Survival analysis for success of Molteno tube implants
D C Broadway, M Iester, M Schulzer, G R Douglas
Department of
Ophthalmology, University of British Columbia, Vancouver, Canada
Correspondence to: Dr D Broadway, Department of Ophthalmology, Norfolk & Norwich Healthcare Trust, West Norwich Hospital, Bowthorpe Road, Norwich, Norfolk NR2 3TU, UK david.broadway{at}norfolk-norwich.thenhs.com
Accepted for publication 27 November
2000
AIM
To apply survival
analysis in assessing the long term outcome of Molteno tube
implantation and to identify risk factors for failure.
METHODSA
retrospective, 10 year, consecutive case series study of 119 eyes that
underwent implantation of a Molteno tube. The main outcome measures
considered were intraocular pressure (IOP), visual acuity, and complications.
RESULTSA 30% or
greater reduction in IOP was achieved in 68.9% of cases. However, the
overall, "complete success" rate (IOP <22 mm Hg with no
medications) after a mean (SD) follow up period of 43 (33) months
(range 6-120) was only 33.6% despite a fall in mean (SD) IOP from
38.2 (8.2) mm Hg to 20.1 (11.0) mm Hg. 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, 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.
CONCLUSIONSIn 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.
© 2001 by British Journal of Ophthalmology
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