Implante de Molteno e transplante penetrante de córnea

Implante de Molteno e transplante penetrante de córnea


Paulo E. C. Dantas,
Ralph Cohen,
M. Cristina Nishiwaki-Dantas,
Carmo Mandia Jr,
Geraldo Vicente de Almeida


Arquivos Brasileiros de Oftalmologia

versão impressa ISSN 0004-2749versão On-line ISSN 1678-2925

Arq. Bras. Oftalmol. vol.62 no.1 São Paulo fev. 1999



To describe our early clinical surgical experience with the combined procedure of penetrating keratoplasty and aqueous humor dra inage device in the treatment of refractory glaucoma associated with corneal disease.


Fifteen eyes from 15 patients with refracto ry glaucoma associated with corneal opacities were submitted to combined surgery, penetrating keratoplasty and Molteno implant. We evaluated best corrected visual acuity (BCVA), tonometry and biomicroscopy, correlating them to treatment effectiveness and corneal transparency of the donor tissue during the observation period.


Effective TOP lowe ring was present in 14 (93.3 %) treated eyes. BCVA improved in 12 (80 %) patients, remained the sarne in 2 (13.3 %) patients and worsened in 1 (6.6%). Thirtteen (86. 6%) of the donor corneas remained clear until th e end of the follow-up. Main complications were high IOP (1 case), retrocorneal membrane (1 case) and endothelial touch (2 cases).


Combined penetrating keratoplasty and Molteno implant is an effective alternative in the treatment of patients with refractory glaucoma and associated corneal disease.

Keywords: Aqueous drainage device; Molteno implant; Glaucoma; Corneal transplant


1 McDonnel PJ, Robin JB, Schanzlin DJ, Minckler D, Baerveldt G, Smith RE, Heuer D. Molteno implant for control of glaucoma in eyes after penetrating keratoplasty. Ophthalmology 1988;95:364-9.
2 Beebe WE, Starita RJ, Felman RL, Lynn JR, Gellender H. The use of Molteno implant and anterior chamber tube shunt to encircling band for the treatment of glaucoma in keratoplasty patients. Ophthalmology 1990;97(1 1):1414-22.
3 Kirkness CM, Steel AD, Ficker LA, Rice NSC. Coexistent corneal disease and glaucoma managed by either drainage surgery and subsequent keratoplasty or combined drainage surgery and penetrating keratoplasty. Br J Ophthalmol 1992;76:146.
4 Sherwood MB, Smith MF, Driebe WT, Stern GA, Beneke JA, Zam ZS. Drainage tube implants in the treatment of glaucoma following penetrating keratoplasty. Ophthalmic Surg 1993;24:185-9.
5 Rapuano CJ, Schmidt CM, Cohen EJ, Rajpal RK, Raber IM, Katz LJ, Wilson RP, Laibson PR, Kremer I. Results of alloplastic tube shunt procedures before, during, or after penetrating keratoplasty. Cornea 1995;14(1):26-32.
6 Olson RJ, Kaufman HE. A mathematical description of causative factors and prevention of elevated intraocular pressure after keratoplasty. Invest Ophthalmol Vis Sei 1977;16:1085-92.
7 Omi CA, de Almeida GV, Cohen R, Mandia Jr C, Kwitko S. Modified Shocket implant for refractory glaucoma: experience of 55 cases. Ophthalmology 1991;98:221-4.
8 Hodkin MJ, Goldblatt WS, Burgoyne CF, Bali SF, lnsler MS. Early clinical experience with the Baerveldt implant in complicated glaucomas. Am J Ophthalmol 1995;1(20):32-40.
9 Omi CA, de Almeida GV, Kwitko S, Cohen R, Mandia Jr C. Implante de Schocket modificado para o controle do glaucoma pós-ceratoplastia penetrante. Arq Bras Oftal 1990;53(4):155-7.
10 De Almeida GV, Omi CA, Mandia Jr C, Cohen R, Kwitko S. Experiência inicial com o implante de Molteno em glaucomas refratários. Arq Bras Oftal 1990;53(3):101-4.