Journal
CURRENT OPINION IN OPHTHALMOLOGY
Volume 23, Issue 2, Pages 118-126Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/ICU.0b013e32834ff2d1
Keywords
glaucoma surgery; trabeculectomy; tube shunt
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Funding
- Pfizer, Inc., New York, NY, USA
- Abbott Medical Optics, Santa Ana, CA, USA
- National Eye Institute [EY014801]
- National Institutes of Health, Bethesda, MD, USA
- Research to Prevent Blindness, Inc., New York, NY, USA
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Purpose of review The Tube Versus Trabeculectomy (TVT) Study is a multicenter randomized clinical trial comparing the safety and efficacy of tube-shunt surgery to trabeculectomy with mitomycin C (MMC) in eyes with previous cataract and/or failed glaucoma surgery. This article interprets results from the TVT Study and applies them to clinical practice. Recent findings Both tube-shunt surgery and trabeculectomy with MMC produced intraocular pressure (IOP) reduction to the low teens throughout the 5-year duration of the study. Tube-shunt surgery was associated with use of more glaucoma medications than trabeculectomy with MMC during the first 2 years of the study, but medical therapy equalized with longer follow-up. Trabeculectomy with MMC had higher rates of surgical failure and reoperation for glaucoma compared with tube-shunt surgery. Vision loss occurred at a similar rate with the two surgical procedures. Early complications were more frequent after trabeculectomy with MMC relative to tube-shunt surgery, but both procedures had similar rates of late postoperative complications and serious complications. Summary Tube-shunt surgery and trabeculectomy with MMC are both viable surgical options for managing glaucoma in patients who have undergone prior cataract and/or failed filtering surgery. Results of the TVT Study support the expanding use of tube shunts beyond refractory glaucomas.
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