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Efficacy and safety of a single-use dual blade goniotomy: 18-month results
Susan M Wakil1, Faith Birnbaum, Daniel M Vu
1From the Department of Ophthalmology, Duke Eye Center, Duke University Medical Center (Wakil, Birnbaum, Vu, McBurney-Lin, and Tseng), Durham, North Carolina, USA; Department of Ophthalmology, University of Montreal, Montreal (Wakil), Quebec, Canada; Ocala Eye (ElMallah), Ocala, Florida, USA.
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.
