Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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 source (direct Gemma or distilled Codex), 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".