Persistent Leak After Glaucoma Aqueous Shunt Implantation
Bibliographic record
Abstract
PURPOSE: To present 4 cases of persistent leak attributed to subconjunctival fistula formation after glaucoma aqueous shunt implantation. Our preferred method for management is also described. METHODS: Retrospective noncomparative case series. RESULTS: Four cases of persistent leak after glaucoma aqueous shunt surgery are described. Three patients had an underlying diagnosis of iridocorneal endothelial syndrome and 1 patient had a diagnosis of chronic panuveitis. Three patients had prior trabeculectomy with adjunctive periocular application of antiproliferative agents (mitomycin C and/or 5-fluorouracil). One patient had aqueous shunt implantation as a primary glaucoma procedure. Implantation of the Molteno (1 patient), Ahmed (2 patients), and Baerveldt (1 patient) aqueous shunts was uneventful in all cases. Early onset of the leak, between postoperative months 1 and 2, was typical. The use of aqueous suppressants, bandage contact lens, conjunctival photocoagulation, sutures, tissue adhesives, conjunctival autografts, and scleral patch grafts were unsuccessful in the described cases. Resolution of the leak occurred after removal of the aqueous shunt and elimination of the causative subconjunctival fistula. Histologic support for fistulization was obtained in 3 cases. Severe complications including endophthalmitis (1 patient), hypotony (4 patients), suprachoroidal hemorrhage (2 patients), and corneal decompensation (3 patients) occurred because of the persistent leaks. CONCLUSIONS: Persistent leak is a rare but important complication after glaucoma aqueous shunt implantation. Early consideration for the presence of a subconjunctival fistula, especially in patients with iridocorneal endothelial syndrome or chronic uveitis, can spare many ineffective efforts to repair the leak and prevent severe vision threatening complications.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".