The Molteno tube shunt is the most widely used aqueous drainage device. Obstruction of the tube in the anterior chamber by fibrin, iris tissue, vitreous, or blood is a common reason for failure, with reported incidences up to 14.6%.1 Use of the neodymium (Nd)-YAG laser to open occluded tubes can be attempted before surgery is performed to restore patency in these complicated cases.2
The picosecond Nd—yttrium lithium fluoride (Nd-YLF) laser (1053 nm) (Intelligent Surgical Lasers Inc, San Diego, Calif), which uses low-energy-per-pulse levels with high repetition rates, can create optical break-down of target tissues with minimal thermal damage to adjacent structures. We report herein a case in which the picosecond Nd-YLF laser was used safely and controllably to open an occluded Molteno tube and restore aqueous drainage.
Report of a Case.
A 32-year-old man with bilateral advanced developmental glaucoma and subluxed lenses underwent uneventful doubleplate Molteno implant surgery
Oram O, Gross RL, Severin TD, Orengo-Nania S, Feldman RM. Opening an Occluded Molteno Tube With the Picosecond Neodymium-Yttrium Lithium Fluoride Laser. Arch Ophthalmol. 1994;112(8):1023. doi:10.1001/archopht.1994.01090200025010