Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes

Salinas, Lauriane; Chaudhary, Ankita; Berdahl, John P.; Lazcano‐Gomez, Gabriel; Williamson, Blake K.; Dorairaj, Syril; Seibold, Leonard K.; Smith, Sanjay; Aref, Ahmad A.; Darlington, Jason K.; Jiménez-Román, Jesús; Mahootchi, Ahad; Boucékine, Mohamed; Mansouri, Kaweh

doi:10.1097/ijg.0000000000001019

Cited by 90 publications

(79 citation statements)

References 31 publications

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“…The IOP reductions seen in this study are consistent with a prior study of stand-alone goniotomy with the KDB in eyes with severe and refractory glaucoma, in which mean IOP reductions of 24% were observed, medication reduction was 36.6%, and nearly 60% of eyes achieved a minimum 20% IOP reduction [14]. These results also compare favorably with other blebless, stand-alone, ab interno procedures.…”

Section: Discussionsupporting

confidence: 89%

Six-Month Outcomes of Goniotomy Performed with the Kahook Dual Blade as a Stand-Alone Glaucoma Procedure

Berdahl

Gallardo²,

ElMallah

et al. 2018

Adv Ther

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IntroductionTo characterize the reduction in intraocular pressure (IOP) and IOP-lowering medication use following goniotomy via trabecular meshwork excision performed using the Kahook Dual Blade as a stand-alone procedure in adult eyes with glaucoma uncontrolled on a regimen of 1–3 topical IOP-lowering medications.MethodsIn this retrospective analysis, data from consecutive patients undergoing goniotomy with the Kahook Dual Blade by 11 surgeons were analyzed. Preoperative, intraoperative, and postoperative follow-up data through 6 months of follow-up were collected. The primary efficacy endpoint was IOP reduction from preoperative baseline; reduction in IOP-lowering medication use was a secondary endpoint.ResultsData were collected from 53 eyes of 42 subjects. Mean (± SE) preoperative IOP was 23.5 ± 1.1 mmHg, and from day 1 through 6 months of postoperative follow-up mean IOP reductions of 7.0–10.3 mmHg (29.8–43.8%; p < 0.001 at each time point) were observed. Mean preoperative medication use was 2.5 ± 0.2 medications per eye and was reduced by month 6 to 1.5 ± 0.2 (a 40.0% reduction; p < 0.05). Eyes with higher baseline IOP experienced mean IOP reductions of 13.7 mmHg (− 46.4%) at month 6, while eyes with lower baseline IOP experienced mean IOP reductions of 3.8 mmHg (− 21.0%) at month 6. Mean medications were reduced by 1.3 medications in high-IOP eyes and by 0.9 in low-IOP eyes at month 6. No significant sight-threatening adverse events were observed.ConclusionsGoniotomy via trabecular meshwork excision performed using the Kahook Dual Blade effectively and safely lowered IOP when performed as a stand-alone procedure in eyes with glaucoma. The significant drop in IOP met or exceeded the recommended targets for these glaucoma patients.FundingNew World Medical, Inc.

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Section: Discussionsupporting

confidence: 89%

Six-Month Outcomes of Goniotomy Performed with the Kahook Dual Blade as a Stand-Alone Glaucoma Procedure

Berdahl

Gallardo²,

ElMallah

et al. 2018

Adv Ther

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“…As shown in previous studies, having experienced surgeons to train residents in a new surgical technique has been beneficial in reducing complications in the operative setting. 14,18 Additionally, residency wet-laboratory workshops, review of surgical videos prior to cases, and close supervision from attending surgeons may also lead to more efficient surgical time management while maintaining low complication rates. 19 Microhyphema, or suspended red blood cells in the anterior chamber, is an expected observation in the first 2 weeks following phaco-KDB due to blood reflux from Schlemm's canal, 10 and often does not affect the final IOP or best corrected vision.…”

Section: Discussionmentioning

confidence: 99%

“…5,7, 9,10 Intraoperative or postoperative anterior chamber blood reflux is common and expected as with any Schlemm's canal bypassing procedures, 12,13 but this generally resolves in the first postoperative week without additional intervention. 10,14 As the surgical treatment of glaucoma continues to increase, the demand for well-trained ophthalmic surgeons who are capable of performing glaucoma procedures will continue to grow. As such, increasing numbers of comprehensive ophthalmologists are beginning to incorporate MIGS into their practice, 15 as well as the potential for a stronger emphasis to be placed on incorporating MIGS into the training curriculum for ophthalmology residency programs.…”

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confidence: 99%

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Pratte

Landreneau

Hirabayashi

et al. 2020

Journal of Academic Ophthalmology

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Objective Kahook Dual Blade goniotomy (KDB) has proven effective in lowering intraocular pressure (IOP) and reducing the medication burden in patients with glaucoma. This study compares outcomes up to 12 months postoperatively after KDB combined with phacoemulsification (phaco-KDB) between an ophthalmology attending and residents. Methods A retrospective analysis was performed on 160 eyes of 113 patients who received a phaco-KDB performed by either an ophthalmology attending or a resident under direct guidance of the attending. Data for each patient was collected preoperatively and at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. The primary outcome measure was surgical success, defined as 20% IOP reduction or at least 1 medication reduction at 12 months. The secondary outcome measures included mean IOP and medication reduction at each postoperative time point, adverse events, operating time, and survival time, defined as time to failure to meet the criteria for surgical success or requiring a secondary IOP-lowering procedure. Results Preoperative mean IOP was comparable between the two groups (p = 0.585), while baseline medications were higher in the attending group (p = 0.040). Rate of successful outcomes was similar in both groups at 12 months (73.3% attending vs. 87.5% residents, p = 0.708). Mean IOP reduction (1.7 vs. 4.3%, p = 0.278) and medication reduction (0.7 vs. 0.6, p = 0.537) also did not differ at 12 months. Presence of adverse events was similar between the groups (21.6 vs. 27.3%, p = 0.938). The survival time was significantly longer in the attending group (356.3 ± 20.2 days vs. 247.1 ± 26.8 days, p = 0.003). Resident cases took ∼10 minutes longer compared with attending cases (p < 0.001). Conclusion IOP lowering outcomes and rate of adverse events of KDB were similar whether the primary surgeon was an attending or a resident surgeon. The survival time was significantly longer in the attending group, but overall success rate was 77.5% for both groups. This suggests phaco-KDB is an effective procedure that can be safely performed by a trainee under direct supervision of an experienced surgeon.

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“…Morales et al, with Phaco-ECP, reported the results obtained for IOP lowering to 15 mmHg and report an absolute success of 11.9% with a quali ed success of 72.3% 14 . A retrospective Brazilian study on 247 patients, de ned success based on IOP 21mmHg with 3 years of follow-up reported the corresponding rates were 55.7% for absolute success and 90.7% for quali ed success 15 .…”

Section: Cataract Extraction As a Stand Alone Procedures Does Not Provmentioning

confidence: 99%

Primary Outcomes of Combined Cataract Extraction Technique with Ab-interno Trabeculectomy  and Endoscopic Cyclophotocoagulation  in Patients with Primary Open Angle Glaucoma

Izquierdo¹,

Mejias²,

Cañola³

et al. 2020

Preprint

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Background: Glaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma. Methods: A retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. Inclusion criteria: 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP <14 mmHg either with no medications (complete success) or with medications (qualified success). Results: A total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0±3.7 mmHg and postoperatively was 11.6±1.9 mmHg and 11.4±1.8 mmHg (P<0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9±1.4 to 0.56±1.05 at 9 month follow-ups (P<0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months.Conclusions: In patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.

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Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes

Abstract: Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.

Cited by 90 publications

References 31 publications

Six-Month Outcomes of Goniotomy Performed with the Kahook Dual Blade as a Stand-Alone Glaucoma Procedure

Six-Month Outcomes of Goniotomy Performed with the Kahook Dual Blade as a Stand-Alone Glaucoma Procedure

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Primary Outcomes of Combined Cataract Extraction Technique with Ab-interno Trabeculectomy  and Endoscopic Cyclophotocoagulation  in Patients with Primary Open Angle Glaucoma

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Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes

Abstract: Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.

Cited by 90 publications

References 31 publications

Six-Month Outcomes of Goniotomy Performed with the Kahook Dual Blade as a Stand-Alone Glaucoma Procedure

Six-Month Outcomes of Goniotomy Performed with the Kahook Dual Blade as a Stand-Alone Glaucoma Procedure

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Primary Outcomes of Combined Cataract Extraction Technique with Ab-interno Trabeculectomy and Endoscopic Cyclophotocoagulation in Patients with Primary Open Angle Glaucoma

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Primary Outcomes of Combined Cataract Extraction Technique with Ab-interno Trabeculectomy  and Endoscopic Cyclophotocoagulation  in Patients with Primary Open Angle Glaucoma