Molteno tube shunt with pericardial patch graft

Refractory glaucoma is commonly defined as glaucoma no longer responsive to medical or laser therapy, with the progression of visual field loss. Patients with long-standing glaucoma have not only angle pathology but also distal disease in the collector channels, making trabecular meshwork bypass procedures mostly inadequate for IOP control. Refractory glaucoma requires a procedure that directs aqueous from inside the eye to outside the eye. Tube shunts are either valved or non-valved. The advantage of valved tube shunts include less incidence of postoperative hypotony and not having to block the tube; however the downside is less pressure lowering effect and a higher incidence of the hypertensive phase. Non-valved tube shunts offer better long-term pressure control; however patients require more postoperative visits as well as a method of releasable tube occlusion. Supra-Tenon's placement of the Molteno 35 tube shunt has been designed to decrease the fibrosing effect of Tenon's capsule.