Patients Need Fewer Meds After Trabeculectomy Than Tube Shunt Surgeries

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Five years after researchers performed trabeculectomy with mitomycin C and tube shunt surgeries, patients who underwent the trabeculectomies required fewer glaucoma medications.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of the American Academy of Ophthalmology, held in New Orleans from November 12 to 15, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the ophthalmology experts at the AAO. Check back for more from the AAO 2021 Meeting.


With fewer glaucoma medications, trabeculectomy with mitomycin C (MMC) achieved similar results as tube shunt surgery did in the Primary Tube Versus Trabeculectomy (PTVT) Study, according to research results presented at the American Academy of Ophthalmology 2021 Annual Meeting, held November 12 to 15.

The research presented at the conference summarizes 5-year follow-up data, the latest results, for a randomized controlled trial that compared the efficacy of 2 leading surgical treatments for reducing IOP in patients with glaucoma. Both methods carry risk of complications and need for additional surgery. In a recent study published in Ophthalmology Glaucoma, both tube shunt surgery and trabeculectomy required reoperation within 5 years for about 15% of patients who had not previously received incision surgery.

Researchers administered Baerveldt glaucoma implant (350 mm²) to 225 patients and trabeculectomy with MMC (0.4 mg/ml for 2 minutes) to 117 patients.

The investigators analyzed results of intraocular pressure (IOP), medical therapy, and failure (IOP > 21 mmHg or reduced <20%, IOP ≤ 5 mm Hg, reoperation for glaucoma, or no light perception (NLP) vision).

After 5 years, cumulative failure rate was 42.4% in the tube shunt group and 34.1% in the trabeculectomy group (P =.14; HR 1.38; 95% CI, 0.9-2.1). IOP was slightly higher (13.4±3.4 mm Hg) in the tube group compared with the trabeculectomy group (12.2±5.2 mm Hg P =.16). 

Trabeculectomy was associated with requiring fewer medications (1.2±1.4) compared with tube shunt surgery (2.2±1.3 P <.001) while rate of failure was not significantly different. 

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Gedde SJ, Feuer WJ, Lim K-S, et al. Treatment outcomes in the primary tube versus trabeculectomy study after 5 years of follow-up. Presented at: American Academy of Ophthalmology 2021 Annual Meeting. Abstract PA005.