Abstract
The aim of this study is to compare the surgical efficacy and safety between microhook ab-interno trabeculotomy (µLOT) and iStent trabecular micro-bypass stent implantation when both were combined with cataract surgery in both eyes of patients. Sixty-four glaucomatous eyes (32 participants; mean age, 75.9 ± 7.6 years; 15 men, 17 women) were included retrospectively. Intraocular pressure (IOP), number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF) and corneal endothelial cell density (CECD) were evaluated preoperatively, as well as 2, 3, 6, and 12 months postoperatively. Surgical complications and interventions were compared between the procedures. The preoperative IOP and medications with µLOT (18.8 ± 5.7 mmHg and 3.0 ± 1.2, respectively) were higher than with the iStent (15.5 ± 3.4 mmHg and 2.7 ± 1.2, respectively) (p = 0.0001 and p = 0.0437, respectively). At 12 months, the µLOT values (12.6 ± 2.3 mmHg and 2.3 ± 0.9, respectively) were identical to iStent (12.8 ± 2.5 mmHg and 2.3 ± 0.9, respectively) (p = 0.0934 and p = 0.3251, respectively). At 12 months, the IOP decreased more with µLOT (6.2 mmHg, 29.5%) than iStent (2.7 mmHg, 15.6%) (p = 0.0003). The decrease in medications was greater with µLOT (0.7) than iStent (0.4) (p = 0.0437). Survival rate of IOP control ≤15 mmHg and IOP reduction ≥20% was significantly higher after µLOT (40.6% at 12 months) than iStent (18.8%) (p = 0.0277). The frequency of layered hyphema was significantly greater with µLOT (8 eyes, 25%) than iStent (0 eyes, 0%) (p = 0.0048). The increase in the ACF at 2 weeks postoperatively was significantly greater with µLOT than iStent (p = 0.0156), while changes in the BCVA and CECD were identical between groups. The fellow-eye comparison showed that the IOP reduction was greater with µLOT than iStent when combined with cataract surgery.
Highlights
Introduction published maps and institutional affilGlaucoma, which is characterized by loss of retinal ganglion cells, is a leading cause of blindness worldwide [1]
The fellow-eye comparison showed that the Intraocular pressure (IOP) reduction was greater with μLOT than iStent when combined with cataract surgery
The distribution of glaucoma subtypes did not differ significantly between the two groups; they approached significance (p = 0.0681), i.e., the eyes that underwent μLOT had more EXG than those implanted with the iStent
Summary
Glaucoma, which is characterized by loss of retinal ganglion cells, is a leading cause of blindness worldwide [1]. Intraocular pressure (IOP) reduction by medications or surgery remains the mainstay of glaucoma treatment [2]. Conventional filtration surgery has been established as the gold standard in glaucoma surgery; it is fraught with complications such as bleb scarring, endothelial cell loss and hypotony [3,4]. Several less-invasive approaches have been recognized as effective treatments especially for open-angle glaucoma (OAG) [7]. We previously reported a microhook ab-interno trabeculotomy (μLOT) procedure, a novel and less-invasive approach using a microhook device and its efficacy in reducing IOP [8,9,10,11]. IStent (Glaukos, San Clemente, CA, USA) trabecular micro-bypass implantation combined with cataract iations
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