The weight of evidence from clinical trials over the past two decades supports the greater use of glaucoma drainage devices, said Kuldev Singh, MD, MPH.
Dr. Singh, professor of ophthalmology and director of the Glaucoma Service, Stanford University School of Medicine in California, described that evidence.
“When I was a resident in the 1980s, practitioners would commonly perform two or three trabeculectomy procedures before considering a tube implant,” said Dr. Singh. “But now, we are implanting tubes earlier, even as primary therapy in some cases.”
Dr. Singh showed a slide of Medicare data in which trend lines for trabeculectomy rates had declined over the past two decades, while tube implantation rates were steadily rising with about a 10-fold increase in annual numbers over the past two decades.
One key trial was the Tube Versus Trabeculectomy Study (American Journal of Ophthalmology, 2012;153:789-803.)
In this study, 212 eyes that had undergone prior cataract surgery, trabeculectomy, or both procedures, were randomly assigned to either implantation with a 350-mm Baerveldt implant (Abbott Medical Optics) or a superior mitomycin C-augmented trabeculectomy.
Trabs had issues