Reoperation rate similar for trabeculectomy, tube shunt at 5 years
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NASHVILLE, Tenn. — Patients with glaucoma who underwent trabeculectomy or tube shunt surgery had similar rates of reoperation and similar surgical outcomes regardless of initial procedure, according to a study.
Sara J. Coulon, MD, and colleagues analyzed data from the Primary Tube Versus Trabeculectomy (PTVT) study to explore the incidence and outcomes of reoperations.
“In previous publications of PTVT study data, patients were censored from analysis after glaucoma reoperation,” she said. “Therefore, the outcomes of patients who underwent additional glaucoma surgery in the PTVT study have not been previously reported.”
The study comprised 242 patients with medically uncontrolled glaucoma with no previous ocular surgery. The 5-year cumulative reoperation rate for glaucoma was 16.8% in the tube group and 10.3% in the trabeculectomy group, which Coulon said was not a statistically significant difference.
Both groups also had similar mean IOP (13.9 mm Hg for tube vs. 15.8 mm Hg for trabeculectomy) and number of medications (2.0 vs. 1.1, respectively) at the final follow-up. The cumulative probability of failure at 3 years was 37.8% in the tube group and 21.3% in the trabeculectomy group.
Tube shunt was the most common surgery in patients who failed trabeculectomy, while a second tube or cyclophotocoagulation was the most common surgery in the tube group.
Coulon said some surgeons prefer trabeculectomy as an initial treatment because they believe it leaves them with more options and a better chance for positive outcomes should it fail.
“However, this did not appear to be the case based on our study results,” she said. “Similar surgical outcomes were observed after additional glaucoma surgery, irrespective of whether the patient was initially randomized to tube shunt surgery or trabeculectomy with mitomycin C in the PTVT study.”
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Coulon SJ, et al. Outcomes of glaucoma reoperations in the Primary Tube Versus Trabeculectomy study. Presented at: American Glaucoma Society meeting; March 3-6, 2022; Nashville, Tennessee.
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