Supra-Tenon's capsule placement of a single-plate Molteno implant

Aim: To describe clinical results of a new technique for inserting Molteno implants in a supra-Tenon's capsule location. Design: Prospective interventional case study. Participants: 19 patients, 18 of whom had suffered previous filter or glaucoma implant failure. Seventeen had open-angle glaucoma, and two had neovascular glaucoma. Seventeen patients were black and two were Asian. Intervention: All patients underwent supra-Tenon's capsule placement of a single-plate Molteno implant. Goldmann applanation tensions and Snellen visual acuities were determined before the operation and at the last follow-up visit. The numbers of preoperative and postoperative adjunctive drugs were compared before and after surgery. Main outcome measures: Success was defined as intraocular pressure <= 18 mm Hg with or without anti-glaucoma drugs. Results: Mean age was 62 years. Mean pressure before and after surgery was 31 and 16 mm Hg, respectively. Mean follow-up was 22 months (range 12-48). Vision returned to within 2 lines of preoperative vision, except in one patient who lost light perception. Surgery was regarded as a failure in four patients, including both patients with neovascular glaucoma. The difference between the median number of drugs used before (three) and after (one) the operation was significant (p < 0.001). Complications were minimal, characterised by small choroidal effusions in three patients; all resolved spontaneously. Conclusion: Supra-Tenon's capsule placement of Molteno implants in eyes with previously failed glaucoma surgery is an effective method for controlling intraocular pressure.