Mills R P, Reynolds A, Emond M J, Barlow W E, Leen M M
Department of Phthalmology, University of Washington, Seattle, WA 98195-6485, USA.
Ophthalmology. 1996 Feb;103(2):299-305. doi: 10.1016/s0161-6420(96)30700-8.
To evaluate the long-term outcome of the Molteno implant drainage device using survival analysis.
A retrospective chart review was performed on 77 eyes of 71 patients that underwent Molteno implantation for intractable glaucoma unresponsive to conventional management from October 1984 to April 1990 at the University of Washington Eye Center and had at least 6 months of follow-up data. Success was defined as a postoperative intraocular pressure of 22 mmHg or lower with (qualified success) or without (complete success) glaucoma medications and no additional glaucoma surgery, phthisis, or loss of light perception.
The median follow-up was 44 months (range, 6-107 months). Indications for Molteno implantation were aphakia/pseudophakia (n=24), neovascular glaucoma (n=20), uveitic glaucoma (n=12), failed trabeculectomy (n=9), traumatic glaucoma (n=8), and congenital glaucoma (n=4). The total success was 57% (23% complete; 34% qualified) at the last follow-up. Kaplan-Meier survival curves demonstrated a continuous and relatively linear attrition of success over at least 5 1/2 postoperative years. The uveitic glaucoma group had the highest success rate of 75%. Eyes with neovascular glaucoma failed significantly more frequently than those with uveitic glaucoma (P<0.01). There was no significant difference in outcome based on sex, race, single versus double plate, anterior chamber versus posterior chamber tube placement, or two-stage versus single-stage surgery. Younger age was associated with a significantly higher failure rate after controlling for glaucoma category (P<0.01).
The Molteno implant drainage device offers a reasonable long- term outcome in eyes with intractable glaucomas. However, an ongoing rate of failure, not unlike that seen after other filtration surgery, is to be expected.
采用生存分析评估莫尔顿植入引流装置的长期效果。
对1984年10月至1990年4月在华盛顿大学眼科中心因传统治疗无效而行莫尔顿植入术治疗难治性青光眼的71例患者的77只眼进行回顾性病历审查，且这些患者至少有6个月的随访数据。成功定义为术后眼压在使用（合格成功）或不使用（完全成功）青光眼药物的情况下为22 mmHg或更低，且未进行额外的青光眼手术、眼球痨或无光感。
中位随访时间为44个月（范围6 - 107个月）。莫尔顿植入术的适应证包括无晶状体/人工晶状体眼（n = 24）、新生血管性青光眼（n = 20）、葡萄膜炎性青光眼（n = 12）、小梁切除术失败（n = 9）、外伤性青光眼（n = 8）和先天性青光眼（n = 4）。末次随访时总成功率为57%（完全成功23%；合格成功34%）。Kaplan-Meier生存曲线显示，术后至少5年半成功情况呈持续且相对线性的下降。葡萄膜炎性青光眼组成功率最高，为75%。新生血管性青光眼的眼比葡萄膜炎性青光眼的眼失败频率显著更高（P < 0.01）。基于性别、种族、单盘与双盘、前房与后房置管、两期与一期手术的结果无显著差异。在控制青光眼类型后，年龄较小与失败率显著较高相关（P < 0.01）。
莫尔顿植入引流装置为难治性青光眼患者提供了合理的长期效果。然而，与其他滤过性手术后所见情况类似，失败率仍会持续存在。
