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The Tube Versus Trabeculectomy Study: interpretation of results and application to clinical practice

Gedde, Steven J.a; Singh, Kuldevb; Schiffman, Joyce C.a; Feuer, William J.a

Current Opinion in Ophthalmology: March 2012 - Volume 23 - Issue 2 - p 118–126
doi: 10.1097/ICU.0b013e32834ff2d1
GLAUCOMA: Edited by Donald L Budenz

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.

aBascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida

bDepartment of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA

Correspondence to Steven J. Gedde, MD, Bascom Palmer Eye Institute, 900 Northwest 17th Street, Miami, FL 33136, USA. Tel: +1 305 326 6435; fax: +1 305 326 6478; e-mail: sgedde@med.miami.edu

© 2012 Lippincott Williams & Wilkins, Inc.