“Tube versus trabeculectomy” refers to comparing glaucoma drainage implants with trabeculectomy as surgical options for lowering intraocular pressure. Both aim to protect the optic nerve in moderate to advanced disease.
Key Differences
Trabeculectomy creates a new drainage channel using the eye’s own tissues, while tube surgery implants a device to divert fluid to a plate. Trabeculectomy often achieves lower pressures but may have more early complications and relies heavily on wound healing behaviour.
- Tubes can be advantageous in eyes with scarring, previous surgery, or complex glaucoma
- Randomised studies suggest tubes may have better long‑term success in some high‑risk eyes, with different profiles of complications
- Trabeculectomy may be preferred as initial surgery in eyes with favourable anatomy and no prior conjunctival scarring
- Both procedures still require ongoing glaucoma monitoring and possible medications
Choosing Between Them
The decision is individual and depends on glaucoma type, target pressure, past surgery, and surgeon expertise. Detailed discussion of risks, benefits, and aftercare helps patients make an informed choice.
- Visual needs, age, and general health also influence selection
- In some cases, combined cataract‑glaucoma procedures incorporate elements of both approaches
- Second‑line surgery may be needed if the first method fails
- Shared decision‑making with the glaucoma specialist is essential
