Comparative Efficacy of Trabeculectomy versus Tube Shunt Surgery for Refractory Glaucoma in South West Nigeria

Glaucoma surgical intervention is indicated when maximum tolerated medical therapy fails to control intraocular pressure, with trabeculectomy and tube shunt surgery being the principal surgical options. Evidence comparing their efficacy in African patients with refractory glaucoma in Nigerian settings is limited. This study compares the surgical outcomes of trabeculectomy with mitomycin C versus tube shunt surgery (Ahmed valve) for refractory glaucoma among patients at University College Hospital Ibadan and Lagos University Teaching Hospital, South West Nigeria. A prospective comparative cohort study will be conducted among 100 eyes with refractory glaucoma, allocated to trabeculectomy or tube shunt surgery based on surgeon preference and patient clinical profile. Primary outcomes will include IOP at 6 and 12 months, surgical success defined as IOP between 6 and 18 mmHg, number of anti-glaucoma medications post-operatively, and best-corrected visual acuity. Secondary outcomes will include complications, re-operation rates, and bleb morphology for trabeculectomy patients. The Tube versus Trabeculectomy (TVT) study and its follow-up data from high-income countries suggest broadly comparable long-term outcomes, but Nigerian patient profiles, including younger age, higher IOP at presentation, and advanced disease, may alter this balance. This study addresses this evidence gap with Nigerian-specific data. Recommendations will guide the development of evidence-based surgical treatment algorithms for refractory glaucoma in West African ophthalmology practice. Keywords: trabeculectomy, tube shunt, refractory glaucoma, surgical outcomes, South West Nigeria