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

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.

Effects of Reduction in Intraocular Pressure Following Trabeculotomy on Axial Length and Intraocular Lens Selection

“…The SIA in the LOT group was 0.22 diopters and 78 degrees, which is consistent with the previously reported value of 0.22 diopters and 88 degrees. 2 In this study, the refractive outcome variabilities were greater in the LOT group than in the CAT group. Previous reports on the Kahook Dual Blade have identified preoperative visual acuity and IOP as factors affecting refractive outcomes.…”

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

“…[115][116][117][118] Ab externo trabeculotomy showed similar IOP-lowering effects as ab interno but had more postoperative complications. 119 However, the reported results of MAT illustrate the safety and effectiveness of 360-degree trabeculotomy on GFCS and promote the application of ab interno trabeculotomy in GFCS. These limited studies indicate that ab interno trabeculotomy may be an alternative, minimally invasive surgery to control IOP.…”

“…GATT and MAT reportedly have satisfactory effects on GFCS with up to 3 years of follow-up (Table 1). 115–118 Ab externo trabeculotomy showed similar IOP-lowering effects as ab interno but had more postoperative complications 119. However, the reported results of MAT illustrate the safety and effectiveness of 360-degree trabeculotomy on GFCS and promote the application of ab interno trabeculotomy in GFCS.…”

The effect of axial length on the short-term outcomes of cataract surgery combined with ab interno trabeculotomy

“…However, usually, medications are required to control the postoperative IOP. IOP spikes and IOP increases have been reported in up to 20% of patients [ 25 ], and hyphema in 4.6–33.9%; the latter is thought to be a major risk factor for IOP spike [ 26 – 28 ]. The blood reflux is a valuable indicator of correct trabecular pathway incision and aqueous outflow enhancement, but the IOP occasionally increases given the associated hyphema.…”