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Three-year TVT study results influencing glaucoma patient care, surgeon says
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WAILEA, Hawaii — A surgeon said here the information from the Tube Versus Trabeculectomy Study is influencing his treatment of glaucoma patients.
 Thomas W. Samuelson |
While trabeculectomy remains the gold standard in transscleral filtration surgery, Thomas W. Samuelson, MD, said at Hawaiian Eye 2009 that there are a number of reasons surgeons would want to move to a different form of surgery, such as to avoid the increased risk of endophthalmitis that comes with trabeculectomy.
Dr. Samuelson said that in the TVT study, which has 3-year follow-up data that has been presented but not yet published, tube surgery was more likely than trabeculectomy with mitomycin C to maintain IOP control and avoid persistent hypotony and reoperation. Both procedures were similar in their rates of IOP reduction, need for additional medication and visual acuity results, he said.
"Early postoperative complications occurred more frequently after trabeculectomy with MMC than tube shunt surgery," Dr. Samuelson said. "The rates of late postoperative complications and serious complications resulting in vision loss and/or reoperation were similar for both surgical procedures."
Dr. Samuelson said that from these results, he is now performing fewer trabeculectomies and implanting more tubes. He said he is also performing almost no repeat trabeculectomies, and he is using tubes on younger patients, high myopes and contact lens wearers.
Dr. Samuelson noted that the TVT study is using only the 350-mm² Baerveldt glaucoma implant, and he is looking forward to study results from comparisons of other tubes, such as the Ahmed, Molteno or 250-mm² Baerveldt.