Abstract
To describe intraocular pressure (IOP) and ocular hypotensive medication outcomes of combined phacoemulsification and ab interno trabeculectomy with the Kahook Dual Blade (KDB; New World Medical, Inc, Rancho Cucamonga, CA) in adults with cataract and open-angle glaucoma (OAG). Retrospective chart review of existing medical records. Data collected included intraocular pressure (IOP) and IOP-lowering medication use preoperatively and through up to 24 months postoperatively. Paired t-tests were utilized to compare preoperative to postoperative mean IOP and mean medications used. Data from 32 eyes of 26 subjects were analyzed. Subjects were predominantly Caucasian (25/26) had mean (standard error) age of 79.3 (1.2) years, and eyes had moderate-advanced OAG (mean visual field mean deviation -8.3 [1.3] dB). Mean IOP was 19.8 (0.8) mmHg at baseline and 15.5 (0.6) mmHg (p<0.0001) after mean follow-up of 11.5 (1.0) months; IOP reductions of ≥20% were achieved in 20/32 eyes (62.5%). Mean medication use declined from 2.4 (0.2) medications per eye at baseline to 0.5 (0.2) at last follow-up (p<0.0001); 23/32 eyes (71.9%) were medication-free at last follow-up. No vision-threatening complications were observed. Combined phacoemulsification and ab interno trabeculectomy with the KDB safely provided mean IOP reductions of 21.7% and mean IOP medication reductions of 83% after mean follow-up of 12 months in eyes with moderate to advanced OAG. This procedure provides medication-independence in most eyes with statistically and clinically significant IOP reductions.
Highlights
Glaucoma is the leading cause of irreversible blindness worldwide [1], and the prevalence of primary open-angle glaucoma (POAG) among adults over age 65 years in England and Wales —the most common form of glaucoma in the region [2]—is 3% [3] and in Northern Ireland is 2.83% [4]
Mean intraocular pressure (IOP) was 19.8 (0.8) mmHg at baseline and 15.5 (0.6) mmHg (p
At last follow-up, IOP reductions of 20% were achieved in 20/32 eyes (62.5%)
Summary
Glaucoma is the leading cause of irreversible blindness worldwide [1], and the prevalence of primary open-angle glaucoma (POAG) among adults over age 65 years in England and Wales —the most common form of glaucoma in the region [2]—is 3% [3] and in Northern Ireland is 2.83% [4]. The development of numerous minimally invasive surgical options that lower IOP somewhat less than older procedures but with more favorable safety profiles has expanded indications for surgery earlier in the disease course and in the treatment cascade [9,10,11]. Many of these procedures can be performed either as standalone surgery in eyes with inadequate IOP control or in combination with cataract surgery to reduce IOP and/or the medication burden in eyes with coincident glaucoma
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