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Review
. 2023 Mar 1;34(2):129-137.
doi: 10.1097/ICU.0000000000000928. Epub 2022 Nov 9.

Results from the Primary Tube Versus Trabeculectomy Study and translation to clinical practice

Steven J Gedde  1 , Kateki Vinod  2 , Bruce E Prum Jr  3 ; Primary Tube Versus Trabeculectomy Study Group
Affiliations
Review

Results from the Primary Tube Versus Trabeculectomy Study and translation to clinical practice

Steven J Gedde et al. Curr Opin Ophthalmol. .

Abstract

Purpose of review: The Primary Tube Versus Trabeculectomy (PTVT) Study is a multicenter randomized clinical trial comparing the safety and efficacy of tube shunt surgery and trabeculectomy with mitomycin C (MMC) in eyes without previous incisional ocular surgery. This article reviews results from the PTVT Study and suggests how they may be translated to clinical practice.

Recent findings: Tube shunt surgery had a higher failure rate than trabeculectomy with MMC in the PTVT Study, and the difference was statistically significant at 1 year but not at 3 years and 5 years. Both surgical procedures reduced intraocular pressure (IOP) to the low teens throughout 5 years of follow-up. Mean IOPs were lower after trabeculectomy with MMC compared with tube shunt implantation, and the differences were statistically significant during the first postoperative year and at 3 years. The greater IOP reduction after trabeculectomy with MMC was achieved with significantly fewer glaucoma medications relative to tube shunt placement. Surgical complications were common in the PTVT Study, but most were transient and self-limited. The incidence of early postoperative complications was significantly higher after trabeculectomy with MMC than tube shunt surgery. The rates of late postoperative complications, cataract progression, and vision loss were similar with both surgical procedures. Serious complications producing vision loss and/or requiring a reoperation to manage the complication developed more frequently after trabeculectomy with MMC compared with tube shunt surgery, and the difference was statistically significant at 1 year but not at 3 years and 5 years postoperatively.

Summary: Tube shunt implantation and trabeculectomy with MMC are both viable surgical options for managing glaucoma in patients without previous incisional ocular surgery. Results from the PTVT Study support further expansion of tube shunt use beyond refractory glaucomas.

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Conflict of interest statement

The authors have no financial interest in the content of this article.

CONFLICTS OF INTEREST

The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Kaplan-Meier plots showing the cumulative probability of failure in the PTVT Study. Adapted from [■■].
Figure 2.
Figure 2.
Kaplan-Meier plots showing the cumulative probability of failure in the PTVT Study among patients with preoperative intraocular pressure < 21 mmHg (A), 21–25 mmHg (B), and > 25 mmHg (C). Adapted from [■■].
See this image and copyright information in PMC

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      ■ This article describes use of laser and incisional glaucoma surgeries among Medicare beneficiaries from 2008 through 2016. A decline in trabeculectomy surgery and a concurrent rise in tube shunt implantation was observed during the study period.

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