Abstract
The use of double-plate Molteno tubes is well established in the management of intractable glaucoma, particularly in eyes that may have had previous surgical procedures, often involving the superior conjunctiva with subsequent sUbconjunctival scarring. As it is frequently the case that the area of least scarring is inferiorly, we have sited the tubes there but have found that, although this usually provides good control of intraocular pressure, successful drainage of aqueous has been associated with the development of hypertropia due to upward displacement of the globe by fluid encapsulated around the plates. We report a retrospective study of 16 eyes undergoing inferiorly sited double-plate Molteno tubes, in which 9 eyes developed significant hypertropia at a mean time after insertion of 3.5 months. Mean degree of hypertropia was 9.8 prism dioptres. The management of this complication is discussed.
Similar content being viewed by others
Article PDF
References
Ancker E, Molteno ACB : Molteno drainage implant for neovascular glaucoma. Trans Ophthalmol Soc UK 1982, 102: 122–4.
Brown RD, Cairns JE : Experience with the Molteno long tube implant. Trans Ophthalmol Soc UK 1983, 103: 299–312.
Freedman J : Scleral patch grafts with Molteno setons. Ophthalmic Surg 1987, 18: 532–4.
Heuer DK, Abrabs DA, Baarvelot G, et al: Randomized clinical trial of single and double plate Molteno implants in patients with poor clinical prognosis. Invest Ophthalmol Vis Sci 1989, 30 (Suppl): 282.
Minckler DS, Heuer DK, Hasty B, et al: Clinical experience with the Molteno implant in complicated glaucomas. Ophthalmology 1988, 95: 1180–8.
Molteno ACB : Use of Molteno implants to treat secondary glaucoma. In: Cairns JE, editor. Glaucoma. vol 1. London: Grune and Stratton, 1986, pp. 211–38.
Traverso CE, Tomey FK, Al-Karf A, et al: The Molteno draining implant for the management of complicated glaucoma cases. Ophthalmology 1987, 94 (Suppl): 80.
Melamed S and Fiore PM : Molteno implant surgery in refractory glaucoma. Surv Ophthalmol 1990, 34: 441–8.
Molteno ACB : The optimal design of drainage implants for glaucoma. Trans Ophthalmol Soc NZ 1981, 33: 39–41.
Mets MB, Wendell ME, Gieser RG : Ocular deviation after retinal detachment surgery. Am J Ophthalmol 1985, 99: 667–72.
Arruga A : Motility disturbances induced by operations for retinal detachment. Mod Prob Ophthalmol 1977, 18: 404–14.
Kanski JJ, Elkington AR, Davies MS : Diplopia after retinal detachment surgery. Am J Ophthalmol 1973, 76: 38–40.
Sewell JJ, Knoblock WH, Eifrig DE : Extraocular muscle imbalance after surgical treatment for retinal detachment. Am J Ophthalmol 1974, 78: 321–3.
Wolff SM : Strabismus after retinal detachment surgery. Trans Am Ophthalmol Soc 1983, 81: 182–92.
Munoz M, Rosenbaum AL : Long-term strabismus complications following retinal detachment surgery. J Pediatr Ophthalmol Strabismus 1987, 24: 309–14.
Smiddy WE, Loupe D, Michels RG, et al: Extraocular muscle imbalance after scleral buckling surgery. Ophthalmology 1989, 96: 1485–9.
Sternberg P, Aguilar H, Drews C, Aaberg TM : The effect of tissue plasminogen activator on retinal bleeding. Arch Ophthalmol 1990, 108: 720–2.
Williams GA, Lambrou FH, Jaffe GA, et al: Treatment of postvitrectomy fibrin formation with intraocular tissue plasminogen activator. Arch Ophthalmol 1988, 106: 1055–8.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wilson-Holt, N., Franks, W., Nourredin, B. et al. Hypertropia following insertion of inferiorly sited double-plate Molteno tubes. Eye 6, 515–520 (1992). https://doi.org/10.1038/eye.1992.109
Issue Date:
DOI: https://doi.org/10.1038/eye.1992.109