Molteno implantation for secondary glaucoma in juvenile rheumatoid arthritis.

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Abstract
Objective: To evaluate the outcome of Molteno implantation in secondary glaucoma associated with juvenile rheumatoid arthritis. Methods: Between January 1, 1986, and December 1, 1996, 27 eyes of 19 consecutive patients with secondary glaucoma due to juvenile rheumatoid arthritis received a Molteno implant. The diagnosis of juvenile rheumatoid arthritis was made according to the American Rheumatism Association criteria. Results: At the end of the follow-up (mean, 40 months; range, 6-116 months), the mean (±SD) postoperative intraocular pressure (IOP) (14.4±4.3 mm Hg) was statistically significantly lower than the preoperative IOP (38.3±5.6 mm Hg) (P<.001). The Snellen visual acuity remained within 1 line of the preoperative level or improved in 23 (85%) of 27 eyes. A successful outcome (defined as a final IOP of ≥6 mm Hg and ≤22 mm Hg, with fewer than or an equal number of antiglaucoma medications as preoperatively) was achieved in 24 (89%) of 27 eyes. Life-table analysis success rates were 95% after 27 months and 90% after 52 months of follow-up. Postoperative complications included flat anterior chamber (3 eyes), tube block by iris or vitreous (3 eyes), cataract (3 eyes), cornea-tube touch (2 eyes), choroidal detachment (1 eye), corneal edema (1 eye), and corneal abrasion (1 eye). Conclusion: The Molteno implant is useful and well tolerated in controlling IOP in patients with glaucoma secondary to juvenile rheumatoid arthritis.