What is new after 40 years of glaucoma implants.

Forty years ago, Molteno introduced the prototype of the present day long tube implant. Since then, modifications in size and shape and introduction of valve system have taken place. Aqueous has been shown to contain proinflammatory substances that have been shown to influence the thickness of the bleb wall, and the hypertensive phase has been seen with the implants. The effect of the aqueous may be modified by the use of systemic antiinflammatory medication or by surgical modification, namely supra-Tenon insertion of the implant. Recent studies have shown that tube implantation is as efficacious as trabeculectomy in patients who were either pseudophakic or earlier had failed filters. Newer nontube implants, such as the Express shunt, have been introduced along with others, such as the gold micro shunt implant and the iStent, presently in clinical trials.