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The Primary Tube Versus Trabeculectomy Study was designed to answer a practical glaucoma-surgery question: does a tube shunt provide comparable long-term pressure control to trabeculectomy with mitomycin C in eyes undergoing initial incisional surgery? At five years, the cumulative probability of failure was not significantly different between the two procedures, and mean IOP was also similar. Trabeculectomy patients, however, required fewer glaucoma medications at the five-year visit. The findings support both approaches as valid surgical options rather than establishing a universal winner. For HCPs, the appropriate operation depends on target pressure, previous surgery, conjunctival status, ocular surface disease, medication burden and the patient's ability to attend postoperative follow-up. The study also reinforces the importance of long-term surveillance because postoperative success is not determined at the first few months. In AIOC's context, the evidence is particularly relevant to discussions of tube shunts versus trabeculectomy and the position of MIGS earlier in the treatment pathway.
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The Primary Tube Versus Trabeculectomy Study was designed to answer a practical glaucoma-surgery question: does a tube shunt provide comparable long-term pressure control to trabeculectomy with mitomycin C in eyes undergoing initial incisional surgery? At five years, the cumulative probability of failure was not significantly different between the two procedures, and mean IOP was also similar. Trabeculectomy patients, however, required fewer glaucoma medications at the five-year visit. The findings support both approaches as valid surgical options rather than establishing a universal winner. For HCPs, the appropriate operation depends on target pressure, previous surgery, conjunctival status, ocular surface disease, medication burden and the patient's ability to attend postoperative follow-up. The study also reinforces the importance of long-term surveillance because postoperative success is not determined at the first few months. In AIOC's context, the evidence is particularly relevant to discussions of tube shunts versus trabeculectomy and the position of MIGS earlier in the treatment pathway.
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