Notice bibliographique
Résumé
Broadway DC, Iester M, Schulzer M, Douglas GR. Survival analysis for success of Molteno tube implants. Br J Ophthalmol 2001; 85:689–695. Original study reprint requests: D. Broadway, Department of Ophthalmology, Norfolk & Norwich Healthcare Trust, West Norwich Hospital, Bowthorpe Road, Norwich, Norfolk NR2 3TU, UK. Research Objective To apply survival analysis in assessing the long-term outcome of Molteno tube implantation and to identify risk factors for failure. Study Design A retrospective, consecutive case series study. Location University of British Columbia, Vancouver, Canada. Funding Sources Supported by the Frost Trust, London, UK, the Norwich Glaucoma Research Fund, Norwich, UK, and the University of Genoa, Italy. Relevant Methodology Patient records of 119 eyes that had undergone Molteno tube implantation over a 10-year period were reviewed. Outcome Measures Intraocular pressure (IOP), visual acuity, and complications. Results A 30% or greater reduction in IOP was achieved in 68.9% of eyes that had undergone Molteno tube implantation. The overall, “completer success” rate (IOP <22 mmHg with no medications) after a mean (SD) follow-up period of 43 (33) months (range: 6–120) was only 33.6%, despite a decrease in mean (SD) IOP from 38.2 (8.2) mmHg to 20.1 (11.0) mmHg. The “qualified success” rate (IOP <22 mm Hg with or without medications) was 60.5%. Failure was most common in the first postoperative year but could occur after several years, with the survival curve having an exponential shape. The only statistically significant risk factor for failure identified was pseudophakia, although eyes with neovascular glaucoma tended to fare poorly. Postoperative IOP tended to be lower after double-plate than after single-plate implantation. There was no significant difference in outcome based on age, sex, race, previous penetrating keratoplasty, or previous conjunctival surgery. Conclusions In eyes at high risk of trabeculectomy failure, implantation of an aqueous shunt device should be considered. Pseudophakia should be considered an additional risk factor for failure. Early failure appeared relatively more common, but long-term follow-up of all cases is recommended to ensure adequate management of late failures. Comment The authors give further credence to the notion that drainage implants are here to stay. The findings of prolonged IOP reduction in eyes with poor prognosis for trabeculectomy are convincing. Of greater importance, however, is the observation that IOP control can be achieved in poor prognosis eyes with an acceptably low complication rate. For example, fear of corneal injury or rejection after transplantation remains a major concern after drainage device implantation. Of the 24 eyes that had undergone penetrating keratoplasty before Molteno drainage surgery, 3 developed graft failure. Corneal decompensation developed in 9 of 119 eyes, 36 of which were aphakic and were likely to have been at higher risk to develop corneal endothelial dysfunction. The devastating complications of suprachoroidal hemorrhage (1/119; 0.8%) and endophthalmitis (0/119) were rarely encountered. Transient choroidal effusions (18/119; 15.1%) frequently occurred, but prolonged postoperative hypotony was uncommon, (5/119; 4.2%). Problems unique to drainage implant surgery, such as tube obstruction (10/119; 8.4%) and strabismus (3/119; 2.5%), did not permanently affect IOP control. Their complication rate compares favorably with those in follow-up reports of lesser duration. 1 The categorization of results as “complete success,” “partial success,” “qualified success,” and “complete failure,” is based on reaching predetermined IOP levels; however, it is not possible to determine the IOP outcome range of individual patients during the follow-up period. A recent report of Advanced Glaucoma Intervention Study suggests that maintenance of IOP within lower ranges, less than 18 mmHg at all times, may be associated with decreased risk of developing further visual field loss. 2 Future long-term visual field data will be required to determine whether the IOP has been lowered sufficiently after Molteno drainage implantation in most patients to prevent further progression.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,003 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».