Excisional Goniotomy in Latino Patients with Open-Angle Glaucoma: Outcomes Through 24 Months

To characterize the efficacy of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (KDB-phaco) in eyes of Latino adults with cataract and open-angle glaucoma (OAG).

Health records of consecutive Latino patients undergoing KDB-phaco were retrospectively reviewed. Intraocular pressure (IOP) and IOP-lowering medication use were recorded at baseline and each postoperative visit through up to 24 months. Primary outcomes were reductions in IOP and medication use from baseline; secondary outcomes were the proportions of eyes achieving IOP reductions of ≥20% and medication reductions ≥1 medication from baseline. Subgroup analysis was conducted in eyes with high and low baseline IOP.

Data from 44 eyes of 32 Latino patients with OAG were analyzed. Mean IOP was 17.8 (0.7) mmHg at baseline and postoperatively ranged from 12.4 to 13.8 mmHg (p≥0.0003), representing mean IOP reductions of 4.2-4.6 mmHg (19.7-23.1%). Mean medication was 1.5 (0.2) medications per eye at baseline and postoperatively ranged from 0.2 to 1.0 (p≥0.0061), representing mean medication reductions of 0.7-1.2 medications per eye (47.1-87.2%). In the low baseline IOP group (<18 mmHg), mean IOP was significantly reduced through Month 24 and medications through Month 12; in the high baseline IOP group (≥18 mmHg), IOP and medications were significantly reduced through Month 24. From Months 1-24, IOP reductions of ≥20% were achieved by 48.4-56.2% of eyes in the full cohort, by 20.0-33.3% in the low IOP group, and by 66.7-100% in the high IOP group; medication reductions of ≥1 medication were achieved by 72.0-95.6%, 64.7-94.2%, and 87.5-100% of eyes, respectively.

Combined KDB-phaco in eyes of Latino patients with glaucoma and cataract significantly lowers IOP and the need for IOP-lowering medications for up to 24 months and should be considered for such patients who warrant IOP reduction, medication reduction, or both.