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M. A. Connor, J. W. Doyle, M. F. Smith; Tube versus Trabeculectomy Revisited- the Novice Surgeon Perspective. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1251. doi: https://doi.org/.
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To evaluate and compare the long term outcomes of two well-established surgical interventions for poorly controlled glaucoma, when the surgeries are performed by resident surgeons.
After obtaining IRB approval, a retrospective chart review was undertaken to assess outcomes of all patients on who a resident surgeon performed either trabeculectomy or glaucoma drainage device (GDD) surgery between 2001 - 2006 at the local Veterans Medical Center. Failure of treatment was defined by the original TVT study and includes: intraocular pressure greater than 21mmHg or not reduced by 20% below baseline on two consecutive follow up visits after three months, or intraocular pressure less than 5mmHg on two consecutive follow up visits after three months, or need for additional glaucoma surgery or loss of light perception vision. Follow up data was recorded from the three, six and twelve month post operative visits and included failure of treatment, follow-up appointments, complications, visual acuity, number of medications and need for further surgery.
A total of 150 eyes underwent either trabeculectomy or glaucoma drainage device surgery for poorly controlled glaucoma. Ninety-one eyes received a trabeculectomy and 59 eyes received a tube. Mean preoperative IOP in the trabeculectomy and GDD groups respectively was 19.8 (+/- 1.4)mmHg and 29.2 (+/- 10.3)mmHg. At one year follow up, the average IOP was 12.1 (+/- 5.3) mmHg in the trabeculectomy group and was 13.0 (+/- 7.6) mmHg in the tube group. The last documented IOP in the successful cases, averaged 11.4 (+/- 2.12)mmHg and 12.0 (+/-4.2)mmHg in the trabeculectomy and GDD groups respectively with the follow-up ranging between 1 - 4.5 years . The number of follow up visits within the first month postoperatively averaged 10.2 (+/-1.6) in the trabeculectomy group and 4.5 (+/-1.4) in the tube group. Complications included a significantly greater incidence of hypotony and wound leak and one case of endophthalmitis in the trabeculectomy group and one case of tube extrusion and two cases of endophthalmitis in the GDD group. The probability of failure during the first year of follow-up was 38% in the trabeculectomy group and 25% in the glaucoma drainage device group.
Glaucoma drainage device surgery, when performed by novice surgeons, may be associated with fewer complications, less morbidity and a higher chance of success at one year than trabeculectomy with mitomycin C performed by novice surgeons.
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