Comparison of effectiveness and complications in trabeculotomy with phacoemulsification between ab externo and ab interno using a spatula-shaped microhook

Ryosuke Fujino,Yohei Nomoto,Takashi Fujishiro,Takahiro Arai,Satoru Kanda,Takashi Omoto,Makoto Aihara

doi:10.1038/s41598-021-96701-0

Abstract

To compare the short-term surgical effectiveness and safety profile of trabeculotomy ab externo and ab interno with microhook in terms of the recovery of visual acuity. A retrospective chart review was performed on patients who underwent trabeculotomy combined with phacoemulsification and lens implantation at Asahi General Hospital, with 6 months of follow-up. The patients treated by trabeculotomy were classified into two groups depending on the surgical procedures: ab interno with Tanito microhook (TMH) and ab externo with rigid probe trabeculotome (LOT). The demographics, preoperative and postoperative intraocular pressure (IOP), number of medications (Med), best-corrected visual acuity (BCVA), surgical-induced astigmatism (SIA), and postoperative complications were analyzed at pre-operation, and 1 week and 1–6 months post-operation. Fifty-two eyes of 38 Japanese patients underwent TMH and 42 eyes of 32 patients underwent LOT. The decreases in IOP and Med from the baseline were significant at all time points in both groups (p < 0.001), but there were no significant differences between the two groups. BCVA improved significantly in TMH and LOT after the operation (p < 0.001). BCVA and SIA significantly improved, mostly at 1 week in TMH, compared with LOT (p = 0.02 and 0.003). Hyphema and IOP spike exceeding 30 mmHg (spike) occurred in 11% and 6% of participants in TMH, and 33% and 26% of participants in LOT, respectively. Hyphema and IOP spike occurred more frequently in the LOT than in the TMH group (p = 0.01 and 0.005). Ab interno trabeculotomy showed similar IOP-lowering effects as ab externo, but had less postoperative complications.

Highlights

To compare the short-term surgical effectiveness and safety profile of trabeculotomy ab externo and ab interno with microhook in terms of the recovery of visual acuity
Baseline intraocular pressure (IOP) was significantly lower in Tanito microhook (TMH) than in LOT (p = 0.004)
Ab externo trabeculotomy has undergone some changes in the past 50 years. This is the second report to declare the surgical outcome of ab externo and interno trabeculotomies with microhook, and the first to show the changes in visual acuity with the corneal astigmatism in the early postoperative phase

Summary

Introduction

To compare the short-term surgical effectiveness and safety profile of trabeculotomy ab externo and ab interno with microhook in terms of the recovery of visual acuity. The patients treated by trabeculotomy were classified into two groups depending on the surgical procedures: ab interno with Tanito microhook (TMH) and ab externo with rigid probe trabeculotome (LOT). There are many reports of effective IOP control via trabeculotomy in open-angle glaucoma, including childhood glaucoma, steroid-induced glaucoma, and exfoliation glaucoma[2,3,4,5]. This surgery aims to cleave the trabecular meshwork and inner wall of SC, where the main sight of resistance for aqueous outflow is thought to b e2,6,7. There are 3 types of this hook; straight, angle-right and angle-left, which allows the surgeons to approach all quadrants of the trabecular m eshwork[14]

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