A 62-year-old patient with POAG on maximum medical therapy (prostaglandin analog + beta-blocker + carbonic anhydrase inhibitor) still has IOP of 22 mmHg with progressive visual field loss. According to current guidelines, which surgical option has the highest evidence for long-term IOP control compared to trabeculectomy in terms of fewer serious complications?

• A Tube shunt surgery (Ahmed/Baerveldt) ✓
• B Selective laser trabeculoplasty (SLT)
• C Deep sclerectomy
• D Canaloplasty

Explanation

The TVT (Tube Versus Trabeculectomy) study demonstrated that tube shunt surgery (Baerveldt) achieved comparable IOP lowering to trabeculectomy at 5 years but with fewer serious complications such as hypotony maculopathy and bleb-related infections. In patients with prior failed trabeculectomy or on maximum medical therapy, tube shunts are currently the preferred surgical approach. SLT is appropriate for earlier-stage disease, while deep sclerectomy and canaloplasty have less robust long-term data.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.