A multicenter retrospective comparison of goniotomy versus trabecular bypass device implantation in glaucoma patients undergoing cataract extraction

Dorairaj, Syril; Kahook, Malik Y.; Williamson, Blake K.; Seibold, Leonard K.; ElMallah, Mohammed K; Singh, Inder Paul

doi:10.2147/opth.s158403

Cited by 72 publications

(68 citation statements)

References 10 publications

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“…The retrospective nature of data collection is a limitation of the study; the risk of selection bias was mitigated by including data from all Latino subjects undergoing the procedure within the data collection window. The lack of a control group is also a limitation that precludes benchmarking these outcomes against other procedures, although the similarity of the results in this series to published results of other studies—including comparative studies 16 , 18 , 20 , 21 , 25 , 26 supports the representative nature of these data. Also, as this was a retrospective study, there was no specific protocol for the addition or withdrawal of medications; instead, these decisions were made by the investigator on a case by case basis determined by clinical status, as reflects clinical practice.…”

Section: Discussionsupporting

confidence: 59%

<p>Excisional Goniotomy in Latino Patients with Open-Angle Glaucoma: Outcomes Through 24 Months</p>

Porter

Garza

Gallardo³

2020

OPTH

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Purpose To characterize the efficacy of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (KDB-phaco) in eyes of Latino adults with cataract and open-angle glaucoma (OAG). Methods Health records of consecutive Latino patients undergoing KDB-phaco were retrospectively reviewed. Intraocular pressure (IOP) and IOP-lowering medication use were recorded at baseline and each postoperative visit through up to 24 months. Primary outcomes were reductions in IOP and medication use from baseline; secondary outcomes were the proportions of eyes achieving IOP reductions of ≥20% and medication reductions ≥1 medication from baseline. Subgroup analysis was conducted in eyes with high and low baseline IOP. Results Data from 44 eyes of 32 Latino patients with OAG were analyzed. Mean IOP was 17.8 (0.7) mmHg at baseline and postoperatively ranged from 12.4 to 13.8 mmHg (p≥0.0003), representing mean IOP reductions of 4.2–4.6 mmHg (19.7–23.1%). Mean medication was 1.5 (0.2) medications per eye at baseline and postoperatively ranged from 0.2 to 1.0 (p≥0.0061), representing mean medication reductions of 0.7–1.2 medications per eye (47.1–87.2%). In the low baseline IOP group (<18 mmHg), mean IOP was significantly reduced through Month 24 and medications through Month 12; in the high baseline IOP group (≥18 mmHg), IOP and medications were significantly reduced through Month 24. From Months 1–24, IOP reductions of ≥20% were achieved by 48.4–56.2% of eyes in the full cohort, by 20.0–33.3% in the low IOP group, and by 66.7–100% in the high IOP group; medication reductions of ≥1 medication were achieved by 72.0–95.6%, 64.7–94.2%, and 87.5–100% of eyes, respectively. Conclusion Combined KDB-phaco in eyes of Latino patients with glaucoma and cataract significantly lowers IOP and the need for IOP-lowering medications for up to 24 months and should be considered for such patients who warrant IOP reduction, medication reduction, or both.

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Section: Discussionsupporting

confidence: 59%

<p>Excisional Goniotomy in Latino Patients with Open-Angle Glaucoma: Outcomes Through 24 Months</p>

Porter

Garza

Gallardo³

2020

OPTH

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“…50% of the iStent price. Studies comparing the efficacy of the iStent treatment and KDB goniotomy (both procedures performed in conjunction with cataract phacoemulsification) showed that the degree of IOP reduction was similar for both modalities [37] or KDB goniotomy was superior to a single iStent [38,39].…”

Section: Discussionmentioning

confidence: 99%

“…The tissue to be excised is lifted on an appropriately profiled ramp and removed from its original position, so that it can be removed from the eye after the procedure is completed. Such controlled excision of the trabecular meshwork establishes a direct connection of the anterior chamber with Schlemm's canal and then communication with the aqueous veins [10,11]. Through this sequence, the procedure increases the aqueous humor outflow via the conventional pathway.…”

Section: Introductionmentioning

confidence: 99%

Ab interno goniotomy with a Kahook Dual Blade in 6-month follow-up

Majer¹,

Kaszuba-Modrzejewska²,

Petrus³

et al. 2020

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Aim of the study: Evaluation of ab interno goniotomy using a Kahook Dual Blade in combination with phacoemulsification in patients with primary open angle glaucoma during a 6-month follow-up. Material and methods: 75 patients with mild and moderately advanced primary open angle glaucoma, who had phacoemulsification combined with ab interno goniotomy using a Kahook Dual Blade (New World Medical, USA), were included in this analysis. The average age was 68.4 ±8.9 years. Mean pre-and postoperative intraocular pressure, number of antiglaucoma medications, complications of the surgery and need for another procedure were analysed in the 6-month follow-up. Results: Before the surgery, mean intraocular pressure was 21.9 ±3.9 mmHg and the number of antiglaucoma medications was 2.2 ±1.2. A reduction in intraocular pressure of 17.53% and a decrease in number of antiglaucoma medications of 60% (p < 0.001) were observed in the 6-month follow-up. There was slight intra-operative bleeding into the anterior chamber from the incision in all cases. On the first days after surgery there were diffuse blood cells or a clot in the anterior chamber in 38% of eyes. Increase in intraocular pressure above 25 mmHg on the first day after surgery was observed in 30.6% of eyes. In one eye there was no postoperative intraocular pressure stabilisation and laser cyclodestruction was performed. Conclusions: Ab interno goniotomy performed simultaneously with phacoemulsification results in a significant reduction in intraocular pressure and a decrease in the number of anti-glaucoma drugs used. The treatment is characterized by a good safety profile and does not require intensive postoperative management.

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“…In a study of 42 eyes of 24 subjects with angle closure glaucoma undergoing phacoemulsification and KDBassisted goniosynechialysis and excisional goniotomy, 6 months of follow-up demonstrated mean IOP reductions of 10.1-12.8 mmHg (38.4-49.5%; P < 0.0001) [23]. At 6 months, 92.9% of eyes achieved IOP ≤ 18 mmHg, all eyes achieved IOP reduction of ≥ 20%, and 85.7% were medication-free [24]. Although there was no comparison to cataract surgery alone, their findings suggest that goniosynechialysis and excisional goniotomy with the KDB together with cataract extraction may play a helpful role in optimizing outflow and IOP reduction in angle closure glaucoma eyes.…”

Section: Kahook Dual Bladementioning

confidence: 96%

“…Two recent studies compared the efficacy of goniotomy with the KDB to iStent implantation in glaucoma patients undergoing cataract surgery. In a retrospective multicenter comparison of 237 eyes undergoing KDB goniotomy with phacoemulsification and 198 eyes undergoing iStent implantation with phacoemulsification, authors reported that those in the KDB group had a significantly greater IOP reduction (− 4.2 mmHg, 23.7%) compared to the iStent implantation and phacoemulsification group (− 2.7 mmHg, 16.4%, P < 0.001) after six months of follow-up in eyes with mild to moderate glaucoma [24].…”

Section: Comparative Studiesmentioning

confidence: 99%

An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

Tassel

Chen

2019

Curr Ophthalmol Rep

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Purpose of Review In this article, we review the current options for microinvasive glaucoma surgery (MIGS) combined with cataract extraction in the USA and the efficacy of the various approaches. Recent Findings MIGS is a rapidly growing area of research and clinical interest. Available surgeries aim to reduce intraocular pressure by improving aqueous outflow through the trabecular or subconjunctival pathways or by reducing aqueous production. Summary Multiple approaches to MIGS are utilized in clinical practice. On average, these surgeries are safe and modestly effective in reducing intraocular pressure. Future research will demonstrate which surgical approaches are most efficacious, whether and how to combine MIGS, and the role of MIGS in improving patient quality of life.

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A multicenter retrospective comparison of goniotomy versus trabecular bypass device implantation in glaucoma patients undergoing cataract extraction

Cited by 72 publications

References 10 publications

<p>Excisional Goniotomy in Latino Patients with Open-Angle Glaucoma: Outcomes Through 24 Months</p>

<p>Excisional Goniotomy in Latino Patients with Open-Angle Glaucoma: Outcomes Through 24 Months</p>

Ab interno goniotomy with a Kahook Dual Blade in 6-month follow-up

An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

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