Two-Year Outcomes of Combined Phacoemulsification and Ab Interno Tanito Microhook Trabeculotomy in Open-Angle Glaucoma

IF 3.3 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2026-05-01 Epub Date: 2025-12-15 DOI:10.1016/j.ogla.2025.12.004

Devendra Maheshwari MD , Madhavi Ramanatha Pillai DNB , Davinder S. Grover MD, MPH , Nimrita Gyanchand Nagdev MS , Shivam Gupta MS , Mohammed Sithiq Uduman MSc , Rengappa Ramakrishnan DO, MS

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Abstract

Purpose

To evaluate the 24-month safety and efficacy of phacoemulsification combined with ab interno Tanito microhook trabeculotomy (microLOT) compared with phacoemulsification alone in patients with open-angle glaucoma (OAG) and cataract.

Design

Prospective, randomized, interventional clinical trial.

Participants

Patients with mild-to-moderate OAG and visually significant cataract.

Methods

One hundred fourteen eyes of 114 patients were randomized to phacoemulsification and microLOT (Phaco-microLOT) (n = 57) or phacoemulsification alone (n = 57).

Main Outcome Measures

Intraocular pressure (IOP), antiglaucoma medication (AGM) burden, best-corrected visual acuity, surgical success, and complications were assessed through 24 months. Success was defined as a combination of at least 20%, 25%, or 30% reduction in IOP and an absolute IOP of less than 21, 18, or 15 mmHg, respectively (criteria 1, 2, and 3).

Results

At 24 months, 99 patients out of the original cohort of 114 patients were analyzed (group 1 = 50; group 2 = 49). The mean IOP decreased from 26.5 ± 5.2 to 15.2 ± 4.9 mmHg in the Phaco-microLOT group and from 25.3 ± 3.1 to 18.2 ± 2.8 mmHg in the phaco-alone group (P < 0.001). The percentage IOP reduction was significantly greater in group 1 (42.6% vs. 28.1%, P = 0.004). In group 1, the mean (standard deviation) AGM used preoperatively was 0.6 (0.9), which significantly decreased to 0.2 (0.4) at 24 months, whereas in group 2, it marginally increased from 1.4 (0.6) to 1.5 (0.9). Overall success (complete + qualified) in group 1 using criteria 1, 2, and 3 was 83.3%, 72.9%, and 43.8%, whereas in group 2 it was 57.8%, 40%, and 20%, respectively. The risk of failure in group 2 was 2.87 times higher. No additional complications were observed, and no interventions were required between 12 and 24 months of follow-up.

Conclusions

Phacoemulsification and microLOT achieved sustained and superior IOP and medication reduction at 24 months, with a favorable safety profile compared to the phacoemulsification alone group. These results underscore the long-term role of microLOT for OAG.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

查看原文本刊更多论文

联合超声乳化术和Ab - Interno Tanito微钩小梁切开术治疗开角青光眼的两年疗效：一项前瞻性随机试验。

目的：评价开角型青光眼（OAG）合并白内障患者超声乳化术联合微钩小梁切开术（microLOT）与单纯超声乳化术治疗24个月的安全性和有效性。设计：前瞻性、随机、介入性临床试验。方法：114例患者的114只眼随机分为超声-显微lot组（n=57）和单纯超声乳化组（n=57）。结果测量：通过24个月评估眼压（IOP）、抗青光眼药物（AGM）负担、最佳矫正视力（BCVA）、手术成功率和并发症。成功定义为IOP降低至少20%、25%或30%，绝对IOP分别低于21,18或15mmhg（标准1、2和3）。结果：在24个月时，分析了114例原始队列患者中的99例患者（组1= 50；组2= 49）。phaco-microLOT组的平均IOP从26.5±5.2下降到15.2±4.9 mmHg， phaco-单独组的平均IOP从25.3±3.1下降到18.2±2.8 mmHg。结论：与单独超声乳化组相比，phaco-microLOT在24个月时实现了持续和优越的IOP和药物降低，具有良好的安全性。这些结果强调了microLOT对OAG的长期作用。

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