Fellow-Eye Comparison between Phaco-Tanito Microhook Trabeculotomy and Phaco-iStent Inject W

Abstract

This study aims to compare the surgical efficacy and safety of the Tanito microhook trabeculotomy (TMH-CE) and iStent inject W (Inject-CE) when performed in combination with cataract surgery on the eyes of glaucoma patients. A total of 78 glaucomatous eyes from 39 participants were retrospectively analyzed. Intraocular pressure (IOP), the number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF), and corneal endothelial cell density (CECD) were all evaluated preoperatively and at multiple postoperative time points. The preoperative IOP was significantly higher in the TMH-CE (19.6 ± 6.7 mmHg) than in the Inject-CE (15.7 ± 3.8 mmHg) (p < 0.0001). At the 12-month follow-up, reductions in IOP and the number of medications were more pronounced in the TMH-CE (6.6 mmHg, 27.6% and −1.1, respectively) group than Inject-CE (2.7 mmHg, 12.4% and −0.7, respectively) (p < 0.0001 and p = 0.0034), while the IOP and medication-number levels were identical between TMH-CE (13.0 ± 3.3 mmHg and 1.3 ± 0.9, respectively) and Inject-CE (12.9 ± 2.6 mmHg and 1.9 ± 0.9, respectively) (p = 0.88 and p > 0.99, respectively). The TMH-CE group exhibited a higher ACF, a higher frequency of layered hyphema, and a greater anterior chamber floating red blood cells score in the early postoperative periods. Despite these differences, the changes in BCVA, ACF, and CECD were equivalent between the two groups in later follow-up periods. TMH-CE provides a more significant IOP reduction and medication-number reduction compared to Inject-CE, while Inject-CE shows quicker BCVA recovery. This study provides valuable insights for ophthalmologists choosing the most suitable surgical approach for glaucoma and cataract patients.

Comparison of Phaco-Tanito Microhook Trabeculotomy between Propensity-Score-Matched 120-Degree and 240-Degree Incision Groups

“…Similarly, the incidence of hyphema was more common following goniotomy with a 360-degree incision than with a 120-degree incision [12,13]. In our previous research, we reported higher hyphema scores in eyes undergoing TMH than in those receiving first-and secondgeneration iStent implants during the early postoperative period [19,29]. These findings suggest that the severity of hyphema correlates with the extent of incision width following angle surgeries.…”

“…Other studies have reported greater IOP reductions with goniotomy using a Kahook Dual Blade (KDB) at 90 degrees compared to the first-generation iStent trabecular bypass implantation with one 120 µm-lumen stent [22][23][24][25] or the second-generation iStent inject W with two 80 µm-lumen stents [26,27]. In our previous studies, fellow-eye comparisons demonstrated a greater IOP reduction with TMH than with both the first- [28] and second- [29] generation iStent when combined with cataract surgery. Further, other research has shown similar IOP reduction effectiveness between TMH and KDB [30,31].…”