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Abstract #20415 Published in IGR 10-1
The last 11 years of Molteno implantation at the University of Cape Town. Refining our indications and surgical technique
Woodcock MG; Richards JC; Murray ADEye 2008; 22: 18-25
AIMS: To analyse outcomes, factors influencing surgical success, and surgical technique of Molteno implantation over the past 11 years in order to identify ways of improving long-term control. METHODS: Retrospective interventional review of case records of all consecutive patients undergoing Molteno implantation at Groote Schuur Hospital between 1/1/1991 and 31/12/2002. Data were recorded on an MSAccesstrade mark database and processed using Kaplan-Meier survival curves and life table analysis. RESULTS: We analysed 162 consecutive single-phase Molteno tube implantation procedures on 157 eyes of 148 patients with mean follow-up of 2.9 years. Intraocular pressure (IOP) dropped from a mean of 43.3 at booking to 19.1 at final follow-up. Overall 'complete success' was achieved in 30% and 'partial success' in 16%. A high preoperative IOP was a significant predictor of a high postoperative pressure. Pseudophakic patients had significantly better postoperative pressure control. Neovascular glaucoma was a risk factor for poor pressure control. Race, gender, previous surgery, uveitis, and trauma did not influence surgical outcome. Follow-up adjusted incidence of 2.4 cases of endophthalmitis per patient year was unexpectedly high. Tubes that migrated had been secured with absorbable sutures in 4/5 cases. CONCLUSIONS: In this study, high preoperative IOPs were probably a significant contributing factor to relatively poor postoperative pressure control. Addressing this issue may aid in improving outcomes in future surgery. The high postoperative pressure outcomes suggest that single plate Molteno implantation is not an ideal way of achieving low target pressure in third world glaucoma patients.
Dr. M.G. Woodcock, Department of Surgery, Division of Ophthalmology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, West Midlands, UK
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
