Outcomes of Stand-alone Kahook Dual Blade Goniotomy: Higher Maximum Intraocular Pressure and Laser Trabeculoplasty as...

To investigate stand-alone Kahook Dual Blade (KDB) goniotomy outcomes, prognostic factors, and specifically whether preoperative laser trabeculoplasty (LTP) influences outcomes.

This retrospective review included 26 eyes with predominantly severe glaucoma (n = 17, 65.4%) undergoing stand-alone KDB. Inclusion criteria included postoperative follow-up of ≥ 6 months. The primary outcome was surgical success, defined as IOP reduction ≥ 20% or reduced medication burden, and IOP ≤ 21 without reoperation. Secondary outcomes included IOP reduction, glaucoma medication use, and surgical complications. The Kaplan-Meier models were used to analyze surgical success. The Cox model determined risk factors for failure.

Surgical success rates at postoperative months (POM) 6 and 18 were 57.7% ± 9.7 and 35.2% ± 9.9, respectively. Greater preoperative maximum IOP (Tmax) (Unit HR 1.11, 95% CI: 1.03-1.19, p = 0.007) and postoperative IOP spike (HR 6.54, 95% CI: 1.73-24.77, p = 0.006) were risk factors for failure. IOP decreased by 35.5% through POY 1.5 (p = 0.001) with no difference in medications. LTP-naïve eyes had significantly greater IOP reduction than those with prior LTP at POM 9 (53.7% ± 5.2 vs 21.5% ± 9.8, p = 0.022) and POY 1 (46.7% ± 6.7 vs 22.0% ± 17.7, p = 0.010). Five (19.2%) eyes experienced postoperative complications, most commonly IOP spike (n = 4, 15.4%).

Stand-alone KDB offers safe IOP reduction through POY 1.5. Those with a history of LTP have one-half the IOP response as LTP-naïve eyes. Despite IOP improvement, only one-third were successful at POY 1.5, with Tmax and postoperative IOP spike identified as risk factors for failure.

Ophthalmologists performing stand-alone KDB may expect less IOP improvement in patients with a history of LTP and should understand this procedure may provide insufficient IOP control in those with a greater preoperative Tmax or who experience a postoperative IOP spike.

Claxton MR, McHenry JG, Jones JK, et al. Outcomes of Stand-alone Kahook Dual Blade Goniotomy: Higher Maximum Intraocular Pressure and Laser Trabeculoplasty as Poor Prognostic Indicators. J Curr Glaucoma Pract 2025;19(2):90-95.