title: The Tube Versus Trabeculectomy Study: interpretation of results and application to clinical practice.
abstract: 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 C (MMC) in eyes with previous cataract and/or failed glaucoma surgery. This article interprets results from the TVT Study and applies them to clinical practice.
  
  
  RESULTS
  Both tube-shunt surgery and trabeculectomy with MMC produced intraocular pressure (IOP) reduction to the low teens throughout the 5-year duration of the study. Tube-shunt surgery was associated with use of more glaucoma medications than trabeculectomy with MMC during the first 2 years of the study, but medical therapy equalized with longer follow-up. Trabeculectomy with MMC had higher rates of surgical failure and reoperation for glaucoma compared with tube-shunt surgery. Vision loss occurred at a similar rate with the two surgical procedures. Early complications were more frequent after trabeculectomy with MMC relative to tube-shunt surgery, but both procedures had similar rates of late postoperative complications and serious complications.
  
  
  CONCLUSIONS
  Tube-shunt surgery and trabeculectomy with MMC are both viable surgical options for managing glaucoma in patients who have undergone prior cataract and/or failed filtering surgery. Results of the TVT Study support the expanding use of tube shunts beyond refractory glaucomas.
authors.affiliation: Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA. sgedde@med.miami.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Gedde
authors.forename: Kuldev
authors.initials: K
authors.lastname: Singh
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Schiffman
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage; D002387:Cataract Extraction / Q000009:adverse effects; D005901:Glaucoma / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D020327:Glaucoma Drainage Implants / Q000009:adverse effects; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D016685:Mitomycin / Q000008:administration & dosage; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*
chemical_list: D000959:Antihypertensive Agents; D016685:Mitomycin