Six-Month Outcomes of Combined Phacoemulsification and Kahook Dual Blade Excisional Goniotomy Surgery in Various...

To evaluate the efficacy and safety of the Kahook Dual Blade (KDB) excisional goniotomy procedure combined with phacoemulsification in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and primary angle-closure glaucoma (PACG).

This retrospective study included 25 eyes of 25 patients (13 males, 12 females) who underwent combined phacoemulsification and KDB excisional goniotomy for early- to moderate-stage glaucoma. Pre- and postoperative intraocular pressure (IOP), number of antiglaucoma medications, and best-corrected visual acuity (BCVA) were evaluated. Postoperative complications and surgical success rates were analyzed during a 6-month follow-up period. Surgical success was defined as a ≥20% reduction in IOP from baseline and IOP <18 mmHg, with or without medication.

The patients' mean age was 67.0±11.9 years; 36% had POAG, 36% PEXG, and 28% PACG. The mean preoperative IOP was 22.7±6.0 mmHg, which significantly decreased to 12.8±2.2 mmHg at 6 months (p<0.05). The median number of medications decreased from 2 preoperatively to 0 postoperatively (p<0.05). There were no significant differences in 6-month IOP values (p=0.96) or IOP reduction rates (p=0.61) among glaucoma subtypes. BCVA improved from 0.5±0.4 to 0.1±0.1 logarithm of the minimum angle of resolution (p=0.001). The most common complications were transient hyphema (12%) and corneal edema (20%), all of which resolved with conservative/topical treatment. One patient required trabeculectomy at month 3, and 3 patients demonstrated less than 20% IOP reduction. The surgical success rate at month 6 was 84%.

The KDB procedure combined with cataract surgery provided significant reductions in both IOP and the need for IOP-lowering medications at 6 months of follow-up in patients with early and moderate POAG, PACG, and PEXG, while maintaining a very low rate of complications.