<p>Early Results of Goniotomy with the Kahook Dual Blade, a Novel Device for the Treatment of Glaucoma</p>

Abstract

PurposeTo report the outcomes of patients who underwent goniotomy with the Kahook Dual Blade (KDB) either as a standalone procedure or in combination with cataract extraction.Patients and methodsThis retrospective chart review included 111 eyes of 90 patients who underwent KDB goniotomy from January to November 2016 at Glaucoma Associates of Texas. KDB goniotomy was combined with cataract surgery in 100 eyes. The main outcome measures were postoperative intraocular pressure (IOP) and number of IOP lowering medications.ResultsPreoperatively, mean IOP was 17.1 ± 4.7 mmHg (range 8–34 mmHg) and mean number of IOP lowering medications was 2.4 ± 1.3 (range 0–6). Postoperatively, mean IOP was 14.9 mmHg, 13.9 mmHg, 14.1 mmHg, 14.4 mmHg, and 14.7 mmHg at 1, 3, 6, 9, and 12 months follow-up, respectively (all p <0.004). Mean numbers of IOP lowering medications were 0.8, 1.0, 1.0, 1.0, and 1.6 at 1, 3, 6, 9, and 12 months follow-up, respectively (all p <0.001). The cumulative reoperation rates for uncontrolled IOP after KDB were 0%, 1.0%, 2.1%, and 4.6% at 3, 6, 9, and 12 months, respectively. Eyes with a preoperative IOP >21 mmHg were significantly more likely to undergo reoperation (p = 0.038, log-rank test). There were no serious complications at any time point in the follow-up period.ConclusionThe Kahook Dual Blade results in a reduction in IOP and use of glaucoma medications after one year of follow-up. Further prospective studies are needed to fully characterize safety and efficacy.

Long Term Outcome of Combined Phacoemulsification and Excisional Goniotomy with the Kahook Dual Blade in Different Subtypes of Glaucoma

“…Similarly, medication reductions in the current study are similar to previously reported outcomes in POAG eyes (21-71%). 13,14,[19][20][21][22][23][24][25][26] These prior benchmarks were reported in studies generally of 6-12 months' duration. The current study included data from all subjects through 12months, from 48 (84.2%) through 24 months, and from 18 (31.6%) through 36 months.…”

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

“…Previous studies on excisional goniotomy with KDB have reported IOP reductions of −31% as a stand-alone procedure and from −14% to −28% in combined surgeries. [12][13][14][15][16] In the same studies, reported reductions in medication burden were −26% in stand-alone surgery and −21% to −70% in the combined subgroups. In this study, IOP reductions of −28.4% in the stand-alone and −32.0% in the combined subgroups were observed along with a medication reduction of −14.3% and −21.5%, respectively.…”

Twelve-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy in Japanese patients with open-angle glaucoma

“…In a recent study, a higher rate of re-operation was noted in eyes with a higher preoperative IOP after ab interno trabeculotomy surgery mostly combined with cataract surgery [ 19 ]. This is in contrast with our result of absence of significant changes in IOP after surgery ( Table 2 ).…”

“…Ab interno trabeculotomy is often performed in combination with cataract surgery [11][12][13][14][15][16][17][18][19]; however, few studies have reported the clinical results of this approach, including series of stand-alone ab interno trabeculotomy surgery alone [20], with the exception of small case series of juvenile patients [21][22][23]. One possible explanation for this lack of studies is the achievement of sufficient reduction of IOP reduction or the number of medications needed is considered to be difficult in the absence of phacoemulsification.…”