Kahook Dual Blade Goniotomy vs iStent inject: Long-Term Results in Patients with Open-Angle Glaucoma

Abstract

Purpose: Efficacy and safety evaluation of Kahook Dual Blade (KDB) goniotomy vs iStent inject implantation. Materials and Methods: Retrospective study in patients that underwent goniotomy with KDB or iStent inject implantation, stand-alone or combined with cataract surgery. Main outcome parameters were intraocular pressure (IOP), number of glaucoma medications, proportion of eyes achieving >20% IOP reduction and number of eyes with postoperative IOP <19 mmHg at last follow-up. Results: A total of 29 patients (30 eyes) were included in the iStent inject group and 30 patients (32 eyes) in the KDB group. Mean follow-ups were 20.9±6.5 (KDB-alone) to 29.5 ±7.6 (phaco-iStent inject) months. Pre-and post-operative IOPs were 22.2±5.8 mmHg and 15.9±4.3 mmHg (P=0.004) in the KDB-alone, 24.2±6.8 mmHg and 16.2±6.7 mmHg (P=0.001) in the phaco-KDB, 20.6±5.4 mmHg and 20.9±6.8 mmHg (P=0.598) in the iStent inject-alone as well as 20.9±5.5 mmHg and 15.6±3.4 mmHg (P=0.003) in the phaco-iStent inject subgroups. No major complications occurred. Conclusion: All KDB and iStent subgroups except the stand-alone iStent inject subgroup showed a clinically significant IOP-lowering effect as a stand-alone procedure or combined with cataract surgery. Goniotomy with KDB in this setting seems to offer an advantageous IOP reduction compared to iStent inject.

Ab Interno Goniotomy with the Kahook Dual Blade in a Monocular Patient with Mucous Membrane Pemphigoid and Refractory Open Angle Glaucoma: A Case Report

“…Phaco-KDB results in an average IOP reduction of 12-32.1% with pressures in the mid-teens along with glaucoma medication requirements reduction of 21-89.1% over a follow-up period of 6-24 months. 7,8,[15][16][17][18][26][27][28] This IOP lowering effect is associated with the pre-operative IOP level. 8,9 However, most trabecular by-passing or ablating procedures cannot achieve an IOP at the level of episcleral venous pressure as they do not address all sources of resistance to aqueous outflow.…”

“…Ab interno excisional goniotomy with the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA, USA) is a MIGS procedure, that targets the trabecular meshwork, which is the main site of aqueous outflow resistance. 7 It has been effective in mild to moderate primary open-angle glaucoma (POAG), [8][9][10] uncontrolled glaucoma, 11 angle closure 12 and secondary glaucoma, 13 and can be performed as a standalone procedure 7,9,10,14,15 or in combination with cataract surgery. 7,8,12,[15][16][17][18] The purpose of this report is to present the case of a monocular patient with ocular MMP and open angle glaucoma refractory to medical treatment, that was managed successfully with ab interno KDB goniotomy at the time of cataract surgery.…”

“…Ab interno excisional goniotomy with the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA, USA) is a MIGS procedure, that targets the trabecular meshwork, which is the main site of aqueous outflow resistance. 7 It has been effective in mild to moderate primary open-angle glaucoma (POAG), 8–10 uncontrolled glaucoma, 11 angle closure 12 and secondary glaucoma, 13 and can be performed as a stand-alone procedure 7 , 9 , 10 , 14 , 15 or in combination with cataract surgery. 7 , 8 , 12 , 15–18 …”

Comments on the Article by Arnljots and Economou [Letter]

“…First, I wish to congratulate the authors on their effort to analyze KDB vs iStent inject outcomes. 1 Although the study provides real-world data of an experienced surgeon, some important inconsistencies prevent definitive conclusions from the analysis. Heterogeneous cohort: The study included primary/secondary open-angle glaucomas; standalone/combined procedures; patients with/without prior ocular procedures (including prior SLT, filtering surgery, and one patient with CRVO/PRP); and different surgical goals (e.g., patients with uncontrolled IOP and visual field progression despite maximum therapy, vs those with well-controlled glaucoma desiring medication reduction).…”

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First, I wish to congratulate the authors on their effort to analyze KDB vs iStent inject outcomes. 1 Although the study provides real-world data of an experienced surgeon, some important inconsistencies prevent definitive conclusions from the analysis.

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