Comparative One-Year Outcomes of T-Hook®-Versus Kahook Dual Blade®-Assisted Ab Interno Trabeculotomy Combined with Phacoemulsification for Primary Open-Angle Glaucoma

Background: The T-hook is a recently introduced device for ab interno trabeculotomy, first reported in 2022. This study compared the one-year surgical outcomes of Kahook Dual Blade (K group)- and T-hook (T group)-assisted trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study included patients with POAG who underwent 180° ab interno trabeculotomy combined with phacoemulsification at our institution between June 2018 and September 2024 and were followed for at least 12 months. Changes in intraocular pressure (IOP), mean IOP reduction rate, number of antiglaucoma medications, postoperative complications (hyphema and transient IOP spikes), and cumulative surgical success rates were evaluated. Results: A total of 45 patients (61 eyes) were included, comprising 29 patients (42 eyes) in the K group and 16 patients (19 eyes) in the T group. A transient increase in IOP at one week postoperatively observed in the K group (p < 0.0001); however, both groups demonstrated significant IOP reduction from baseline after 1 month (p < 0.05). The mean IOP reduction rate at 12 months did not differ significantly between groups (p = 0.0720, ANCOVA). The number of antiglaucoma medications significantly decreased at all postoperative time points in both groups compared with baseline (p < 0.05). Kaplan–Meier survival analysis revealed no significant difference in cumulative surgical success rates between groups (p = 0.6217). The incidence of hyphema was comparable between groups (p = 1.00), whereas transient IOP spikes occurred significantly more frequently in the K group (p = 0.0057). Conclusions: While both procedures demonstrated comparable intraocular pressure-lowering efficacy, T-hook-assisted trabeculotomy was associated with fewer transient postoperative IOP spikes during the early postoperative period in this cohort.