Outcomes of phacoemulsification combined with ab interno trabeculotomy: stratified by incision extent, glaucoma severity, and baseline number of medications

Abstract Objectives To evaluate outcomes of phacoemulsification plus Tanito microhook (TMH) trabeculotomy and assess differences by incision extent, glaucoma severity, and baseline medications classes. Methods Retrospective cohort of 880 open-angle glaucoma eyes (119 exfoliation glaucoma, 761 primary open-angle glaucoma) undergoing phaco-TMH. Success was defined using the American Academy of Ophthalmology (AAO) minimally invasive glaucoma surgery (MIGS) endpoint for cataract-combined procedures ( ≥ 1 medication reduction without intraocular pressure [IOP] increase, or ≥20% IOP reduction to ≤21 mmHg) with no additional glaucoma surgery, hypotony, or loss of light perception. Prespecified alternative IOP-defined success definitions were also evaluated. Outcomes were stratified by incision extent ( < 6 and ≥6 clock hours), baseline glaucoma severity (early, moderate, advanced), and baseline medications classes (0–1, 2, ≥3). Time-to-failure was evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards models adjusted for surgical year and baseline covariates. Results Mean (SD) IOP decreased from 17.2 (4.9) mmHg at baseline to 13.1 (3.5) at 12 months and 13.1 (3.9) at 24 months, and medications decreased from 2.6 (1.3) to 2.0 (1.3) at 12 and 24 months. Two-year cumulative success was 59.0% (95% CI, 54.4 to 63.2) by AAO MIGS criteria. In the multivariable Cox model, ≥6 clock hours was not significantly associated with surgical failure compared with <6 clock hours (adjusted HR, 1.14; 95% CI, 0.85 to 1.53; P = 0.367). Higher baseline medication burden was associated with worse success across IOP-defined criteria. Conclusions In patients undergoing phacoemulsification combined with TMH trabeculotomy, IOP and medication burden improved through 2 years. Surgical success did not differ by incision extent or baseline glaucoma severity, whereas higher baseline medication burden was associated with worse IOP-defined success.