Original vs Shoji Edition of Tanito Microhook Trabeculotomy Combined with Cataract Surgery: Comparative Clinical Outcomes

Précis: This matched-cohort study compares the original and Shoji editions of the Tanito microhook trabeculotomy (TMH), a reusable, FDA-cleared MIGS device, when combined with cataract surgery. Both designs demonstrated similar 2-year surgical success and safety profiles. While the Shoji edition incorporates ergonomic refinements, no significant differences in clinical outcomes were observed, supporting the continued use of either version in routine glaucoma care. Purpose: To compare the clinical efficacy and safety of the Shoji edition of the Tanito microhook trabeculotomy (TMH Shoji edition) with the original version, both performed in combination with phacoemulsification and intraocular lens implantation, in patients with open angle glaucoma. Methods A retrospective matched-cohort study including 518 eyes (original: 259, Shoji: 259) was conducted. Groups were matched on age, sex, glaucoma type, baseline IOP, visual field mean deviation, and number of medications. The primary outcome was surgical success over 2 years, followed by the American Academy of Ophthalmology’s recommended criteria for MIGS combined with cataract surgery: ≥1 medication reduction without IOP increase, or ≥20% IOP reduction to ≤21 mm Hg without additional surgery, loss of light perception vision, or hypotony. IOP, number of medications, and postoperative complications were also recorded. Statistical analyses included Fisher exact tests and Kaplan-Meier survival with log-rank testing. Results: At 12 months, surgical success was achieved in 46.4% of the original group and 50.1% of the Shoji group; at 24 months, the rates were 32.0% and 44.2%, respectively. Kaplan-Meier estimates showed no significant difference between groups (log-rank P = 1.000). Both groups achieved reductions from baseline in mean IOP and number of glaucoma medications at all time points. Postoperative complications were infrequent and comparable between groups. Conclusions: Both versions of TMH trabeculotomy combined with cataract surgery demonstrated acceptable mid-term surgical success and safety profiles. The Shoji edition, designed to improve access and usability, may offer advantages in certain surgical settings.