J Cataract Refract SurgOctober 202029 citations

Efficacy and safety of a single-use dual blade goniotomy: 18-month results.

Wakil Susan M, Birnbaum Faith, Vu Daniel M, McBurney-Lin Shan, ElMallah Mohammed K, Tseng Henry

View on PubMed DOI: 10.1097/j.jcrs.0000000000000263

AI Summary

KDB goniotomy, alone or with cataract surgery, effectively lowered IOP and medication use for various glaucoma severities over 18 months, offering a safe, less invasive surgical option.

Abstract

Purpose

To compare the 18-month efficacy and safety of Kahook Dual Blade goniotomy (KDB) in combination with cataract surgery (combined group) or as a standalone procedure (standalone group).

Setting

Single surgeon practice.

Design

Retrospective review study.

Methods

A total of 116 eyes of 100 patients underwent KDB by a single well-experienced surgeon from May 2016 to 2018. A total of 93 eyes and 23 eyes were in the combined and standalone groups, respectively. Main outcome measures were reduction in intraocular pressure (IOP) and IOP-lowering medication and adverse events. Data were collected and analyzed using Welch t tests in R.

Results

A total of 116 eyes of 100 patients were included in the analysis. Moderate or severe glaucoma was observed in 71% of eyes in the combined group compared with 83% in the standalone group. At baseline, mean IOP was 16.5 ± 5.0 mm Hg (n = 93) and 24.3 ± 9.1 mm Hg (n = 23) in the combined and standalone groups, respectively (P < .05). The IOP decreased in both groups at 12 months (14.1 ± 3.9 vs 16.9 ± 7.6, P = .24) and 18 months (14.4 ± 3.7 vs 16.7 ± 7.6, P = .5). There was a statistically significant difference in the number of drops between the combined and standalone groups at baseline (2.4 ± 1.2 vs 2.9 ± 1.0, P < .05) persisting at 12 months (1.3 ± 1.2 vs 2.6 ± 1.2, P < .05) and at 18 months (1.3 ± 1.2 vs 3.3 ± 1.2, P < .05). Complications included transient hyphemas (20 eyes [17%]) and IOP spike (20 eyes [17%]). Seven eyes required additional glaucoma surgery, 5 of which were in the standalone group.

Conclusions

KDB was an effective and safe procedure for different glaucoma disease severities, whether combined with cataract surgery or as a standalone surgery. It is an alternative to consider prior to pursuing more invasive glaucoma surgeries.

MeSH Terms

HumansIntraocular PressureRetrospective StudiesTonometry, OcularTrabeculectomyTreatment Outcome

Shields Classification

Ch. 44Surgical Approaches for Coexisting Glaucoma and Cataract

Ch. 45Minimally Invasive Glaucoma Surgery (MIGS)

Key Concepts5

KDB goniotomy combined with cataract surgery or as a standalone procedure was an effective and safe procedure for different glaucoma disease severities.

TreatmentCase seriesRetrospective review studyn=116 eyes of 100 patientsCh28Ch45

At 18 months, the mean IOP in the Kahook Dual Blade goniotomy combined with cataract surgery group was 14.4 ± 3.7 mm Hg and 16.7 ± 7.6 mm Hg in the standalone group (P = .5).

TreatmentCase seriesRetrospective review studyn=93 eyes (combined group), 23 eyes (st…Ch3Ch45

The number of IOP-lowering medications in the Kahook Dual Blade goniotomy combined with cataract surgery group was 1.3 ± 1.2 and 3.3 ± 1.2 in the standalone group at 18 months (P < .05).

TreatmentCase seriesRetrospective review studyn=93 eyes (combined group), 23 eyes (st…Ch29Ch45

Complications of Kahook Dual Blade goniotomy included transient hyphemas (20 eyes [17%]) and IOP spike (20 eyes [17%]).

TreatmentCase seriesRetrospective review studyn=116 eyesCh28Ch45

Seven eyes required additional glaucoma surgery after Kahook Dual Blade goniotomy, with 5 of these eyes being in the standalone group.