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Editors Selection IGR 17-4

Comments

Comment by George Spaeth 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

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Thank you for giving me the chance to comment on such an excellent paper. My comments focus on three points.

1. I am astonished at the percentage of complications associated with both procedures. It is true that most operated eyes in both groups would fall under the 'refractory' banner, but at the same time all surgeons taking part in the study were 'virtuoso' surgeons. If these were their complication rates, what is to be expected from the 'average' surgeon?

TIf these were their complication rates, what is to be expected from the 'average' surgeon?

2. The results do not give tubes a clear winner state, hitherto, as long-term endothelial loss from tube insertion is yet to be fully examined. My understanding is that preoperative endothelial cell counts were not carried out, which means that we will have to depend on other prospective trials to address this.

3. Full economical analysis, including cost effectiveness and cost utility, should be a comparative parameter. Failure to report this would unfortunately mean the loss of important and relevant information.

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