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Molteno 3 Glaucoma Drainage Device for POAG - Part 4

by Anup Khatana MD

Anup Khatana, MD, presents a 58-year-old Caucasian woman presents with primary open angle glaucoma. The IOP rose to 50mm mercury leading to an emergency trabeculectomy with Mitomycin-C and repeat selective laser trabeculoplasty. The patient developed hypotony that slowly improved over an 8 to 10 month period. One day after phaco, her IOP rose to 25mm mercury and one month postperatively rose to 33 on Cosopt (dorzolamide hydrochloride-timolol maleate ophthalmic solution). Pressure dropped to 28mm after the addition of Diamox (Acetazolamide Oral). A needling revision of the trab with an adjunctive subconjunctival injection of Mytomicin-C was performed 6 weeks after the phaco. IOP dropped to 4mm mercury the day after needling but increased to 33mm mercury one week later. A 230 mm square Molteno3 tube shunt was chosen because of the need for low IOP as well as the desire to avoid problems with postoperative hypotony due to her past history.

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