Comparison of trabectome and microhook surgical outcomes
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ORIGINAL PAPER
Comparison of trabectome and microhook surgical outcomes Naoki Tojo . Mitsuya Otsuka . Atsushi Hayashi
Received: 13 July 2020 / Accepted: 16 August 2020 Ó Springer Nature B.V. 2020
Abstract Background Several methods can be applied for a trabeculotomy, including the uses of thread, a blade, cauterization, and a hook. We compared the outcomes of trabectome surgery and microhook surgery. Methods We analyzed the cases of 133 eyes that underwent trabectome (72 eyes) or microhook (61 eyes) surgery and were followed for [ 1 year. We defined failure as a \ 20% reduction in the postoperative intraocular pressure (IOP) value or requiring additional glaucoma surgery. We used three surgical success definitions: B 21, B 18, and B 15 mmHg IOP reduction. A Kaplan–Meier survival analysis was performed for the surgical outcomes. We compared the trabectome and microhook groups’ postoperative IOP values, number of glaucoma medications, and postoperative complications. Results At 1 year postsurgery, the trabectome surgeries decreased the IOP significantly from 24.6 ± 7.3 to 13.3 ± 3.7 mmHg, and the microhook surgeries significantly decreased the IOP from 24.1 ± 9.2 to 12.5 ± 3.9 mmHg. The two groups’ 1-year postoperative IOP values were not significantly different (p = 0.310). The surgical outcomes of the trabectome surgeries were significantly better than those of the
N. Tojo M. Otsuka A. Hayashi (&) Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan e-mail: [email protected]
microhook surgeries (B 21 mmHg: p = 0.0049, B 18 mmHg: p = 0.0029, and B 15 mmHg: p = 0.0393). There were three patients with ciliary detachment in the microhook surgery group. Conclusions Trabectome surgery provided significantly better surgical outcomes than microhook surgery. The risk of postoperative ciliary detachment should be considered in microhook surgery cases. Keywords Trabectome Microhook Surgical outcome Intraocular pressure MIGS
Background The use of minimally invasive glaucoma surgery (MIGS) is spreading all over the world. There are various ways to incise the trabecular meshwork (trabeculotomy) including the use of thread, a blade, cautery, and a hook [1–4]. The trabectome (Neomedix, Tustin, CA, USA) was approved for clinical use by the U.S. Food and Drug Administration in April 2004 [2]. An ab interno trabeculotomy with a microhook was devised by Dr. M. Tanito in 2016 [2]. Both the trabectome and microhook surgical methods are MIGS, as each spares the conjunctiva and requires an only 1.7-mm corneal incision. The trabectome ablates the trabecular meshwork and inner wall of the Schlemm canal, whereas
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Int Ophthalmol
the microhook can incise them bluntly. Both methods provide the drainage of aqueous humor from the anterior chamber directly to a collector channel. It has been reported that both surgeries can decrease the intraocular pressure (IOP) by decreasin
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