Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma.

Kentaro Iwasaki,Yusuke Orii,Hiroshi Kakimoto,Yoshihiro Takamura,Masaru Inatani,Shogo Arimura

doi:10.3390/jcm11051354

Kentaro Iwasaki, Yusuke Orii + Show 4 more

Open Access

https://doi.org/10.3390/jcm11051354

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Abstract

We retrospectively evaluated the long-term surgical outcomes of phacoemulsification combined with a Kahook dual blade (KDB) procedure in Japanese patients with open-angle glaucoma. The primary outcome was surgical success or failure. Surgical failure was indicated by a <20% reduction in preoperative intraocular pressure (IOP) or IOP > 18 mmHg (criterion A), IOP > 14 mmHg (criterion B), or requirement for reoperation. Glaucoma medications after surgery and postoperative complications were recorded. Surgical outcomes were compared between primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) groups. The probability of success at 36 months postoperation was 52.5% using criterion A and 36.9% using criterion B. Mean IOP decreased significantly from 19.5 ± 6.9 mmHg preoperatively to 11.9 ± 2.7 mmHg at 36 months, and the mean number of glaucoma medications from 2.4 ± 1.4 to 1.6 ± 1.4 (both p < 0.01). IOP spikes were significantly more common in the ExG group (23.7% vs. 9.1%; p = 0.045), as was the need for additional glaucoma surgery (10.5% vs. 1.8%; p = 0.038). A KDB procedure combined with cataract surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. The complication rate was higher in eyes with ExG. Therefore, these eyes require more careful management after a KDB procedure.

Highlights

Trabeculotomy is effective for the reduction in intraocular pressure (IOP) in patients with glaucoma [1–4]
Ab interno trabeculotomy surgery is often performed in combination with cataract surgery, and we have previously reported the 12-month surgical outcome of the Kahook dual blade (KDB) procedure combined with cataract surgery [15]
Data were analyzed for 148 eyes of 97 patients who underwent phacoemulsification combined with KDB surgery

Summary

Introduction

Trabeculotomy is effective for the reduction in intraocular pressure (IOP) in patients with glaucoma [1–4]. The trabecular meshwork and inner walls of Schlemm’s canal are the main sites of resistance to aqueous outflow [1,5,6]. Removal of that resistance results in reduction in IOP. Conventional trabeculotomy can be performed using an ab externo approach with metal trabecular probes, which requires conjunctival and scleral incisions and sutures. This approach is invasive and leads to obstruction whenever additional trabeculectomy is needed [7–9]. Newer techniques performed using an ab interno approach are becoming popular in Japan due to their minimal invasiveness [10]

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