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September 1992

Surgical Options in High-Risk Patients-Reply

Author Affiliations

New York, NY
Bethesda, Md

Arch Ophthalmol. 1992;110(9):1197. doi:10.1001/archopht.1992.01080210015003

In Reply.  —We thank Dr Higgenbotham for her observations and agree with her statement that alternatives to implant procedures do exist for the management of refractory glaucoma. We did not imply that Molteno implantation was the only treatment for refractory glaucoma, and we also believe controlled studies are needed comparing the effectiveness of Molteno implants and filtering surgery with the use of antifibrosis medication, namely mitomycin-C and/or fluorouracil. Dr Rubin has been pursuing the initiation of such a study at the National Institutes of Health.In her statement that "Molteno implantation is certainly not without its own complications," Dr Higgenbotham seems to be implying that filtration surgery with the use of antifibrosis medication is associated with lower morbidity. We do not believe that the complications associated with filtration surgery and antifibrosis medication result in lower morbidity than do those associated with Molteno implantation, and as of yet, there is no

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