Survival analysis for success of Molteno tube implants.

AIM: To apply survival analysis in assessing the long term outcome of Molteno tube implantation and to identify risk factors for failure. METHODS: A 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. RESULTS: A 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. 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.

Synthesis and photobiological properties of 3-acylangelicins, 3-alkoxycarbonylangelicins and related derivatives.

Convenient synthesis of 3-acyl-2H-furo[2,3-h]-1-benzopyran-2-ones, esters of 2-oxo-2H-furo[2,3-h]-1-benzopyran-3-carboxylic acid and 2H-furo[2,3-h]-1-benzopyran-3-carboxamides was accomplished via aromatization of the adducts obtained by a reaction between (E)-5-dimethyl-aminomethylene-6,7-dihydrobenzofuran-4(5H)-one and the appropriate acylacetate or dialkyl malonate. These compounds are angelicin derivatives which were prepared with the aim of obtaining intrinsically monofunctional drugs for photochemotherapy, with only one photoreactive site in their molecule. The new angelicins appear to be free of the known phototoxicity of furocoumarins on the skin and at a genetic level. The 3-carboxylic esters showed significant antiproliferative activity in Ehrlich ascites cells and T2 bacteriophage; the other derivatives were only slightly effective. The features of these compounds are such that they represent a new model for non-toxic agents for photochemotherapy.

Measurement variability in digital analysis of optic discs.

The optic disc of nine patients with typical glaucomatous disc damage and ten normal controls has been studied by means of the Optic Disc Analysis program of the Topcon Image-net System. Vertical, horizontal and average cup/disc ratio (VC/D, HC/D, AC/D), disc, cup, rim area (DA, CA, RA), cup volume (CV) have been evaluated and the coefficient of variation (COV) of multiple measurements was calculated. For intra-observer intra-image variability assessment, sterovideographs of each disc were taken once and analyzed 10 times (COV range: 1.39-12.08%). Intra-observer interimage variability was evaluated on eight stereovideographs of each disc taken at one minute intervals (COV range: 1.63-96%). Inter-observer intra-image measurements were taken on each disc by 5 different observer (COV range: 1.28-27.08%).