Abstract
Purpose :
The purpose of this study was to evaluate a hybrid MIGS procedure using a Kahook Dual Blade and direct viscodilation of the collector channels with cataract surgery in the reduction of medications and IOP in mild, moderate, and severe glaucoma.
Methods :
After completion of cataract surgery, the Kahook Dual Blade removed 180 degrees of trabecular meshwork, exposing the ostium of the collector channels. Viscoelastic was injected into the collector channels as the perpendicular cannula was held against the outer wall and dragged through the gutted canal. IOP was checked for steroid response and glaucoma drops were added as needed.
Results :
66 eyes achieved 15 months follow-up in the Goniotomy-Viscodilation-Cataract Group. 50% were moderate to severe glaucoma. 30% had previous glaucoma surgery. 60% were diabetics. 80% were African-American. 50% were on anticoagulants. Initial IOP was 19.7mmHg (SD+/- 5.2) with a mean of 1.9 medications. At three months the IOP was 16.1mmHg. It remained between 16 and 17 mmHg through the first year and was 16.5mmHg (SD+/-5.7) at 15 months. A blush of blood was common in the first week but was eliminated in a few weeks. Choroidal detachments, cyclodialysis clefts, and hypotony were not seen. 90% of eyes had IOP< 21 mmHg. 89% of all glaucoma drops were discontinued. There was a 16% reduction in IOP and 86.4%of eyes were off all meds.
Conclusions :
The synergy of this hybrid MIGS technique is responsible for the continued marked reduction of IOP and medications. “Cleaning the gutter and powerwashing the downspouts” is a safe and effective treatment for all levels of glaucoma. Two main obstacles in the prevention of blindness from glaucoma are cost of medications and compliance. The marked elimination of drops using this easily mastered technique solves both issues for the maximum benefit of the patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.