Eyeworld

EW FEATURE 98 Three-year outcome data from the TVT study was reported in Current Opinion in Ophthalmology. According to the abstract, the intermediate-term results of the multicenter, randomized clinical trial supports the use of tube shunts, even beyond refractory glaucoma. "Tube-shunt surgery is an appro- priate surgical option in patients who have undergone prior cataract and/or unsuccessful filtering sur- gery," the study found. Trabeculec- tomy rates in the TVT study were twice as high as for tubes, with 30% of trabs failing within 3 years, com- pared to 15% of tubes. Failure was defined as IOP being too high (>21 mm Hg) or too low (<5 mm Hg), the need for reopera- tion, or loss of light perception vi- sion. Post-op, wound leaks and dysesthesia were more common in the trabeculectomy group, while post-op diplopia was more common in the tube group. Dr. Sarkisian said he removes the cataract before moving on to the shunt implantation in the pars plana. "It's a very rewarding opportu- nity when a patient has had a previ- ous vitrectomy and there might be scarring of the conjunctiva," he ex- plained about the positioning of the device. "Then the tube has no chance of coming in contact with the cornea. "The refractive result is not going to be as impressive initially as it would be when doing the cataract surgery alone," he continued. "IOP control is paramount. You don't want to have inflammation from cataract surgery." EW References 1. Gedde SJ, Schiffman JC, Feuer WJ, et al. The Tube Versus Trabeculectomy Study: De- sign and baseline characteristics of study pa- tients. Am J Ophthalmol 2005;140:275–287. 2. Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the Tube Versus Tra- beculectomy Study after one year of follow- up. Am J Ophthalmol 2007;143:9–22. 3. Minckler DS, Francis BA, Hodapp EA, et al. Aqueous shunts in glaucoma: A report by the American Academy of Ophthalmology. Ophthalmology 2008;115:1089–1098. 4. Wilson MR, Mendis U, Smith SD, Paliwal A. Ahmed glaucoma valve implant vs. tra- beculectomy in the surgical treatment of glau- coma: A randomized clinical trial. Am J Ophthalmol 2000;130:267–273. 5. Tsai JC, Johnson CC, Dietrich MS. The Ahmed shunt versus the Baerveldt shunt for refractory glaucoma: A single surgeon com- parison of outcome. Ophthalmology 2003;110: 1814–1821. Editors' note: Dr. Ahmed has financial interests with AMO. Dr. Samuelson has financial interests with AMO, AcuMems (Menlo Park, Calif.), Alcon, Allergan (Irvine, Calif.), AqueSys (Irvine, Calif.), Endo Optiks (Little Silver, N.J.), Glaukos, iScience (Menlo Park, Calif.), Ivantis (Irvine, Calif.), Pfizer (New York), QLT (Menlo Park, Calif.), and Santen (Napa, Calif.). Dr. Sarkisian has no financial interests related to his comments. Contact information Ahmed: 416-625 3937, ike.ahmed@utoronto.ca Samuelson: 612-813-3628, twsamuelson@mneye.com Sarkisian: 405-271-1093, Steven-Sarkisian@dmei.org Only One System Delivers the Shield of PROTECTION. DuoVisc ® Viscoelastic System offers both the endothelial protection of chondroitin sulfate in Viscoat ®* with the proven mechanical protection and space maintenance found in ProVisc ® . * One System. No Compromises. *OVD = Ophthalmic Viscosurgical Device VIS512 ©2008, Alcon, Inc. EyeWorld 3/11 9,6(:LQGG 30 Glaucoma continued from page 97 February 2011 COMBINED SURGERY March 2011

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