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Editors Selection IGR 11-1

Surgery: TE with MMC versus Baerveldt

Comment by Richard Lewis on:

16835 Surgical complications in the tube versus trabeculectomy study during the first year of follow-up, Gedde SJ; Herndon LW; Brandt JD et al., American Journal of Ophthalmology, 2007; 143: 23-31

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In this multicentered, prospective, randomized trial by Gedde et al. (341), consisting of trabeculectomy with MMC (compared to a Baerveldt implant) was found to have lower success and higher rates of complications at one year. This was the largest multicentered trial with 17 sites and 212 subjects comparing two commonly used surgical procedures. As a result, there is important clinical relevance in deciding on the optimal surgery in patients who have undergone previous filtering or cataract surgery and perhaps other high surgical risk patients. Given this data, drainage devices are a better choice. However, the data is surprising. Most clinicians would have expected lower IOP with trabeculectomy. Another unexpected finding has to do with the large number of complications in both groups. In the trabeculectomy group, 57% of patients develop complications. Perhaps the varying surgical experience of the investigators or the types of referred patients included in this study may account for some of this difference. Regardless, this is a very, very important study. It emphasizes the need for alternative and innovative surgical procedures with fewer complications and higher success. Until such time, clinicians must consider drainage devices earlier in the course of management with greater vigilance managing their post-operative care.

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