Controlled Study of Tanito Microhook (TMH) ab interno trabeculotomy combined with phacoemulsification for POAG/ PACG

Abstract. To evaluate the efficacy of Tanito Microhook (TMH) ab interno trabeculotomy combinated with phacoemulsification in treating primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). A retrospective comparative study was conducted to analyze 16 patients with primary open-angle glaucoma (POAG) who underwent phacoemulsification and TMH at the Second People's Hospital of Changshu from December 2021 to December 2022, along with 19 patients with primary angle-closure glaucoma (PACG) who underwent phacoemulsification, goniosynechialysis, and TMH. The follow-up period ranged from 12 to 24 months. The average preoperative IOP in the POAG group was (26.504.52) mmHg, and the average IOP was (18.001.67) mmHg at 12 months postoperatively, which was significantly lower than the preoperative value (P<0.05). The average preoperative IOP in the PACG group was (34.1114.90) mmHg, and the average IOP was (18.670.87) mmHg at 12 months postoperatively, which was lower than the preoperative value (P<0.05). The average number of anti-glaucoma drugs used by the POAG group before surgery was (2.060.21) types, and the average number of types was (0.180.10) at 12 months postoperatively, which was significantly reduced compared with the preoperative value (P<0.05). The PACG group used an average of (1.890.15) kinds of anti-glaucoma drugs preoperatively, (0.680.17) kinds of drugs postoperatively, and the difference in the number of drugs used between preoperative and postoperative periods was not statistically significant (P>0.05). The complete success rate of the POAG group was 81.3% (13/16), and the conditional success rate was 18.7% (3/16). The complete success rate of the PACG group was 47.4% (9/19), and the conditional success rate was 52.6% (10/19). The intraoperative and postoperative complications in the POAG group mainly included one case of hyphema in the anterior chamber and one case of transient intraocular pressure elevation, while the intraoperative and postoperative complications in the PACG group included one case of shallow anterior chamber after surgery, four cases of hyphema in the anterior chamber, and three cases of transient intraocular pressure elevation. No serious complications occurred in either group. The combination of TMH with cataract phacoemulsification and intraocular lens implantation demonstrates a safe and effective approach for treating POAG. Additionally, when combined with goniosynechialysis (GSL), it may be a safe and effective treatment for PACG. However, the long-term efficacy still requires further investigation through large-scale prospective controlled studies.