Review of results from the Tube Versus Trabeculectomy Study.
OBJECTIVE
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 (MMC) in eyes with previous cataract and/or unsuccessful glaucoma surgery. This article reviews published results from the TVT Study.


RESULTS
Tube-shunt surgery had a higher success rate than trabeculectomy with MMC during the first 3 years of follow-up. Trabeculectomy with MMC produced greater intraocular pressure (IOP) reduction in the early postoperative period compared with tube-shunt placement, but similar IOPs were observed after 3 months. Tube-shunt surgery was associated with greater use of adjunctive-medical therapy than trabeculectomy with MMC during the first 2 years of the study, but no difference in medication use was seen at 3 years. The incidence of postoperative complications was higher after trabeculectomy with MMC compared with tube-shunt surgery, but serious complications associated with vision loss and/or reoperation developed with similar frequency after both surgical procedures. No difference in the rate of vision loss was present following trabeculectomy with MMC and tube-shunt surgery after 3 years of follow-up. Cataract progression was common, but occurred with similar frequency with both procedures.


CONCLUSIONS
Intermediate-term results of the TVT Study support the expanded use of tube shunts beyond refractory glaucomas. Tube-shunt surgery is an appropriate surgical option in patients who have undergone prior cataract and/or unsuccessful filtering surgery.
Gedde
Steven J
SJ
Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA. sgedde@med.miami.edu
Heuer
Dale K
DK
Parrish
Richard K
RK
D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D019654:Lens Implantation, Intraocular; D016685:Mitomycin / Q000008:administration & dosage*; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D016032:Randomized Controlled Trials as Topic; D014130:Trabeculectomy; D016896:Treatment Outcome
D000477:Alkylating Agents; D016685:Mitomycin