Internal Suture Occlusion of the Molteno Glaucoma Implant for the Prevention of Postoperative Hypotony

The Molteno glaucoma drainage implant procedure is useful for managing refractory glaucoma, but a significant concern has been the avoidance of postoperative hypotony due to temporary excessive filtration. We have developed a method of temporarily closing the translimbal tube with an internally-placed occluding suture (4-0 or 5-0 chromic). Seven to 12 days later this suture was removed, without surgery, in an outpatient setting. We have used this method on 30 patients. The advantages are that postoperative hypotony is reduced, and the Molteno drainage implant can be inserted in a single operation.