Glaucoma treatment should be tailored to individual patients
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WAIKOLOA, Hawaii — Clinical research, personal experience, physician skill set, patient factors and goals all influence the decision to perform trabeculectomy or use a tube shunt, a speaker said here at Hawaiian Eye 2022.
“Individualize the treatment choice to the patient in front of you,” Brian E. Flowers, MD, said.
If the IOP target is low or if the patient is younger or has medication tolerance issues, he said the choice leans toward trabeculectomy. Those with significant conjunctival scarring might be better suited for an implant.
“The type of complications that you’re trying to avoid — patients who are high myopes or who have had previous vitrectomies — hypotony in those patients can be devastating,” he said. “For those ones, you might consider using tube vs. trabeculectomy.”
In addition, consider using an inferonasal tube to preserve superior conjunctiva.
“We’re always planning for the next surgery as a glaucoma specialist,” Flowers said. “It’s easier to do a second procedure after a trabeculectomy than it is after a tube.”
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Flowers BE. Tube versus trab: How I decide. Presented at: Hawaiian Eye 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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