Comparison of Postoperative Hyphemas between Microhook Ab Interno Trabeculotomy and iStent Using a New Hyphema Scoring System

Abstract

We have been using our in-house scoring system of hyphemas, i.e., Shimane University RLC postoperative hyphema scoring system (SU-RLC), which we designed to classify postoperative hyphema. SU-RLC classifies the severities of hyphemas based on three factors, i.e., red blood cells (RBCs) (R) 0–3, layer formation (L) 0–3, and clot (C) 0–1, by slit-lamp observation. To test the clinical usefulness of the SU-RLC for quantifying the postoperative hyphema severity, the SU-RLC scores were compared between eyes that underwent different minimally invasive glaucoma surgery (MIGS) procedures, i.e., Tanito microhook ab interno trabeculotomy and cataract extraction (TMH-CE) (n = 64 eyes of 64 subjects; mean age ± standard deviation, 72.4 ± 8.1 years) and iStent-CE (n = 21 eyes of 21 subjects; 76.1 ± 10.6 years). Compared to the iStent-CE, higher hyphema scores with the TMH-CE were found for the R scores on postoperative days 1, 2, and 3; for the L score on postoperative day 1; and for the C score on postoperative day 2. The sums of the R, L, and C scores (RLC) on postoperative day 1 were 3.2 ± 1.1 with the TMH-CE and 1.1 ± 1.3 with the iStent-CE; the scores reached almost 0 by 2 weeks in both groups. Significant differences in the RLC scores between the surgical groups were found on postoperative days 1, 2, and 3. Multivariate analyses showed that the TMH-CE rather than iStent-CE was associated with higher R, C, and RLC scores; anticoagulant/antiplatelet use was associated with higher R score; and myopia was associated with a higher C score. In the TMH-CE group, myopia was associated with a higher C score. In the iStent-CE group, anticoagulant/antiplatelet use was associated with higher R and RLC scores; and higher postoperative 1-day intraocular pressure was associated with a higher C score. The SU-RLC successfully detected the difference in hyphema severity between different MIGS procedures; thus, we concluded that our classification system may be feasible to evaluate hyphemas after glaucoma surgery.

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

“…We found that the frequency of early postoperative layered hyphema and the SU-R score were significantly higher in the TMH-CE group compared to the Inject-CE group. In a previous study, we reported higher hyphema scores in eyes that underwent TMH compared to eyes implanted with the first-generation iStent on postoperative days 1, 2, and 3 [13]. Our current study revealed that postoperative hyphema is even less common with the second-generation iStent than with the TMH.…”

“…The severity of each hyphema was estimated and given an R score according to the Shimane University Hyphema Scoring System (SU-R) [13]. This system, which is specifically designed to classify postoperative hyphema, categorizes the floating red blood cells (RBCs) in AC from 0 to 3.…”

Comparison of Phaco-Tanito Microhook Trabeculotomy between Propensity-Score-Matched 120-Degree and 240-Degree Incision Groups

“…Similarly, the incidence of hyphema was more common following goniotomy with a 360-degree incision than with a 120-degree incision [12,13]. In our previous research, we reported higher hyphema scores in eyes undergoing TMH than in those receiving first-and secondgeneration iStent implants during the early postoperative period [19,29]. These findings suggest that the severity of hyphema correlates with the extent of incision width following angle surgeries.…”

“…The Shimane University Postoperative Hyphema Scoring system (SU-RLC) [19] is utilized to assess the severity of hyphema. This method evaluates hyphema severity through a slit-lamp examination, focusing on three primary elements: red blood cells (RBCs) (R), layering (L), and clot formation (C).…”

Roles of Toric intraocular Lens implantation on visual acuity and astigmatism in glaucomatous eyes treated with iStent and cataract surgery

“…The surgical procedure was performed through two corneal side ports as reported previously [10,11]. Before iStent implantation, phacoemulsification cataract surgery was performed through a 2.2-mm-wide clear corneal incision created at the 9 to 10 o'clock position (i.e., temporal incision for the right eye and nasal incision for the left eye); a one-piece soft acrylic IOL (non-toric or toric) was inserted into the capsular bag through the same clear corneal incision.…”