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. 2023 Nov 9;12(22):7005.
doi: 10.3390/jcm12227005.

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

Akiko Harano  1 , Ayaka Shimada  1 , Sho Ichioka  1 , Kazunobu Sugihara  1 , Masaki Tanito  1
Affiliations

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

Akiko Harano et al. J Clin Med. .

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.

Keywords: Tanito microhook (TMH); cataract surgery; fellow-eye comparison; iStent inject W; intraocular pressure; microhook ab-interno trabeculotomy; minimally invasive glaucoma surgery.

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Conflict of interest statement

The microhooks used were co-developed by Masaki Tanito, and Inami & Co., Ltd. (Tokyo, Japan). Tanito receives royalties from Inami & Co., Ltd. The company had no role in the design of the study, in the collection, analysis, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. Other authors report no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves for successful intraocular pressure (IOP) control in the iStent Inject W (Inject-CE) and microhook ab interno trabeculotomy (TMH-CE) groups. Two failure criteria, criterion A (a) and criterion B (b), were used: IOP < 20% reduction from preoperative IOP value and/or >15 mmHg for criterion A, and IOP < 20% reduction from preoperative value and/or >12 mmHg for criterion B. Patients who did not meet these IOP-failure criteria, as well as those requiring additional glaucoma surgery and/or experiencing no light perception, were considered failures. The log-rank statistics for the comparison between the two groups yielded p-values of 0.37 and 0.68, respectively.
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