Performances of glaucoma operations with Kahook Dual Blade or iStent combined with phacoemulsification in Japanese open angle glaucoma patients

Iwasaki, Kentaro; Takamura, Yoshihiro; Orii, Yusuke; Arimura, Shogo; Inatani, Masaru

doi:10.18240/ijo.2020.06.13

Cited by 27 publications

(19 citation statements)

References 19 publications

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“…All surgeries were performed by experienced glaucoma specialists, and the surgical procedures were as previously described [ 15 ]. Standard phacoemulsification was performed with implantation of an intraocular lens through a clear 2.4-mm temporal corneal incision using topical anesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…The Kahook dual blade (KDB; New World Medical, Rancho Cucamonga, CA, USA) is suitable for use in ab interno trabeculotomy surgery and is designed to excise a strip of the trabecular meshwork and the inner walls of Schlemm’s canal using dual blades to decrease resistance to aqueous outflow [ 14 ]. Ab interno trabeculotomy surgery is often performed in combination with cataract surgery, and we have previously reported the 12-month surgical outcome of the KDB procedure combined with cataract surgery [ 15 ]. Although many studies on the surgical outcomes of the KDB procedure have been published [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ], few have reported the long-term outcomes when this procedure is combined with cataract surgery [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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

Iwasaki

Kakimoto

Orii

et al. 2022

JCM

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Iwasaki

Kakimoto

Orii

et al. 2022

JCM

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“…Iwasaki et al directly compared combined KDB and iStent and found that the overall IOP percentage reduction was higher in the KDB group (26%) vs the iStent group (19%). 23 The KDB group also had a higher success rate at 12 months after surgery while the iStent group showed a better safety profile with only a 2.3% occurrence rate of hyphema vs 16.3% in the KDB group. Thus, in most studies excisional goniotomy with the KDB seems to show an advantage in IOP-lowering capacity, as well as permitting a larger reduction in glaucoma medication burden.…”

Section: Discussionmentioning

confidence: 84%

Kahook Dual Blade Goniotomy vs iStent inject: Long-Term Results in Patients with Open-Angle Glaucoma

Arnljots¹,

Economou²

2021

OPTH

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Purpose: Efficacy and safety evaluation of Kahook Dual Blade (KDB) goniotomy vs iStent inject implantation. Materials and Methods: Retrospective study in patients that underwent goniotomy with KDB or iStent inject implantation, stand-alone or combined with cataract surgery. Main outcome parameters were intraocular pressure (IOP), number of glaucoma medications, proportion of eyes achieving >20% IOP reduction and number of eyes with postoperative IOP <19 mmHg at last follow-up. Results: A total of 29 patients (30 eyes) were included in the iStent inject group and 30 patients (32 eyes) in the KDB group. Mean follow-ups were 20.9±6.5 (KDB-alone) to 29.5 ±7.6 (phaco-iStent inject) months. Pre-and post-operative IOPs were 22.2±5.8 mmHg and 15.9±4.3 mmHg (P=0.004) in the KDB-alone, 24.2±6.8 mmHg and 16.2±6.7 mmHg (P=0.001) in the phaco-KDB, 20.6±5.4 mmHg and 20.9±6.8 mmHg (P=0.598) in the iStent inject-alone as well as 20.9±5.5 mmHg and 15.6±3.4 mmHg (P=0.003) in the phaco-iStent inject subgroups. No major complications occurred. Conclusion: All KDB and iStent subgroups except the stand-alone iStent inject subgroup showed a clinically significant IOP-lowering effect as a stand-alone procedure or combined with cataract surgery. Goniotomy with KDB in this setting seems to offer an advantageous IOP reduction compared to iStent inject.

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“…On the other hand, three patients in the iStent-phaco group developed transient elevation of IOP (15.0%). Iwasaki et al [25] compared the results of a group using Kahook Dual Blade excisional goniotomy and cataract surgery with those of an iStent-phaco group and reported that a transient increase in IOP occurred in 6.8% of the iStent-phaco group. In the present report, there was one case of transient increase in IOP because of incarcerated iris in the iStent-phaco group, and the IOP was reduced by releasing the incarceration with YAG laser irradiation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of minimally invasive glaucoma surgery with trabecular micro-bypass stent and microhook ab interno trabeculotomy performed in conjunction with cataract surgery

Tokuda¹,

Tsukamoto²,

Toyoda³

et al. 2022

Int J Ophthalmol

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AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook (μLOT) or a single iStent® trabecular bypass implantation (iStent) in eyes with cataract and mild-to-moderate glaucoma. METHODS: This study enrolled subjects with mild-to-moderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90y of age. Patients underwent cataract surgery cooperated with either implantation of an iStent (iStent-phaco) or excisional goniotomy with the μLOT (μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while iStent-phaco was carried out on the other eye. Intraocular pressure (IOP) pre- and post-surgery, alterations in anterior chamber flare (ACF), and corneal endothelial cell density (ECD) were estimated. RESULTS: Twenty subjects were enrolled (mean age: 73.6±7.3y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the iStent eyes. The mean final IOP at 12mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the iStent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30d postoperatively, with a value of 11.4 pc/ms. In the iStent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7d postoperatively (11.2 pc/ms at day 7), demonstrating that postoperative inflammation was less in the iStent eyes. The corneal ECD in both groups was not significantly decreased. CONCLUSION: In this study, iStent and μLOT are both effective through 12mo of follow-up. Safety is more favorable in the iStent eyes, based on early anterior chamber inflammation.

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Performances of glaucoma operations with Kahook Dual Blade or iStent combined with phacoemulsification in Japanese open angle glaucoma patients

Cited by 27 publications

References 19 publications

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

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

Kahook Dual Blade Goniotomy vs iStent inject: Long-Term Results in Patients with Open-Angle Glaucoma

Comparison of minimally invasive glaucoma surgery with trabecular micro-bypass stent and microhook ab interno trabeculotomy performed in conjunction with cataract surgery

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