MOLTENO® Ophthalmic Ltd

Founded by Professor Anthony Molteno®, whose ground-breaking glaucoma research has resulted in the hugely successful Molteno® glaucoma implants that are used worldwide today.

Molteno® glaucoma implants are the most refined, most effective and most studied glaucoma drainage devices in the world with clinical research in thousands of patients over thirty years . The Molteno3® implants distil that research into a single device that is slimmer, easier to implant and as effective at reducing intraocular pressure than competing devices .

Molteno® implants are produced in a purpose built facility In Dunedin, New Zealand to the highest levels of tolerance and sterility and meet strict ISO 13485, and CE 0344 standards.

AlexMed is introducing the new generation

Molteno3® S-series Single Plate Implant (SS & SL)

Molteno® Ophthalmic Ltd manufactures the most versatile, safe and effective glaucoma drainage devices with the longest and most comprehensive follow-up of any glaucoma devices on the market . Glaucoma drainage devices are also known as glaucoma shunts, drains or implants

Molteno3® SL(left) and SS glaucoma implants
Molteno3® S-series implant diagrams

 

Many leading glaucoma surgeons now prefer the Molteno3® S-series implants which feature:

  • New anterior suture hole position for fast, easy insertion
  • Two sizes (185 and 245mm2), the smaller SS implants are suitable for most cases
  • Translimbal, pars plana and 'piggy-back' insertion options with one implant
  • Can be positioned supra-Tenon's if necessary.
  • Single plate simplicity with double plate performance .
  • Single quadrant surgery with a low profile implant that slips easily into place between and slightly beneath the adjacent extraocular muscles.
  • Flexible and shaped to fit the eyeball
  • Immediate or delayed drainage (using absorbable suture +/- relieving slit ).
  • Pressure ridge reduces the risk of post-operative hypotony: restricts initial aqueous drainage to the small primary drainage area until the IOP rises sufficiently to lift the tissues and allow drainage of aqueous over the entire plate
  • Pressure ridge and plate design give a permeable bleb with excellent long term control of intraocular pressure .
  • Self-cleaning patented 'biological valve' resists blockage by inflammatory exudate, blood clot or fibroblast ingrowth, unlike a mechanical valve .
  • Suited to cases with large eyes and little space in the orbit
  • The pressure ridge on the Molteno3® S-series implants has been lowered and rounded to reduce the risk of erosion when the implant is placed supra-Tenon's or when the Tenon's tissue and conjunctiva are compromised or poor healing may be expected.
  • MRI safe

 

The Molteno3® implant range is usually used with an absorbable suture ligature (Vicryl® tie, to delay drainage, except when treating urgent cases of acutely raised intraocular pressure, neovascular glaucoma, silicone oil induced glaucoma and a few cases where inflammatory exudate or blood is present in the eye.

Molteno® glaucoma implants compared to trabeculectomy
A guide to selecting the ideal Molteno® glaucoma implant

Hypotensive medication before and after Molteno® Implant surgery:

Before surgery:

Control the intraocular pressure (IOP) optimally to minimise operative complications.

From surgery until the onset of drainage:

Maintain the IOP in the mid-range, around 15mmHg is ideal in most cases.

Once drainage commences, and in all cases with immediate drainage:

Control inflammation, if present, and allow the IOP to rise above 15mmHg (above the episcleral venous pressure). This triggers the process which lea¬ds to a more permeable bleb capsule and long-term control of IOP.

From 3 months postoperatively:

Aim to keep the IOP in the low-normal range (8-12mmHg). When the IOP is well controlled in the months and years after Molteno® Implant surgery, using hypotensive agents if necessary, there is a tendency for increasing permeability of the bleb lining to occur over the long term, reducing the IOP further and decreasing the need for hypotensive medication.

CAUTION:

Up to 3 months after Molteno® implant surgery, miotics, prostaglandin analogues and other topical vasodilating agents should be used with caution as they may increase the episcleral venous pressure and thus increase fibrous tissue deposition and the likelihood of bleb failure.

Medical management to promote successful outcomes long term

The Molteno® 3 Glaucoma Implant for effective long term control of IOP

Surgical Demonstration by Prof. Anthony Molteno®

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