Phacoemulsification with Kahook Dual Blade goniotomy in eyes with medically treated glaucoma: analysis of surgical outcomes and success predictors

Abstract

The purpose of this study was to investigate the postoperative outcomes and evaluate the success predictors of phacoemulsification with Kahook Dual Blade goniotomy for cataract and glaucoma management in eyes with primary open-angle glaucoma.Methods: This was a retrospective, non-comparative; interventional case series in which all patients with primary open-angle glaucoma who underwent phacoemulsification with Kahook Dual Blade goniotomy between June 2018 and April 2019 were enrolled. All the participants had a minimum follow-up period of 6 months. Preoperative and postoperative intraocular pressure values (at 1, 3, and 6 months), number of antiglaucoma medications, best-corrected visual acuity, surgical complications, and any subsequent related events or procedures were recorded. A logistic regression analysis was performed to investigate the association between the different variables and surgical outcomes.Results: A total of 47 patients (57 eyes) were included (mean age, 70.5 ± 7 years). The mean intraocular pressure was reduced from 15.5 ± 4.2 mmHg to 12.2 ± 2.4 mmHg at the last follow-up visit (p<0.001). The mean number of antiglaucoma medications decreased significantly from 1.9 ± 1.0 to 0.6 ± 1.0 during the same period (p<0.001). On the basis of the predefined criterion (intraocular pressure reduction ≥20% and/or reduction ≥1 medication), the 6-month success rate was 86%. A higher preoperative intraocular pressure value (odds ratio [OR]= 2.01; p=0.016) and greater percentage of initial (30 days) intraocular pressure reduction (OR= 1.02; p=0.033) were sig nificantly associated with surgical success. Conclusion: Our findings suggest that phacoemulsification with Kahook Dual Blade goniotomy is an effective and safe alternative for cataract management in eyes with primary open-angle glaucoma that positively impacts intraocular pressure control and medication burden. Eyes with higher baseline intraocular pressure and a more pronounced initial response to the procedure appeared to present better outcomes at 6 months. Further studies are needed to evaluate the long-term efficacy and safety profile of the procedure.

Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade

“…8 Unlike other goniotomy-based MIGS devices, the KDB procedure involves the subsequent removal of the excised material, thus reducing the risk of scarring and probability of reoperation. 7,9 KDB excisional goniotomy is indicated for use with or without phacoemulsification and across the spectrum of disease severity in patients with open angle glaucoma (OAG) 7,8,[10][11][12][13][14][15] but successful outcomes have been reported in patients with angle closure glaucoma, [16][17][18][19] congenital glaucoma, 20 and uveitis-associated ocular hypertension. 21 The follow-up period of most reports on KDB ranges from 6-to 24-months, with only two studies reporting 36-month outcomes.…”

“…Conversely, Ibrahim et al also evaluated 6-month surgical success outcomes (defined as ≥20% IOP reduction and/or ≥1 medication reduction if postoperative IOP was +2 mmHg from baseline) of combined phacoemulsification and KDB goniotomy and did not find the baseline number of glaucoma medications to be a significant success predictor (OR, 1.73; P = 0.166); however, the authors established that a higher baseline IOP was associated with greater surgical success (OR, 2.01; P = 0.016);. 10 When stratifying our study cohort by baseline IOP, pressures ranged from 14 to 21 mmHg in 63.5% of eyes (Group 1) and 22-34 mmHg in 36.5% of eyes (Group 2). At 60 months, IOP decreased to 13.5 mmHg in both groups, therefore it is unlikely that baseline IOP was a significant success predictor within our study.…”