Comparison of Surgical Outcomes of Ab Interno Trabeculotomy Using Tanito Microhook, Suture, and Trabectome

Précis: The choice of surgical techniques among Tanito Microhook, Suture, and Trabectome does not significantly impact postoperative efficacy or complication rates. However, a wider incision in the trabecular meshwork may increase the risk of hyphema. Purpose: To evaluate preoperative and postoperative characteristics of ab interno trabeculotomy using the Tanito Microhook (TMH), suture technique (sLOT), and Trabectome (TOM). Methods: Preoperative and postoperative intraocular pressure (IOP), glaucoma medication scores, and complications were retrospectively analyzed in the eyes of patients undergoing ab interno trabeculotomy. Results: The analysis included 196, 122, and 87 eyes in the sLOT, TMH, and TOM groups, respectively. Mean IOP decreased from 23.0, 21.3, and 24.8 mmHg to 14.1, 14.2, and 16.2 mmHg at 3 months (reductions: 32.6, 26.3, and 27.0%; P <0.001) in the sLOT, TMH, and TOM groups, respectively. No significant differences in percent IOP change ( P =0.085) or survival rates based on four success criteria defined by IOP thresholds (≤18/≤15 mmHg) and reductions (≥0%/≥20%) ( P =0.44–0.88) were observed. Hyphema occurred in 43.4%, 19.7%, and 18.4%, and IOP spikes in 24.5%, 9.8%, and 20.7% of the sLOT, TMH, and TOM groups, respectively. Multivariable analysis revealed that exfoliation glaucoma, higher baseline IOP, and concomitant cataract extraction surgery were associated with greater IOP reduction. Wider trabecular meshwork incisions increased hyphema risk, while concomitant cataract surgery reduced it. Higher baseline IOP increased IOP spike risk. Device selection did not significantly influence IOP reduction, hyphema incidence, or IOP spikes. Conclusion: TMH, sLOT, and TOM provide similar IOP-lowering efficacy. Considering patient factors—such as baseline IOP and lens status—and using available devices while avoiding excessively wide incisions may contribute to favorable surgical outcomes.