[Molteno/von Denffer drainage implants in therapy-refractory glaucomas].

Background: In glaucoma eyes in which the pressure regulation was not possible with drugs and surgery or which were blind already, we treated the patients with a Molteno implant by von Denffer.

Materials And Methods: In 10 years (1995 to 2004) we treated 19 eyes with a glaucoma drainage device -- the Molteno implant developed by von Denffer. The average age of the patients was 64 (range: 15 to 77) years. On average 3,1 operations were realised before the implant. The average eye pressure was 44 mm Hg preoperatively. Our patients suffered from different glaucomatous diseases: 7 primary glaucomas (congenital, open and narrow angle glaucoma) and secondary: neovascular glaucoma (4), PEX glaucoma (2), traumatic glaucoma (3) and postoperative glaucoma (3).

Results: The intraocular pressure had a successful outcome of under 20 mm Hg in 13 eyes, 5 patients out of these were treated with 1 to 3 drugs. Early complications (flat anterior chamber, hyphaema, hypotonia) were reversible. Late complications were phthisis bulbi (3), explantation of the implant (2) and one evisceration bulbi. We found an improvement of the visual acuity in 4 cases in traumatic and postoperative glaucoma. The stabilisation of visual acuity was possible in primary glaucoma.

Conclusions: The implantation of the Molteno implant by von Denffer is an ultimate ratio in eyes with persistent high intraocular pressure. A durable reduction of the pressure is possible in two-thirds and the conservation of the bulbus was achieved in three-fourths of the patients.