Single-use dual blade goniotomy plus phacoemulsification resulted in a significant and sustained reduction in IOP and a decrease in glaucoma medications after 6 months of follow-up.

IntroductionTo describe the 12-month efficacy and safety of goniotomy performed using the Kahook Dual Blade (KDB) in combination with cataract surgery in eyes with medically treated open-angle glaucoma (OAG).MethodsThis was a prospective, interventional case series conducted at seven centers in North America. Consecutive patients with medically treated OAG and visually significant cataract underwent phacoemulsification combined with goniotomy (PE + goniotomy) using KDB. Indications for glaucoma surgery included reduction of intraocular pressure (IOP) and reduction of IOP-lowering medications. De-identified data were collected and included pre-, intra-, and postoperative data on IOP, the use of IOP-lowering medications, and adverse events through 12 months of follow-up.ResultsAmong 52 eyes undergoing surgery, mean IOP was reduced from 16.8 ± 0.6 mmHg at baseline to 12.4 ± 0.3 mmHg at month 12 (P < 0.001), a 26.2% reduction. Mean IOP across time points ranged from 12.4–13.3 mmHg during follow-up. The mean number of topical IOP-lowering medications was reduced from 1.6 ± 0.2 at baseline to 0.8 ± 0.1 at month 12 (P < 0.05), a 50.0% reduction. At month 12, 57.7% of eyes had IOP reduction ≥ 20% from baseline, and 63.5% were on ≥ 1 fewer IOP-lowering medications. In subgroup analysis, 84.6% of eyes with lower mean baseline IOP were using ≥ 1 fewer medications at month 12, and 100% of eyes with higher mean baseline IOP had IOP reductions ≥ 20%. The most common postoperative adverse events were pain/irritation (n = 4, 7.7%), opacification of the posterior lens capsule (n = 2, 3.8%), and IOP spike > 10 mmHg (n = 2, 3.8%).ConclusionPE + goniotomy using the KDB significantly lowers both IOP and dependence on IOP-lowering medications in eyes with OAG. Adverse events were not sight-threatening and typically resolved spontaneously.FundingNew World Medical, Inc.

Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.

Intraocular pressure, a major modifiable risk factor for glaucoma, has been shown to fluctuate throughout the day in patients with glaucoma. The detection and measurement of this fluctuation may help guide the clinical management of glaucomatous individuals. The Sensimed Triggerfish contact lens sensor (CLS), which has recently gained approval for marketing in the USA, is designed to detect intraocular pressure-related changes in an eye over a 24-hour period. This review will provide an overview of the Triggerfish CLS, as well as summarize current clinical data pertaining to the device. Overall, the current evidence suggests that the Triggerfish CLS is safe and well tolerated, and provides reproducible results. One challenge of using the Triggerfish CLS is that it may only provide data on relative changes in intraocular pressure rather than absolute intraocular pressure. In addition, its validity at estimating intraocular pressure compared to other methods is still controversial. Despite these limitations, recent studies suggest a myriad of potential indications for the Triggerfish CLS, including predicting glaucomatous progression and predicting efficacy of glaucoma treatment. With further research, the Triggerfish CLS may become a useful tool for eye care practitioners.

Lowering intraocular pressure (IOP) is the only proven therapeutic intervention for glaucomatous optic neuropathy. Despite advances in laser and microsurgical techniques, medical IOP reduction remains the first-line treatment option for the majority of patients with open-angle glaucoma. Prostaglandin analogs are the most efficacious topical agents and carry a remarkable safety profile. Topical beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors are often employed as adjunctive agents for further IOP control. Newer preserved and nonpreserved formulations are available and appear to be less toxic to the ocular surface. Oral carbonic anhydrase inhibitors, miotic agents, and hyperosmotics are infrequently used due to a host of potentially serious adverse events. Medical therapies on the horizon include rho-kinase inhibitors, neuroprotective interventions, and gene therapies.