Trabeculectomy versus Tube Shunt efficacy and safety in patients with Pre-operative Intraocular Pressure of More than 40 mmHg: A Retrospective Study

Abstract

Purpose : To compare the clinical outcomes between trabeculectomy (trab) and tube shunt (tube) in eyes with a pre-operative (pre-op) IOP > 40 mmHg.

Methods : 70 eyes with a pre-op IOP of > 40 mmHg who underwent either a trab or tube were enrolled in this study. Demographic data, glaucoma type, glaucoma severity, visual acuity, IOP, number of medications (NOM), and post-operative (post-op) complications were gathered. Neovascular and secondary glaucoma eyes were excluded. Failure was defined as an IOP reduction of < 20%, IOP less than or equal to 5 mmHg or > 21 mmHg on two consecutive appointments after 3 months, post-op greater than or equal to pre-op NOM after 3 months, further glaucoma surgery, or vision change to no light perception. Eyes that met the failure criteria were censored and excluded from further analysis.

Results : Tubes and trabs were performed in 34 and 36 eyes, respectively. Baseline characteristics were similar including age (p=.05), race (p=0.19), pre-op IOP (p=.06), NOM (p=.24), glaucoma type (p=0.10), and glaucoma severity (p=0.18). The IOP change was greater in the trab group at all follow-up visits, with the difference significant at 1 month post-op (p<0.001). The trab group required fewer glaucoma medications at 1, 3, and 6-month follow-up appointments (p<0.001). One-year success rate was higher in the trabs compared to the tubes (82% vs 68.3%; p=0.20). Complications including choroidal effusion or hemorrhage, and endophthalmitis occurred in < 3% of trabs and 13.9% of tubes (p=0.02)

Conclusions : Trabs required less post-op glaucoma medications and had less sight-threatening complications. Though trabs had higher 1-year success rate, it was not statistically significant which may be related to limited sample size.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.