Efficacy of Goniotomy With Kahook Dual Blade in Patients With Uveitis-associated Ocular Hypertension.

Abstract

In a small case series of patients with uveitis-associated ocular hypertension (OHTN) or glaucoma, goniotomy with Kahook Dual Blade (KDB) was an effective surgical treatment option for lowering intraocular pressure (IOP). The purpose of this study is to review the success of goniotomy using the KDB with trabecular meshwork (TM) excision in lowering the IOP of patients with uveitis-associated OHTN or glaucoma. A retrospective chart review was completed for all patients with uveitis-associated OHTN or glaucoma who underwent KDB goniotomy with TM excision alone or in combination with phacoemulsification cataract surgery at a single institution. The study included 12 patients (16 eyes). Patients were followed for a minimum of 5 months postoperatively. The main outcome measures of this case series included postoperative IOPs, percent IOP reduction, and reduction of glaucoma medications. The mean maximum IOP of the patients before maximum-tolerated medical therapy or surgery was 35.6±5.8 mm Hg. The mean preoperative IOP at the clinical office visit before surgery of these patients was 28.1±8.5 mm Hg on maximum-tolerated medical therapy. Ten eyes (62.5%) have maintained an IOP at or below their goal through their most recent follow-up visit (mean follow-up time of 9.6±5.6 mo). The mean number of glaucoma medications was significantly reduced from 3.6±0.9 medications to 2.1±1.7 medications, for a mean reduction of 1.5±1.4 medications (P=0.004). On the basis of this small case series, KDB goniotomy may be a safe, less invasive, and effective first-line surgical alternative for patients with uveitis-associated OHTN or glaucoma refractory to medical therapy.