<p>Outcome of phacoemulsification combined with excisional goniotomy using the Kahook Dual Blade in severe glaucoma patients at 6 months</p>

Abstract

Purpose The aim of this study was to describe 6-month rates of achieving target IOP without requiring additional glaucoma surgery after excisional goniotomy using the Kahook Dual Blade combined with phacoemulsification (phaco-KDB) in patients with severe-stage glaucoma. Methods Retrospective review of 42 eyes from 36 patients with severe glaucoma who received phaco-KDB. Primary and secondary open-angle and combined-mechanism glaucoma were included. Preoperative, intraoperative, and postoperative data were collected through the 6-month follow-up period. The primary outcome was proportion of patients achieving IOP ≤15 mmHg without additional glaucoma procedures. Secondary outcomes were mean change in IOP, reduction of glaucoma medications, additional glaucoma procedures needed, and adverse events. Results Preoperative baseline mean IOP was 17.1±4.8 mmHg (mean ± SD) and number of medications was 2.4±1.3. At 6 months, 64.3% (27/42) of eyes had achieved IOP ≤15 mmHg without additional glaucoma procedures, 45.2% (19/42) reached this target IOP on fewer medications, and 31.0% (13/42) on no medications. Mean IOP reduction was 2.1±4.67 mmHg ( P =0.022) and mean medication reduction was 1.2±1.4 ( P ≤0.001). Visually significant complications were experienced by 7.1% (3/42) of eyes, and 7.1% (3/42) required additional IOP-lowering procedures within 6 months of surgery. Conclusion Patients with severe-stage open-angle glaucoma achieved significant IOP and medication reductions following phaco-KDB. Notably, about two-thirds of eyes achieved an IOP of ≤15 mmHg at 6 months without additional glaucoma procedures. Complications and need for additional procedures were rare. Phaco-KDB may be an effective and safe alternative to more invasive filtering surgery in many patients with severe glaucoma.

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

“…14,18 Additionally, residency wet-laboratory workshops, review of surgical videos prior to cases, and close supervision from attending surgeons may also lead to more efficient surgical time management while maintaining low complication rates. 19 Microhyphema, or suspended red blood cells in the anterior chamber, is an expected observation in the first 2 weeks following phaco-KDB due to blood reflux from Schlemm's canal, 10 and often does not affect the final IOP or best corrected vision. 23 The rate of "visually significant" hyphema defined as grade 2 to 4 hyphema beyond postoperative week 2 of phaco-KDB was low; therefore, we were not able to determine any significant differences between the two cohorts.…”

“…Intraoperative and postoperative adverse events included visually-significant hyphema, defined as grade 2 to 4 layered blood in the anterior chamber with decreased vision from the baseline, among other adverse events commonly reported. 9,10,21 Steroid-related IOP spike was assessed separately and defined as an IOP increase of >25% from baseline while on topical prednisolone with minimum IOP of 28 mm Hg and subsequent reduction >25% after discontinuing the topical prednisolone. 22…”

“…[5][6][7] Goniotomy performed with the Kahook Dual Blade ([KDB] New World Medical, Rancho Cucamonga, CA) is a type of Schlemm's canal MIGS procedure that has shown success in lowering IOP and reducing the medication burden in adult glaucoma patients as both a stand-alone procedure (KDB) 8,9 and combined with phacoemulsification (phaco-KDB). 5,7,10 The design of the parallel blade with a ramp allows a precise excision of the diseased trabecular meshwork en bloc to allow the aqueous humor to directly drain through the Schlemm's canal into the collector channels. 11 In addition to an effective IOP-lowering capacity, phaco-KDB has shown to be a safe procedure with limited vision-threatening complications.…”

“…11 In addition to an effective IOP-lowering capacity, phaco-KDB has shown to be a safe procedure with limited vision-threatening complications. 5,7, 9,10 Intraoperative or postoperative anterior chamber blood reflux is common and expected as with any Schlemm's canal bypassing procedures, 12,13 but this generally resolves in the first postoperative week without additional intervention. 10,14 As the surgical treatment of glaucoma continues to increase, the demand for well-trained ophthalmic surgeons who are capable of performing glaucoma procedures will continue to grow.…”

“…5,7, 9,10 Intraoperative or postoperative anterior chamber blood reflux is common and expected as with any Schlemm's canal bypassing procedures, 12,13 but this generally resolves in the first postoperative week without additional intervention. 10,14 As the surgical treatment of glaucoma continues to increase, the demand for well-trained ophthalmic surgeons who are capable of performing glaucoma procedures will continue to grow. As such, increasing numbers of comprehensive ophthalmologists are beginning to incorporate MIGS into their practice, 15 as well as the potential for a stronger emphasis to be placed on incorporating MIGS into the training curriculum for ophthalmology residency programs.…”