Trabeculectomy vs. Tube shunt surgery for the treatment of open-angle glaucoma: current understanding and evolving use of procedures

ABSTRACT

Introduction

This review summarizes the evolving use, indications, success rate, and post-operative complications of trabeculectomy versus tube shunt surgery for the treatment of open-angle glaucoma (POAG). Trabeculectomy leads to significantly sustained reductions in IOP and therefore remains the gold standard of care for advanced POAG. While tube shunt surgeries have been historically reserved as second-line procedures for glaucoma, they have been used with increasing frequency in recent years as effective alternatives to trabeculectomy.

Areas covered

This review discusses major clinical trials and studies on tube shunt surgery and trabeculectomy for the treatment of POAG, encompassing studies published between 1961 and 2024. A PubMed-based search protocol was conducted using the following keywords: ‘advanced open-angle glaucoma,’ ‘Ahmed,’ ‘Baerveldt,’ ‘trabeculectomy,’ ‘trabeculectomy versus tube shunt,’ ‘surgical failure,’ ‘IOP,’ and ‘complications.’ Studies included were experimental or observational, involving eyes with various stages of POAG with or without prior glaucoma operations that underwent trabeculectomy or tube shunt surgery.

Expert opinion

Tube shunt surgeries represent an effective method for lowering IOP with a reduced rate of complications compared with trabeculectomy. However, since trabeculectomy achieves optimal IOP reduction and remains the superior surgical option for certain patient populations, trabeculectomy must remain a tool that is learned and practiced by glaucoma surgeons.

KEYWORDS:

• Advanced open-angle glaucoma
• Ahmed
• Baerveldt
• IOP
• trabeculectomy
• tube shunt

Article highlights

• Both trabeculectomy and tube shunt surgery are effective methods for lowering intraocular pressure (IOP) and preventing visual field (VF) progression in patients with primary open-angle glaucoma (POAG).

• As demonstrated across many landmark clinical trials, trabeculectomy often achieves greater IOP reductions than tube shunt surgery and remains the superior surgical option for select populations of patients.

• Although many studies show that tube shunt surgery cannot achieve the same degree of IOP control as trabeculectomy, tube surgery is associated with less post-operative complications, rendering it a promising alternative for many patients.

• Consideration of prior ocular surgical history and preoperative IOP is important when choosing the appropriate glaucoma procedure for patients.

• Although effective alternative procedures are rising in popularity, trabeculectomy remains a valuable option for many patients and an irreplaceable resource in the glaucoma surgeon’s toolkit.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17469899.2024.2373208

Additional information

Funding

This paper was not funded.