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24-month outcomes of a combined 180-degree phacogoniotomy with KDB procedure
Panagiotis Tsoutsanis1,2, Ananth Ranjit1, Afifa Islam1
1Department of Ophthalmology, Northern Care Alliance NHS Foundation Trust, Rochdale Infirmary, Rochdale, United Kingdom.
Purpose:
We aimed to evaluate the 24-month efficacy and safety of combined 180-degree phacogoniotomy with Kahook Dual Blade (KDB) in patients with various forms of glaucoma.
Methods:
This retrospective, single-centre study included 66 eyes from 66 patients who underwent combined phacogoniotomy with KDB surgery at Rochdale Infirmary, UK, between November 2021 and January 2023. Patients with moderate-to-advanced open-angle, secondary, or narrow-angle glaucoma were included. Primary outcomes were changes in mean intraocular pressure (IOP) and number of IOP-lowering medications from baseline to 24 months. Secondary outcomes included surgical success, defined according to the criteria of Dorairaj et al. and the American Academy of Ophthalmology (AAO) criteria.
Results:
Mean IOP significantly decreased from 19.4 ± 6.6 mmHg at baseline to 14.1 ± 4.3 mmHg at 24 months, representing a mean reduction of 5.3 mmHg (27%) (p < 0.0001). The mean number of IOP-lowering medications was reduced from 3.0 ± 0.7 to 1.7 ± 1.2 at 24 months, a mean reduction of 1.3 medications (43%) (p < 0.0001). At 24 months, 92% of eyes achieved success by Dorairaj's criteria, and 76% achieved qualified success and 19% absolute success according to AAO standards. Visual acuity improved slightly but not significantly.
Conclusion:
Combined 180-degree phacogoniotomy with KDB provides a significant and sustained 24-month reduction in intraocular pressure and medication burden, with a favourable safety profile. These findings support phacogoniotomy with KDB as an effective minimally invasive option for patients with coexisting cataract and glaucoma.