Trabeculectomy versus Transscleral Cyclophotocoagulation as a Primary Surgical Procedure in Glaucoma: A Multicenter Randomized Controlled Trial
In brief
Trabeculectomy put 91% of eyes in the lower pressure range, versus 39% with laser
In this randomized trial of 77 eyes followed for 12 months, trabeculectomy brought 91% into an eye-pressure range of 6 to 14 mm Hg, compared with 39% after slow-burn laser treatment. Both operations usually reached the broader 6 to 18 mm Hg range, but trabeculectomy left patients with lower pressure and fewer medications; longer-term results remain unknown.
- Journal
- Journal of glaucoma (Q1)
- Published
- 12 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Cláudia Gomide Vilela de S Franco, Eduardo Akio, Tiago S Prata, Fábio N Kanadani, Júlia Maggi Vieira, Jayter S Paula, et al.
- PMID
- 42869006
- DOI
- 10.1097/IJG.0000000000002793
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 15 October 2026): Multicenter RCT comparing trabeculectomy vs CPC
Abstract
PRCIS: In this randomized multicenter trial, both TRAB and CPC lowered IOP at 12 months as primary glaucoma surgeries, with TRAB yielding lower final IOP with fewer medications, while both procedures demonstrated meaningful clinical effectiveness. PURPOSE: To compare the efficacy and safety of trabeculectomy (TRAB) and slow-burn transscleral cyclophotocoagulation (CPC) as primary surgical treatments for glaucoma. METHODS: Prospective, randomized, multicenter trial including one eye per patient from July 2020 to July 2023, with 12-month follow-up. Participants were allocated to TRAB (GI) or CPC (GII). The primary endpoint was surgical success at 12 months, defined by intraocular pressure (IOP) between 6 and 18 mm Hg without non-protocol glaucoma surgery or serious complications. RESULTS: Eighty-six eyes were included; nine were excluded (four in GI; five in GII). Baseline demographics were similar between groups. Both significantly reduced IOP at 12 months (GI: 22.97±8.23 mm Hg to 10.14±2.89 mm Hg; GII: 23.47±6.34 mm Hg to 14.58±3.66 mm Hg; P<0.001 for both). Medication use decreased significantly in both groups, with a lower mean number of medications per year in GI (P<0.001). An IOP of 6-14 mm Hg was achieved in 91.4% of GI and 39.4% of GII (P=0.007). Final IOP between 6 and 18 mm Hg was reached by 97.1% of GI and 90.9% of GII (P=0.708). Qualified success rates were high and comparable (GI: 97.4%; GII: 86.8%; P=0.08), while complications were infrequent (four in GI; one in GII; P=0.3). Quality of life improved after TRAB (EQ-5D: 0.71±0.19 to 0.78±0.14; P=0.031) but remained unchanged after CPC (P=0.424). CONCLUSIONS: Both procedures reduced IOP at 12 months as primary glaucoma surgeries. TRAB achieved lower final IOP, required fewer medications, and was associated with improved quality of life, whereas CPC required more adjunctive medication and retreatment in some eyes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.