Molteno Implantation for Secondary Glaucomas Associated with Advanced Epithelial Ingrowth

Nine patients with advanced epithelial ingrowth underwent Molteno implantation for medically uncontrollable secondary glaucomas. Substantial reductions in intraocular pressures (IOPs) were observed in most patients (preoperative IOPs ranged from 5 to 48 mmHg [mean ± standard deviation, 33.6 ± 14.6 mmHg]; postoperative IOPs ranged from 10 to 30 mmHg [mean ± standard deviation, 16.0 ± 6.5 mmHg]); follow-up ranged from 9 to 47 months (mean ± standard deviation, 18.8 ± 12.1 months). Seven (78%) patients had final postoperative IOPs of less than 22 mmHg, five (56%) retained formed vision (visual acuity of at least 1/200), and six (67%) remained comfortable. Postoperative complications related to Molteno implantation included one case each of: conjunctival wound leak, vitreous-tube block, tube-cornea touch, and iris-tube block (or tube retraction). Complications attributed to epithelial ingrowth included five cases of corneal decompensation with band keratopathy. Molteno implantation is an effective technique for palliative treatment of secondary glaucomas associated with advanced epithelial ingrowth, frequently maintaining modest vision and comfort in eyes in which the intraocular epithelialization is too extensive for surgical removal and/or destruction.