Postoperative Use of Pilocarpine After Kahook Dual Blade Goniotomy in Mild to End-Stage Glaucoma

This study aims to determine if using pilocarpine postoperatively affects clinical outcomes after goniotomy.

Retrospective series comparing 532 Kahook Dual Blade goniotomy (KDB-G) procedures with (P+) or without (P-) pilocarpine use in the postoperative period. This study includes patients with both primary and secondary glaucoma ranging from mild to end-stage, undergoing KDB-G with or without phacoemulsification (phaco). The primary outcome measure was surgical success defined as intraocular pressure (IOP) < 21 mmHg in addition to either a reduction of >20% and/or the reduction of ≥1 topical glaucoma medications. Secondary outcomes were mean IOP, number of medications, and rate of hyphema and IOP spike at one week postoperatively.

The success rate was significantly greater in Group P + at postoperative month 1 (p = .02), 3 (p = .01), 12 (p = .048), and 16 (p = .02). The differences in mean IOP (p = .084) and number of medications (p = .15) were not significantly different at one year. However, Group P + required significantly less medications than Group P - at nearly all time points (months 1, 3, 6, 20, and 24). There were no differences in rates of hyphema (p = .30) or postoperative week 1 IOP spikes (p = .66) between groups.

The use of pilocarpine postoperatively may improve surgical success and may reduce the number of glaucoma medications needed after goniotomy.