Trabeculectomy successfully used as primary treatment in glaucoma patients
CORONADO, Calif. — As a primary intervention, trabeculectomy with mitomycin C had a higher success rate than tube shunt surgery at 1 year in patients with glaucoma and no prior ocular surgery, according to a study presented here.
“Not only was the overall success rate higher in the trabeculectomy group but the rate of complete success was significantly higher,” Steven J. Gedde, MD, said at the American Glaucoma Society meeting, where he reported 1-year results of the Primary Tube Versus Trabeculectomy Study.
Steven J. Gedde
The purpose of the ongoing study is to compare the safety and efficacy of tube shunt surgery with trabeculectomy with mitomycin C in patients without previous ocular surgery.
One hundred seventeen patients in the tube group underwent placement of a 350 mm2 Baerveldt glaucoma implant in the superotemporal quadrant with complete restriction of flow; 108 patients in the trabeculectomy group underwent a superior trabeculectomy with a standard dose of mitomycin C of 0.4 mg/mL for 2 minutes. Mean IOP at baseline was about 23.5 mm Hg, with patients on an average of three medications, Gedde said, and overwhelmingly, patients in the study had primary open-angle glaucoma.
“We used the same success and failure criteria as in the TVT study,” Gedde said, with failure being defined as IOP greater than 21 mm Hg or not reduced by 20% below baseline on two consecutive visits after 3 months, IOP of 5 mm Hg or less on two consecutive visits after 3 months, the need for additional glaucoma surgery or the loss of light perception vision.
“There were no significant differences in any of the baseline and demographic ocular characteristics, suggesting that randomization was very effective in creating two balanced groups,” Gedde said.
Furthermore, greater IOP reduction was achieved with fewer glaucoma medications after trabeculectomy with MMC compared with tube shunt implantation during the first year, and patients with lower preoperative IOP benefited more from primary trabeculectomy over primary tube shunt placement, Gedde said. – by Patricia Nale, ELS
Gedde SJ. Treatment outcomes in the primary tube vs. trabeculectomy (PTVT) after 1 year of follow-up. Presented at: American Glaucoma Society annual meeting; March 2-5, 2017; Coronado, Calif.
Disclosure: Gedde reports no relevant financial disclosures. Abbott Medical Optics, the National Eye Institute and Research to Prevent Blindness provided support for the study.