Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma

Ahmed Al Habash,Abdulrahman Albuainain

doi:10.1038/s41598-021-90223-5

Ahmed Al Habash, Abdulrahman Albuainain

Open Access

https://doi.org/10.1038/s41598-021-90223-5

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Journal: Scientific Reports	Publication Date: May 21, 2021
Citations: 16	License type: open-access

Affiliation: King Fahd Hospital of the University

Abstract

To characterize changes in intraocular pressure (IOP) and IOP-lowering medications through up to 2 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma. Prospective, non-comparative, interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Analysis was conducted on open-angle (OAG) and angle-closure (ACG) glaucoma groups separately. Thirty-seven patients with OAG (24 with primary OAG and 13 with pseudoexfoliation glaucoma) and 11 with ACG were enrolled. In OAG eyes, mean (standard error) baseline IOP was 21.1 (0.9) mmHg and through 24 months of follow-up was reduced by 6.4–7.7 mmHg (24.6–32.1%; p ≤ 0.0001 at all time points). In ACG eyes, mean baseline IOP was 20.8 (1.6) mmHg and was reduced by 6.1–8.77 mmHg (23.4–39.0%; p ≤ 0.0353). Mean medications were reduced by 61.9–89.1% (p ≤ 0.0001) in OAG eyes and by 56.3–87.3% (p ≤ 0.0004) in ACG eyes. Phaco-KDB significantly lowered IOP ~ 30% and medications by > 50% through 24 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication and does not adversely affect visual rehabilitation in eyes with cataract and glaucoma.

Highlights

Cataract is the world’s most common cause of blindness[1], and glaucoma represents an important cause of blindness worldwide as well[2]
A series of novel and less-invasive surgical techniques have been developed to provide meaningful intraocular pressure (IOP) reductions with lower risk of complications compared to conventional glaucoma surgery
Most of these procedures avoid the formation of a filtering bleb—and its complications—by shunting aqueous humor across the obstructed trabecular meshwork (TM) into Schlemm’s canal (SC) or into the suprachoroidal space, a few techniques rely on subconjunctival filtration[8,9]

Summary

Introduction

Cataract is the world’s most common cause of blindness[1], and glaucoma represents an important cause of blindness worldwide as well[2]. A series of novel and less-invasive surgical techniques have been developed to provide meaningful IOP reductions with lower risk of complications compared to conventional glaucoma surgery. Most of these procedures avoid the formation of a filtering bleb—and its complications—by shunting aqueous humor across the obstructed trabecular meshwork (TM) into Schlemm’s canal (SC) or into the suprachoroidal space, a few techniques rely on subconjunctival filtration[8,9]. We describe long-term (up to 36 months) outcomes of phacoemulsification and excisional goniotomy using the KDB, combined with goniosynechialysis in cases of angle-closure glaucoma, in patients with cataract and different types and stages of glaucoma

Methods

Results

Conclusion