Comparison of outcomes of 180-degree Tanito Microhook trabeculotomy versus 360-degree gonioscopy-assisted transluminal trabeculotomy combined with phacoemulsification in open-angle glaucoma

To compare the one-year surgical outcomes of Tanito microhook Trabeculotomy combined with phacoemulsification (Phaco-TMH) and 5-0 prolene gonioscopy-assisted transluminal trabeculotomy combined with phacoemulsification (Phaco-GATT) in mild-moderate Open-angle glaucoma Prospective, comparative, non-randomised, interventional study Patients with mild-to-moderate OAG and visually significant cataract Methods:110 patients underwent Phaco-TMH (Group 1, N=55) or Phaco-GATT (Group 2, N=55). The primary outcome measures included changes in intraocular pressure (IOP), antiglaucoma medications (AGM), and best-corrected visual acuity (BCVA). 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 mm Hg, respectively (Criteria 1, 2, and 3). Additionally, interventions and complications were compared between the groups. In Group 1, mean IOP reduced significantly from 26.55±5.22mmHg to 14.60±3.87 mmHg, and in Group 2 from 25.45± 5.65mmHg to 12.80±3.12 mmHg at 12 months (p<0.001), with a significant reduction in Group 2 than in Group 1 (p<0.01). The percentage reduction of IOP in Group 1 was 37.5% and in Group 2 was 47.7 %. AGM significantly reduced from 1.53±0.66 to 0.22±0.57 and from 1.64±0.73 to 0.09±0.29 in Groups 1 and 2, respectively (p<0.001), with no significant difference between the groups (p=0.1). The complete success rates by criteria 1, 2, and 3 in Group 1 were 74.6%, 69.1%, and 52.7%, respectively, and in Group 2 were 89.1%, 81.8%, and 65.4%, respectively. Higher baseline IOP(HR: 0.68, 95% CI: 0.54-0.87, p<0.01) and higher age (HR: 0.93, 95% CI: 0.86-1.00, p=0.05) were associated with a lower likelihood of surgical failure. Hyphema was seen in one patient in Group 1, 7 patients in Group 2, and two patients in Group 2 required anterior chamber wash. IOP spikes were seen in one patient in Group 1 and three patients in Group 2Conclusion: Tanito microhook trabeculotomy is safe, efficacious, and comparable to GATT combined with phacoemulsification. Phaco-GATT achieved greater intraocular pressure reduction at 12 months, with comparable postoperative complication rates between groups