Comparison of One-Year Postoperative Outcomes Between Phacoemulsification With iStent Inject W and Phacoemulsification With Microhook Trabeculotomy: Real-World Data and Propensity Score-Matched Analysis

Purpose This study aimed to compare the one-year postoperative outcomes of cataract surgery combined with the iStent inject W trabecular micro-bypass stent (iStent IW) implantation and cataract surgery combined with microhook trabeculotomy (μLOT) in a real-world clinical setting, before and after propensity score matching (PSM). Methods This retrospective comparative chart review included 41 eyes in the iStent IW group and 72 in the μLOT group. The primary outcomes assessed were postoperative intraocular pressure (IOP) and the number of glaucoma medications. Initially, we compared baseline characteristics and surgical outcomes between both groups before PSM. Then, PSM was performed to minimize baseline differences in glaucoma type, preoperative IOP, and the number of glaucoma medications, enabling a more accurate comparison of the IOP-lowering effects of both procedures. Results In the unadjusted analysis, the iStent IW group had a lower baseline IOP (14.5 ± 3.3 mmHg) than the μLOT group (19.3 ± 4.9 mmHg, p < 0.0001), as well as fewer medications (3.6 ± 1.3 vs. 4.8 ± 1.5, p < 0.0001). Furthermore, the iStent IW group primarily comprised patients with primary open-angle glaucoma and normal-tension glaucoma, whereas the μLOT group included patients with a wider variety of glaucoma types. At 12 months, IOP was comparable between the iStent IW group (12.7 ± 2.8 mmHg) and the μLOT group (14.0 ± 4.1 mmHg; p = 0.2883), although the number of medications remained lower in the iStent IW group (2.2 ± 1.5 vs. 3.3 ± 1.7; p = 0.0299). After PSM, no significant differences in IOP or medications were observed. Layered hyphema occurred more frequently in the μLOT group. Conclusion Both procedures had comparable IOP reduction; however, the μLOT group had more postoperative layered hyphema and required more medications in the unadjusted analysis.