Trabeculectomies and bleb-based procedures are here to stay. In the Primary Tube vs. Trabeculectomy study (PTVT), the trabeculectomy had a lower IOP compared to tube shunts for the first 3 years. For Years 4 and 5, the IOPs equalized but the trabeculectomy obtained this pressure on fewer medications. 1 The Xen is a newer bleb-forming procedure that has been shown to be effective in reducing IOP. 2 and noninferior to trabeculectomy.3 Blebs work, and if done well, they can be long-term solutions for patients with glaucoma.