas = 19; congenital glaucomas = 26; secondary neovascular glaucomas = 12). The interval probability (percentage +/- standard error) of obtaining a successful result (IOP less than or equal to 19 mm Hg) was 79% (+/- 13) at twelve months from surgery, and 53% (+/- 24) at the eighteen month interval. The least favorable results were obtained in the secondary non-neovascular glaucomas. Complications observed included choroidal detachment (24%), tube exposure (4%), tube-endothelium contact (6%), plus band keratopathy, fibrous ingrowth, traction retinal detachment and corneal ulcers. Seventeen cases needed repeated surgery for the management of complications. In order to decrease the post-operative hypotony, we have been using a tourniquet suture around the tube at the time of implantation to occlude it temporarily and limit the outflow.