To the Editor.
—Freedman and Rubin,1 in their article in the October 1991 issue of the Archives, reported their results with Molteno implants as a treatment for "refractory" glaucoma in black patients. When considering any group of patients with glaucoma, it is important to keep in mind alternative treatments such as filtration surgery with adjunctive use of antimetabolites2 (eg, fluorouracil and mitomycin-C), particularly for adult patients, and a second goniotomy or trabeculotomy in cases of congenital glaucoma. It is unclear from the description of their patients if any of the previously failed 39 trabeculectomies were performed after administration of an antimetabolite. Although the authors did not note as great an incidence of choroidal detachment (among other complications) as did other authors, Molteno implantation is certainly not without its own complications. I am sure the authors will agree that the only way to clearly delineate the best management for
Higginbotham EJ. Surgical Options in High-Risk Patients. Arch Ophthalmol. 1992;110(9):1197. doi:10.1001/archopht.1992.01080210015002