Abstract
Purpose :
The aim of this study was to compare the efficacy and complications after Tanito microhook ab-interno trabeculotomy (TMH) combined with cataract surgery in one eye and iStent implantation combined with cataract surgery in the fellow eye of a patient.
Methods :
Sixty-four eyes of 32 participants (mean age, 75.9 ± 7.6 years; 15 men, 17 women) with primary-open angle glaucoma (65.6 %), exfoliation glaucoma (23.4 %), and other glaucoma types (11.0 %) were included retrospectively. The intraocular pressure (IOP) and number of antiglaucoma medications evaluated preoperatively and postoperatively at 2 weeks, 3, 6, and 12 months were collected by chart review. The postoperative complications including layered hyphema and IOP spike of 30 mmHg or higher also were collected. Comparisons between the two surgical procedures were performed by mixed-effects regression models and followed by Wilcoxon signed-rank test or Fisher’s exact probability test.
Results :
The preoperative IOP and medications of TMH group (18.8 ± 5.7 mmHg and 3.0 ± 1.2 medications, respectively) were higher than those of iStent group (15.5 ± 3.4 mmHg and 2.7 ± 1.2 medications, respectively) (p<0.0001 and p=0.0437, respectively); while those of TMH group (12.6 ± 2.3 mmHg and 2.3 ± 0.9 medications, respectively) were identical to those of iStent group (12.8 ± 2.5 mmHg and 2.3 ± 0.9 medications, respectively) (p=0.0934 and p=0.3251, respectively) at the 12 months postoperatively. By mixed-effects regression analysis, postoperative reduction of IOP and medications were significantly different between the two groups (p<0.0001, p<0.0001, respectively). At 12 months postoperatively, reduction of IOP in TMH group (6.2 ± 5.6 mmHg, 29.5％) was greater than those in iStent group (2.7 ± 3.2 mmHg, 18.8％) (p=0.0003); reduction of medication in TMH group (0.7 ± 1.3, 23.3％) was greater than those of iStent group (0.4 ± 1.1, 14.8％) (p=0.0437). Frequency of layered hyphema were significantly higher in TMH group (8 eyes, 25%) than iStent group (0 eye, 0%) (p=0.0048); frequency of IOP spike was equivalent between the groups (TMH, 2 eyes, 6%; and iStent, 2 eyes, 6%) (p=1.0000).
Conclusions :
By fellow-eye comparison, IOP reduction was greater with TMH than with iStent, while achieved levels of IOP was identical between both procedures. The rate of layered hyphema was higher in TMH than iStent.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.