Molteno implant versus trabeculectomy with adjunctive intreoperative mitomycin-C in high-risk glaucoma patients.

PURPOSE

The Molteno implant is one of the most widely used drainage devices for the management of complicated glaucoma. Antiproliferative agents such as mitomycin-C (MMC) have markedly improved the outcome of glaucoma filtering surgery. This case control study compares the results of these two techniques in the management of high-risk glaucoma patients.

METHODS

Forty-three consecutive patients with complicated glaucoma who underwent glaucoma filtration surgery with intraoperative application of 0.3 mg/ml of MMC were matched with a control group of 43 glaucoma patients who previously had tube surgery using a single-plate Molteno drainage implant in most of the cases. Control patients were matched based on diagnostic group of glaucoma, the number of prior filtration surgeries, and patient age. All patients had a minimum follow-up time of 12 months.

RESULTS

Intraocular pressure (IOP) +/- 21 mm Hg was achieved 6 months postoperatively in 34 patients (79.1%) with Molteno implant and in 38 (88.4%) treated with MMC (p < 0.2), and 12 months postoperatively in 26 (60.5%) and 35 (81.4%) patients, respectively (p < 0.03). Complications after Molteno implant included hypotony (20.9%), flat anterior chamber (11.6%). tube-cornea touch (6.9%), and tube exposure (4.7%); after MMC, hypotony occurred in 6.9% and flat anterior chamber in 2.3%

CONCLUSIONS

A significantly greater reduction in IOP was noticed in MMC-treated eyes 12 months postoperatively. Complications occurred more frequently in the Molteno-treated eyes. Filtration surgery with adjunctive MMC therapy seems to have a higher benefit/risk ratio in the management of highrisk glaucoma.