PurposeTo compare reductions in intraocular pressure (IOP) and IOP-lowering medication use following sectoral excisional goniotomy with the Kahook Dual Blade (KDB) or 360° trabeculotomy (via either Trab360 or gonioscopy-assisted transluminal trabeculotomy [GATT]) in eyes with open-angle glaucoma (OAG) undergoing phacoemulsification cataract surgery.MethodsA retrospective review was conducted to collect data from adult subjects with early to advanced primary or secondary OAG undergoing phacoemulsification combined with either KDB or 360° trabeculotomy (Trab360 or GATT) between August 1, 2016 and July 30, 2018 for which 6-month follow-up was available. Data collected included IOP, glaucoma medications, adverse events, and additional IOP-lowering procedures. The primary outcome measure was surgical success (≥20% IOP or ≥1 medication reduction without additional IOP-lowering procedures) at 6 months.ResultsData were collected from 74 eyes of 61 subjects undergoing KDB excisional goniotomy and 27 eyes of 25 subjects undergoing 360° trabeculotomy (19 eyes of 17 subjects undergoing Trab360 and 8 eyes of 8 subjects undergoing GATT). At 6 months, 81.7% (58/71) of KDB eyes and 84.6% (22/26) of 360° trabeculotomy eyes achieved surgical successes (P=0.737). Mean IOP reductions and medication reductions were similar between groups at 6 months. However, more eyes undergoing KDB than Trab360/GATT achieved target IOP ≤18 mmHg (80.0% [56/70] vs 59.3% [16/27], P=0.040) and ≤15 mmHg (61.4% [43/70] vs 25.9% [7/27], P=0.003) without further IOP-lowering interventions at 6 months. The nature and frequency of adverse events were similar between groups.ConclusionsBoth KDB and Trab360 or GATT procedures similarly lowered both IOP and the need for IOP-lowering medications during the first 6 postoperative months. More eyes undergoing KDB excisional goniotomy than 360° trabeculotomy attained target IOP ≤18 mmHg and ≤15 mmHg at 6 months. A full 360° trabecular bypass may not be necessary to achieve maximal efficacy from this class of micro-invasive glaucoma procedures.

PurposeTo compare 6-month surgical outcomes of patients who underwent phacoemulsification (Phaco) combined with iStent implantation (iStent) versus excisional goniotomy using Kahook Dual Blade (KDB).MethodsRetrospective comparative case series of 58 iStent-Phaco eyes and 44 KDB-Phaco eyes operated upon by a single surgeon between 2016 and 2018. Preoperative, intraoperative, and postoperative intraocular pressure (IOP) and IOP-lowering medication data were collected. The primary outcome was the proportion of eyes using ≥1 fewer IOP-lowering medication at Month 6 while maintaining IOP ≤ 18 mmHg.ResultsBaseline IOP was 17.2 (standard error 0.7) in the KDB-Phaco group using a mean of 1.9 (0.2) medications; at Month 6, mean IOP was 14.8 mmHg P=0.002) on 1.0 (0.2) medications (P<0.002). Baseline IOP was 16.7 (0.4) in the iStent-Phaco group using a mean of 1.4 (0.1) medications; at Month 6, mean IOP was 14.2 mmHg (P<0.002) on 1.4 (0.1) medications P=0.374). Changes in IOP and medications were not significantly different between groups (P>0.05). Significantly more KDB-Phaco eyes than iStent-Phaco eyes (43.2% vs 17.2%, P=0.004) were using ≥1 fewer medications while maintaining IOP ≤18 mmHg at Month 6. Adverse events were uncommon and similar in nature and frequency between groups with the exception that more KDB-Phaco eyes than iStent-Phaco eyes (8 [18.2%] versus 1 [1.7%]) experienced an IOP elevation presumed to be related to steroid use.ConclusionKDB-Phaco and iStent-Phaco provided comparable IOP and medication reductions. The proportion of eyes able to discontinue 1 or more medications while maintaining IOP ≤ 18 mmHg was significantly greater in eyes undergoing KDB-Phaco.

No abstract

No abstract