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

Abstract

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 +/- 18.4 months. Preoperatively, the mean +/- SD IOP was 32.8 +/- 7.5 mmHg (range 20-48), and the mean number of medications was 3.1 +/- 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.