Abstract
Purpose :
To evaluate the effects of combined goniotomy using the Kahook Dual Blade and direct viscodilation of the collector channels with cataract surgery in the reduction of intraocular pressure (IOP) and dependence on glaucoma drops in the treatment of mild, moderate and advanced glaucoma. This unique technique dubbed "clean the gutter and powerwash the downspouts" combines goniotomy and canaloplasty for the clean out of Schlemm's canal and collector channels.
Methods :
The combined Goniotomy-Viscodilation-Cataract group contained 105 eyes with all levels of glaucoma severity. Total success was defined as elimination of all drops and IOP of 20mmHg or less. IOPs were monitored early in the postoperative period for steroid response and subsequently every three months. Glaucoma drops were added as needed.
Results :
Half of the eyes were categorized as mild disease with the other half evenly distributed between moderate and advanced glaucoma. Previous glaucoma laser and incisional surgery was done in 30% of eyes. 50% of patients were on anticoagulants. 60% had diabetes. African Americans comprised 80% of patients.
Initial IOP was 19.9 mmHg (SD+/-5.5) with mean 1.8 medications. Mean IOP at one month was 16 mmHg (SD+/-3.8). No medications were required in 90% of patients. Throughout the first year, the mean IOP remained 16.0mmHg (SD+/-4.2) and less than 10% required any glaucoma medications.
Hypotony, choroidal detachments, cyclodialysis clefts, and flat chambers were not seen. Less than 10% had hyphemas that generally cleared in 2 weeks. Anterior washouts were required in 2 eyes with one combined with an Ahmed glaucoma implant. Upon further investigation, the second patient was mistakenly on three anticoagulants.
Conclusions :
Using the "clean the gutter and power wash the downspouts" technique, glaucoma drops were eliminated in more than 90% of the eyes. Unlike the GATT procedure, the Kahook Dual Blade removes the trabecular meshwork that may subsequently collapse into the collector channels. Unlike canaloplasty, collector channels are dilated with direct visualization as the viscoelastic cannula runs along the gutter of Schlemm's canal. We believe that the synergy of these 2 techniques is responsible for the marked elimination of glaucoma medications in this study. This is a safe and effective technique for reduced compliance issues and the financial burden associated with glaucoma treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.