Primary surgical management refractory glaucoma: tubes as initial surgery

Abstract

Glaucoma drainage implants have an increasing role in the surgical management of glaucoma. Traditionally, trabeculectomy is usually recommended to patients as the initial surgery of choice and glaucoma drainage implant is reserved for patients with high risk of failure for filtering surgery. There is a lack of consensus among glaucoma surgeons regarding the use of tube shunts or trabeculectomy. The role of glaucoma drainage implants has historically been limited to refractory glaucoma. Peer review publications in recent years suggest that glaucoma drainage implants may have similar efficacy as well as safety profile compared to trabeculectomy with antimetabolites. The tube versus trabeculectomy demonstrated similar intraocular pressure reduction at 1 year of follow-up. Because glaucoma drainage implant is usually offered at the refractory stage, the limited success rate of glaucoma drainage implant in terms of intraocular pressure lowering effect compared to trabeculectomy has been in the mindset of many glaucoma surgeons. If glaucoma drainage implant was offered as the initial procedure, the success rate may be different in terms of intraocular pressure control. Glaucoma drainage implants should have expanding role in the surgical treatment of glaucoma.