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

Abstract

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.

Effects of Preoperative Intraocular Pressure Level on Surgical Results of Microhook Ab Interno Trabeculotomy

“…Using multiple regression analysis, preoperative IOP was the significant indicator with the highest standard β value for predicting postoperative IOP ( Table 4 ). A lower IOP-reducing magnitude in the lower preoperative IOP group than in the higher IOP group was reported after other goniotomy procedures with Kahook dual blade (KDB) [ 11 , 12 ] and trabectome [ 13 ]. Figure 2 shows the correlation between preoperative IOP and 12 months %IOP reduction after various goniotomy/LOT surgeries including µLOT, KDB, gonioscopy-assisted transluminal trabeculotomy (GATT), and trabectome in subject groups including POAG (data and references used for generation of this figure are shown in Supplementary Table S1 ).…”

“…Previously, various factors that possibly associate with the surgical efficacy of LOT/goniotomy surgeries were reported; the factors assessed included age [ 10 ], preoperative IOP level [ 11 , 12 , 13 ], degree of angle opening [ 14 ], glaucoma severity [ 15 , 16 , 17 , 18 ], and simultaneous cataract surgery [ 10 , 19 , 20 , 21 ]. In case series of µLOT, by using multiple regression analyses, we have previously reported that older age, steroid-induced glaucoma, developmental glaucoma, and the absence of postoperative complications were associated with lower final IOP; exfoliation glaucoma, other types of glaucoma, and higher preoperative IOP were associated with higher final IOP [ 9 ].…”

Risk factors for intraocular pressure elevation in a six-month period after ab interno trabeculotomy using a Kahook Dual Blade

“…An increasing number of reports associated with MIGS have identified the risk factors and prognosis; however, there are still problems to be solved. A vexing complication in procedures targeting the TM tissue is IOP spikes, and the incidence of IOP spikes in ab interno trabeculotomy using a KDB (KDB trabeculotomy) ranges from 7.7% to 18.2% [6][7][8][9]. Uncontrolled high IOP levels may worsen visual field defects; one report showed that 14.3% (6/42) of eyes required additional procedures for IOP reduction within three months after KDB trabeculotomy [10].…”

Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study

“… 12 – 14 IOP lowering at POM12 in the KDB group was lower than those of other studies, which had POM12 reductions ranging from 2.4–6.5 mm Hg. 17 , 21 – 23 …”

“… 15 At a 2-year follow-up, KDB combined with CE/IOL has been shown to decrease IOP by 4.3–7.2 mm Hg and decrease glaucoma medications by 0.7. 16 , 17 Only a few studies have examined outcomes of trainee-performed KDB, 18 , 19 and to our knowledge, none have characterized trainee outcomes with ECP. No studies have directly compared KDB and ECP on a large scale.…”