When not to do a trabeculectomy (Trab vs tube)

Despite the advent of modern minimally invasive glaucoma surgery techniques, trabeculectomy remains the gold standard surgical technique for controlling intraocular pressure in patients with uncontrolled glaucoma—achieving adequate pressure control, often in the low teens. There are, however, particular indications and subtypes of glaucoma where a trabeculectomy may not be the most appropriate first-line surgical technique. This article aims to discuss personal experience and the latest published evidence. These factors lead to both a higher and a lower chance of surgical success. In particular, the rationale for performing tube surgery over a trabeculectomy was discussed.