advertisement

Editors Selection IGR 10-3

Comments

Comment by Ike Ahmed on:

24877 Three-year follow-up of the tube versus trabeculectomy study, Gedde SJ; Schiffman JC; Feuer WJ et al., American Journal of Ophthalmology, 2009; 148: 670-684

Find related abstracts

Gedde and his co-authors have delivered a landmark paper on the state of glaucoma surgery for the current decade and beyond. Providing this degree of analysis in a randomized, prospective multicentered study comparing two commonly performed procedures with three years of follow-up is unique for all ophthalmologists, especially with those interested in glaucoma. There is plentiful data worthy of discussing from this manuscript; I found the area of postoperative complications particularly interesting. The rate of serious compli cations (i.e., loss of greater than two or more lines of visual acuity) was not statistically significant between the two groups despite the fact that 3% of trabeculectomy patients developed endophthalmitis. Overall, 39% of the tube group developed complications as compared to 60% undergoing trabeculectomy. The probability of failure during the three years of follow-up was 15% in the tube group and 30.7% in the trabeculectomy group. The alarming extent of these and other complications raises real concern.

If these procedures were undergoing an FDA clinical trial currently, would either procedure be sufficiently safe to achieve approval?

In fact, many of us who commonly perform these procedures would never have estimated the surprising magnitude of the problem. What steps can be taken to avoid these complications? How can we better anticipate complications when planning for glaucoma surgery? If these procedures were undergoing an FDA clinical trial currently, would either procedure be sufficiently safe to achieve approval? Our inability to provide a 'safe and effective' long-term procedure for our patients is very concerning. As we strive to develop safe and effective surgical options, the tube vs. trabeculectomy paper will be the gold standard from which to compare.

• ← Previous
• Next →