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Early Outcomes of Combined Phacoemulsification and Ab Interno Tanito Microhook Trabeculotomy in Open Angle Glaucoma

Ophthalmol Glaucoma. 2023 Oct 13:S2589-4196(23)00194-1. doi: 10.1016/j.ogla.2023.10.007. Online ahead of print.


PURPOSE: To study the early postoperative efficacy and safety of an Ab Interno microhook trabeculotomy (microLOT) combined with cataract surgery in patients with open angle glaucoma.

METHODS: This prospective, randomized, interventional study was conducted on consecutive patients with visually significant cataract and mild – moderate open angle glaucoma. 114 patients were included for analysis. The patients were randomized to undergo microhook trabeculotomy with phacoemulsification (Group 1) or phacoemulsification alone (Group 2). All patients were evaluated on post-operative day 1, 15, and 30 as well as 3 months, 6 & 12 months post operatively. A p-value <0.05 was considered statistically significant. Baseline and follow-up visits were compared to determine the significant difference in the number of antiglaucoma medications (AGM), intraocular pressure (IOP), and best corrected visual acuity (BCVA).

RESULTS: There were 57 patients in each group. The baseline characteristics were similar between the two groups, except the number of AGM which were greater in Group 2. The mean preoperative IOP for Group 1 (phaco-microLOT) was 26.5 mmHg ±5.2 and Group 2 (phaco alone group) was 25.3 mmHg ±3.1 which decreased to 12.5 mmHg ±3.6(p<0.001) and 20.0 mmHg ± 2.7(p<0.001) at 12 months, respectively. LogMAR Visual acuity improved from 0.48 (IQR, 0.30-0.60) preop to 0.00 (0.00-0.18) post-op (p<0001) in Group 1 and improved from 0.30(IQR 0.30-0.48) to 0.00(0.00-0.00) in Group 2(p<0.001). In Group 1, the mean (SD) AGM used preoperatively was 0.6 (0.9) which was significantly reduced to 0.2 (0.5) at 12 months postoperatively, while in Group 2, at 12 months, the mean (SD) AGM used was reduced from 1.4(0.6) to 1.1(0.9). 90.3% of eyes in Group 1 achieved complete success at the end of one year. The most common complication was hyphema, noted in four patients with 1 eye requiring an anterior chamber washout.

CONCLUSION: Ab interno microhook trabeculotomy (microLOT) combined with phacoemulsification in patients with open angle glaucoma is an efficacious procedure with relatively minimal complications.

PMID:37839794 | DOI:10.1016/j.ogla.2023.10.007

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