Which is More Effective and Safer? Comparison of Propensity Score-Matched Microhook Ab Interno Trabeculotomy and...

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Primary open-angle glaucoma (POAG) management often involves reducing intraocular pressure (IOP).
• Cataract surgery is frequently combined with glaucoma procedures to address both conditions simultaneously.
• Ab interno trabeculotomy (LOT) and iStent inject W (iStent) are minimally invasive glaucoma surgeries (MIGS) used in conjunction with cataract surgery.

Purpose of the Study:

• To compare the surgical outcomes of LOT and iStent implantation when performed alongside cataract surgery.
• To evaluate the safety and efficacy of these two MIGS procedures in patients with POAG.
• To match key patient factors including age, IOP, medication score, central corneal thickness (CCT), and axial length between the surgical groups.

Main Methods:

• A prospective study included 100 eyes from 75/79 patients diagnosed with POAG.
• Patients were divided into two groups: LOT combined with cataract surgery and iStent combined with cataract surgery.
• Propensity score matching was used to ensure comparability of background factors between the LOT and iStent groups.

Main Results:

• Preoperative characteristics such as age, IOP, medication score, CCT, and axial length were similar between the LOT and iStent groups.
• Postoperative IOP and medication scores showed no significant differences between the two groups.
• The change in IOP was -2.1 ± 3.3 mmHg for LOT and -1.5 ± 3.0 mmHg for iStent, with no significant difference. Postoperative IOP was associated with preoperative IOP and CCT.
• Complication rates, including hyphema and transient ocular hypertension, were comparable and low in both groups.

Conclusions:

• LOT and iStent implantation demonstrate similar surgical outcomes and safety profiles when combined with cataract surgery for POAG.
• Both procedures effectively reduce IOP and medication burden, suggesting they are viable options for glaucoma management.
• Preoperative IOP and CCT were identified as significant predictors of postoperative IOP in both surgical groups.