Noninferiority of Microhook to Trabectome: Trabectome versus Ab Interno Microhook Trabeculotomy Comparative Study...

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Trabectome surgery is a common treatment for glaucoma.
• A new reusable microhook device for ab interno trabeculotomy (μTLO) has been developed.
• Evaluating the efficacy of μTLO compared to Trabectome is crucial for glaucoma treatment options.

Purpose of the Study:

• To determine if ab interno microhook trabeculotomy (μTLO) is non-inferior to Trabectome surgery.
• To compare 1-year postoperative outcomes in Japanese glaucoma patients.
• To utilize propensity score analysis for robust comparison.

Main Methods:

• Multicenter, retrospective cohort study involving 553 Trabectome and 392 μTLO patients.
• Propensity score analysis (matching, IPTW, stratification, regression adjustment) was used.
• Non-inferiority margin set at 15% based on prior meta-analysis.

Main Results:

• All four propensity score analysis methods showed that the risk difference for surgical failure in μTLO was within the 15% non-inferiority margin.
• The 95% confidence intervals for the risk difference ranged from -12.7% to +11.1% across methods.
• This indicates comparable surgical outcomes between the two procedures.

Conclusions:

• Ab interno microhook trabeculotomy (μTLO) is not inferior to Trabectome surgery in terms of 1-year postoperative outcomes.
• μTLO represents a viable alternative surgical option for glaucoma management.
• Further research may explore long-term outcomes and broader patient populations.