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

Area of Science:

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

Background:

• Glaucoma management often requires surgical intervention, especially when combined with cataract surgery.
• Minimally invasive glaucoma surgeries (MIGS) are increasingly utilized to lower intraocular pressure (IOP).
• Comparing novel MIGS devices like Tanito microhook trabeculotomy (TMH-CE) and iStent inject W (Inject-CE) is crucial for clinical decision-making.

Purpose of the Study:

• To compare the surgical efficacy and safety of TMH-CE versus Inject-CE when performed concurrently with cataract surgery.
• To evaluate the impact of these MIGS procedures on intraocular pressure (IOP), medication usage, visual acuity, and ocular safety parameters.

Main Methods:

• Retrospective analysis of 78 glaucomatous eyes from 39 participants undergoing combined cataract surgery and MIGS.
• Procedures compared: Tanito microhook trabeculotomy (TMH-CE) and iStent inject W (Inject-CE).
• Evaluated outcomes included IOP, number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF), and corneal endothelial cell density (CECD) preoperatively and postoperatively.

Main Results:

• TMH-CE demonstrated significantly greater reductions in IOP and medication count at 12 months compared to Inject-CE.
• While final IOP and medication levels were similar, Inject-CE showed quicker recovery of BCVA.
• TMH-CE was associated with transient increases in anterior chamber flare and hyphema in the early postoperative period.

Conclusions:

• TMH-CE offers superior IOP and medication reduction efficacy compared to Inject-CE in combined glaucoma and cataract surgery.
• Inject-CE provides a faster visual recovery profile.
• Both procedures are viable options, with the choice depending on the desired balance between IOP control and visual recovery speed.