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Nathaniel Tracer, Samantha Ayoub, Daniela Alvarez, Nathan M Radcliffe; Comparison of Outcomes Between Kahook Dual Blade and VISCO360 in the Treatment of Primary Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4927.
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The relative efficacies of new ab interno surgical approaches to intraocular pressure (IOP) reduction in the treatment of primary open-angle glaucoma (POAG) are unclear. We performed a retrospective case-controlled study comparing outcomes between ab interno canaloplasty with viscoanalastomy using the Sight Sciences VISCO360 Viscosurgical System and excision of trabecular meshwork using New World Medical’s Kahook Dual Blade (KDB).
10 patients diagnosed with POAG who underwent trabecular meshwork excision using the KDB and 20 patients diagnosed with POAG who underwent canaloplasty with viscoanalostomy using the VISCO360 were included in this study. The reviewer selected patients to be included by matching the patients’ ages and baseline IOP between the two groups. The mean baseline age and IOP for the KDB group were 72.2±8.2 years and 18.1±4.7 mmHg, respectively. The mean baseline age and IOP for the VISCO360 group were 67.1±8 years and 17.3±3.2 mmHg, respectively. The mean IOP and mean number of drops used at 1 day, 1 week, 1 month, and 6 months follow-up between the two groups were then compared using two-tailed t-tests.
At 1 day, 1 week, 1 month, and 6 months follow-up mean pressures were 13.6±6.4, 16.67±2.1, 14.2±2.7, and 12±3.4 mmHg in the KDB group and 14.35±6.9, 18.6±8.8, 15.56±4.7, and 15.6±2.6 mmHg in the VISCO360 group (P=.77, P=.36, P=.34, P=.08). The baseline number of drops used in the KDB group was 1.7±1.06 and 1.25±.79 in the VISCO360 group. At 1 day, 1 week, 1 month, and 6 months follow-up the mean number of drops used was .7±1.25 for the KDB group and 1.15±.75, 1.1±.79, 1±.77, and .94±.77 for the VISCO360 group (P=.32, P=.37, P=.5, P=.6).
Neither surgical procedure showed a significantly greater reduction in IOP or drop usage at 1 day, 1 week, 1 month, and 6 months. However, the KBD group exhibited a consistently reduced IOP and drop usage at all follow-ups. In particular, the average percent changes in IOP were -24%, -4.9%, -17.9%, and -20.4% at 1 day, 1 week, 1 month, and 6 months follow-up in the KDB group. By contrast, the average percent changes in IOP for the VISCO360 group were -14.5%, +8.1%, -8.8%, and -4.5%. This finding warrants a larger study to compare the outcomes of these two new surgical procedures in treating POAG. A larger study would likely be required to show if the differences observed are statistically significant.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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