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1 General aspects (0)   1.1 Epidemiology (11)   1.2 Population genetics (0)   1.3 Pathogenesis (4)   1.4 Quality of life (12)   1.5 Glaucomas as cause of blindness (5)   1.6 Prevention and screening (9) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (4)   2.2 Cornea (18)   2.3 Sclera (4)   2.4 Anterior chamber angle (4)   2.5 Meshwork (0)     2.5.1 Trabecular meshwork (7)     2.5.2 Schlemms canal (1)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (1)     2.6.1 Production (0)     2.6.2 Outflow (2)       2.6.2.1 Trabecular meshwork (1)       2.6.2.2 Uveoscleral (0)     2.6.3 Compostion (1)   2.7 Episcleral veins and venous pressure (1)   2.8 Iris (2)   2.9 Ciliary body (1)   2.10 Lens (0)   2.11 Vitreous body (1)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (1)   2.13 Retina and retinal nerve fibre layer (16)   2.14 Optic disc (8)   2.15 Optic nerve (1)   2.16 Chiasma and retrochiasmal central nervous system (9)   2.17 Stem cells (1)   2.20 Other (0) 3 Laboratory methods (0)   3.1 Microscopy (2)   3.2 Electron microscopy (4)   3.3 Immunohistochemistry (5)   3.4 Molecular genetics (0)     3.4.1 Linkage studies (0)     3.4.2 Gene studies (33)   3.5 Molecular biology incl. SiRNA (16)   3.6 Cellular biology (22)   3.7 Biochemistry (5)   3.8 Pharmacology (5)   3.9 Pathophysiology (10)   3.10 Immunobiology (2)   3.11 Pharmacogenetics (0)   3.12 Proteomics (1)   3.13 In vivo imaging (0)     3.13.1 Laser Scanning (0)       3.13.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       3.13.1.2 Confocal Scanning Laser Polarimetry (0)     3.13.2 Optical Coherence Tomography (0)       3.13.2.1 Anterior Segment (0)       3.13.2.2 Posterior Segment (0)     3.13.3 RGC Imaging (0)     3.13.4 Other (0)   3.20 Other (0) 4 Tissue culture of ocular cells (0) 5 Experimental glaucoma; animal models (1)   5.1 Rodent (24)   5.2 Primates (7)   5.3 Other (21) 6 Clinical examination methods (0)   6.1 Intraocular pressure measurement; factors affecting IOP (0)     6.1.1 Devices, techniques (9)     6.1.2 Fluctuation, circadian rhythms (6)     6.1.3 Factors affecting IOP (13)   6.2 Tonography, aqueous flow measurement (see also 2.6) (1)   6.3 Biomicroscopy (slitlamp) (0)     6.3.1 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8 Refractive errors in relation to glaucoma (0)   8.1 Myopia (1)   8.2 Hypermetropia (0)   8.3 Contact lenses (0)   8.4 Refractive surgical procedures (1)   8.5 Other (0) 9 Clinical forms of glaucomas (0)   9.1 Developmental glaucomas (1)     9.1.1 Congenital glaucoma, Buphthalmos (4)     9.1.2 Juvenile glaucoma (7)     9.1.3 Syndromes of Axenfeld, Rieger, Peters, aniridia (3)     9.1.4 Other (0)   9.2 Primary open angle glaucomas (0)     9.2.1 Ocular hypertension (3)     9.2.2 Other risk factors for glaucoma (1)     9.2.3 Open angle glaucoma with elevated IOP (2)     9.2.4 Normal pressure glaucoma (17)   9.3 Primary angle closure glaucomas (0)     9.3.1 Acute primary angle closure glaucoma (pupillary block) (12)     9.3.2 Chronic primary angle closure glaucoma (pupillary block) (3)     9.3.3 Plateau iris syndrome (0)     9.3.4 Primary angle closure suspect (2)     9.3.5 Primary angle closure (0)     9.3.10 Other (0)   9.4 Glaucomas associated with other ocular and systemic disorders (0)     9.4.1 Steroid-induced glaucoma (8)     9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (1)       9.4.2.1 Iridocorneal endothelial syndrome (ICE, incl. irisatrophy) (0)       9.4.2.2 Posterior polymorphous dystrophy (0)       9.4.2.3 Fuchs' endothelial dystrophy (1)       9.4.2.5 Other (0)     9.4.3 Glaucomas associated with disorders of the iris and ciliary body (0)       9.4.3.1 Pigmentary glaucoma (3)       9.4.3.5 Other (3)     9.4.4 Glaucomas associated with disorders of the lens (0)       9.4.4.1 Exfoliation syndrome (10)       9.4.4.2 Glaucomas associated with cataracts (0)       9.4.4.3 Glaucomas associated with lens dislocation (2)       9.4.4.5 Other (2)     9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous (0)       9.4.5.1 Neovascular glaucoma (16)       9.4.5.5 Other (7)     9.4.6 Glaucomas associated with inflammation, uveitis (4)     9.4.7 Glaucomas associated with ocular trauma (5)     9.4.8 Glaucomas associated with intraocular tumors (0)     9.4.9 Glaucomas associated with elevated episcleral venous pressure (0)       9.4.10 Glaucomas associated with hemorrhage (2)     9.4.11 Glaucomas following intraocular surgery (0)       9.4.11.1 Ciliary block (malignant) glaucoma (1)       9.4.11.2 Glaucomas in aphakia and pseudophakia (4)       9.4.11.3 Epithelial, fibrous, and endothelial proliferation (0)       9.4.11.4 Glaucomas associated with corneal surgery (6)       9.4.11.5 Glaucomas associated with vitreoretinal surgery (7)     9.4.15 Glaucoma in relation to systemic disease (26)     9.4.20 Other (1) 10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy (2) 11 Medical treatment (0)   11.1 General management, indication (4)   11.2 Cholinergic drugs (0)   11.3 Adrenergic drugs (0)     11.3.1 Epinephrine (0)     11.3.2 Thymoxamine, dapiprazole (0)     11.3.3 Apraclonidine, brimonidine (1)     11.3.4 Betablocker (13)     11.3.5 Other (0)   11.4 Prostaglandins 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    12.8.1 Without tube implant (18)     12.8.2 With tube implant or other drainage devices (23)     12.8.3 Non-perforating (5)     12.8.4 Using laser (0)     12.8.5 Other (0)     12.8.10 Woundhealing antifibrosis (14)     12.8.11 Complications, endophthalmitis (9)   12.9 Trabeculotomy, goniotomy (1)   12.10 Cyclodestruction (5)   12.11 Cyclodialysis (0)   12.12 Cataract extraction (0)     12.12.1 Intracapsular (0)     12.12.2 Extracapsular (0)     12.12.3 Phacoemulsification (7)   12.14 Combined cataract extraction and glaucoma surgery (0)     12.14.1 Intracapsular (0)     12.14.2 Extracapsular (0)     12.14.3 Phacoemulsification (15)   12.15 Capsulotomy (0)   12.16 Vitrectomy (0)   12.17 Anesthesia (3)   12.20 Other (9) 13 Therapeutic prognosis and outcome (0)   13.1 Prognostic factors (0)   13.2 Outcome (0)     13.2.1 IOP (1)     13.2.2 Visual field (0)       13.2.2.1 Progression (2)       13.2.2.2 Improvement (0)     13.2.3 Other (0) 14 Costing studies; pharmacoeconomics (7) 15 Miscellaneous (8)

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Abstract #25604 Published in IGR 12-1

Molteno aqueous shunt as a primary surgical intervention for uveitic glaucoma: Long-term results

Vuori M -L
Acta Ophthalmologica 2010; 88: 33-36

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Purpose: To evaluate the efficacy of Molteno aqueous shunt as a primary surgical treatment in uveitic glaucoma. Methods: Nonrandomized, interventional, retrospective clinical study. The intraocular pressure (IOP), survival rate and complications were analyzed in 30 patients with uveitic glaucoma treated with Molteno implant. Results: The mean follow-up time was 59.3 (plus or minus) 18.4 months. Preoperatively, the mean (plus or minus) SD IOP was 32.8 (plus or minus) 7.5 mmHg (range 20-48), and the mean number of medications was 3.1 (plus or minus) 0.6. The mean IOP decreased significantly (p < 0.001) to 17.7 and 15 mmHg at 3 and 6 months postoperatively. The mean number of medications decreased statistically significantly (p < 0.001) from the preoperative number 3.1 to 1.9 three months postoperatively. The number of medications continued to decrease significantly up to 3 years postoperatively. The qualified success rate (Kaplan-Meier estimate) was 97%, 93%, 90% and 85% at 1, 2, 3 and 4 years, respectively. Two patients failed because of hypotony, two patients developed conjunctival erosion and one patient had corneal decompensation. Conclusions: Molteno aqueous shunt as the first glaucoma procedure decreased IOP effectively in uveitic glaucoma. Even after 4 years, the survival estimate was quite high. The IOP decreased continuously during the first year after the surgery, and the medication was slowly tapered even up to 3 years postoperatively. It is suggested that it may be possible to postpone further surgical intervention during the first postoperative year after Molteno implantation even if the IOP is not quite optimal.

M.-L. Vuori. Department of Ophthalmology, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland. marja-liisa.vuori@tyks.fi

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Classification:

9.4.6 Glaucomas associated with inflammation, uveitis (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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