Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Minimally Invasive Glaucoma Surgery (MIGS)

Background:

• Glaucoma management often requires surgical intervention to lower intraocular pressure (IOP).
• Microhook ab-interno trabeculotomy (µLOT) and iStent trabecular micro-bypass stent implantation are MIGS procedures.
• Combining MIGS with cataract surgery is a common approach for patients with coexisting conditions.

Purpose of the Study:

• To compare the surgical efficacy and safety of µLOT versus iStent implantation.
• To evaluate outcomes when both procedures are combined with cataract surgery.
• To assess IOP reduction, medication usage, visual acuity, and safety profiles.

Main Methods:

• Retrospective study including 64 glaucomatous eyes from 32 participants.
• Fellow-eye comparison of µLOT and iStent implantation combined with cataract surgery.
• Evaluation of IOP, antiglaucoma medications, BCVA, ACF, and CECD at multiple postoperative time points.

Main Results:

• Both µLOT and iStent significantly reduced IOP and medication use post-surgery.
• µLOT achieved a greater IOP reduction (29.5%) and medication decrease (0.7) at 12 months compared to iStent (15.6%, 0.4).
• µLOT showed a higher IOP control survival rate (40.6% vs. 18.8%) but also a greater frequency of layered hyphema (25% vs. 0%) and anterior chamber flare.

Conclusions:

• µLOT is more effective than iStent in reducing IOP and medication burden when combined with cataract surgery.
• While µLOT has a higher risk of transient complications like hyphema and anterior chamber flare, its efficacy in IOP lowering is superior.
• Both procedures demonstrated comparable effects on best-corrected visual acuity and corneal endothelial cell density.