Three-Year Fellow-Eye Comparison of Phacoemulsification Combined with iStent Inject W and Microhook Ab Interno Trabeculotomy in Primary Open-Angle Glaucoma

Background/Objectives: This study aimed to compare the three-year efficacy and safety of phacoemulsification combined with iStent inject W implantation (inject W-phaco) and microhook ab interno trabeculotomy (µLOT-phaco) using a fellow-eye design in patients with bilateral primary open-angle glaucoma (POAG). Methods: We retrospectively analyzed 44 eyes from 22 patients with primary open-angle glaucoma. In each patient, the eye with more advanced visual field loss underwent µLOT-phaco, whereas the fellow eye underwent inject W-phaco. Intraocular pressure (IOP), glaucoma medication use, anterior chamber flare (ACF), corneal endothelial cell density, complications, cumulative surgical success, and Humphrey Field Analyzer mean deviation (HFA MD) were evaluated over 36 months using statistical methods that accounted for the paired-eye design. Results: At 36 months, mean IOP was 13.0 ± 1.5 mmHg after µLOT-phaco and 13.4 ± 1.7 mmHg after inject W-phaco. Medication use decreased to 0.8 ± 1.1 in both groups. ACF returned to not significantly different from baseline earlier after inject W-phaco. Longitudinal HFA MD change did not differ significantly between procedures. Conclusions: Both procedures were associated with sustained reductions in IOP and medication use over 3 years; postoperative anterior chamber inflammation resolved earlier after inject W-phaco.