Outcomes of Kahook Dual Blade Goniotomy for Uveitis Associated Open Angle Glaucoma or Ocular Hypertension

Abstract

Précis: Kahook Dual Blade (KDB) goniotomy can successfully lower intraocular pressure in some patients with uveitis-associated ocular hypertension or glaucoma. Purpose: The purpose of this study was to report a case series of patients that underwent KDB goniotomy at a single institution for uveitis-associated ocular hypertension or glaucoma with an open angle. Methods: We performed a retrospective chart review of all patients with uveitis-associated ocular hypertension or glaucoma who underwent KDB goniotomy with trabecular meshwork excision alone or in combination with phacoemulsification cataract surgery at a single center between August 2017 and February 2020. The case series included 45 eyes of 37 patients. All eyes developed ocular hypertension refractory to maximum-tolerated medical therapy and required surgical intervention. Two eyes were excluded as they were lost to follow-up before 5 months postoperatively. Surgical success was defined as reaching the goal intraocular pressure or lower for each patient, including ongoing medical therapy. Results: At most recent follow-up, 25 (55.6%) of 45 eyes had an intraocular pressure that was at goal. Mean follow-up time was 15.2±12.1 months ranging from 0.5 to 36 months postoperatively, considering that patients were eliminated from the data analysis once they required a second surgery. The mean number of preoperative medications, including oral carbonic anhydrase inhibitors was 3.7±1.2 medications. The mean number of postoperative medications through the last clinic visit was 2.5±1.9 medications for a mean reduction of 1.2±1.6 medications (P-value <0.0001*). Conclusions: This larger case series shows that some patients with uveitis-associated ocular hypertension or glaucoma with an open angle may have success with KDB goniotomy.

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

“…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. 14,15 Currently, there is an unmet need for KDB studies with long-term follow-up.…”