KDB-ASSISTED GONIOTOMY COMBINED WITH CATARACT SURGERY: A PROSPECTIVE ANALYSIS OF SURGICAL OUTCOMES AND SUCCESS PREDICTORS

Abstract

Purpose : In recent years, substantial innovation in glaucoma surgical technique has sought to develop procedures that would provide a significant intraocular pressure (IOP) reduction but with a more favorable safety profile than conventional incisional surgery. Herein, we present the initial results of a prospective study investigating the success rates, safety profile and possible success predictors of Kahook Dual Blade assisted goniotomy (KDB) combined with cataract extraction (PHACO) in eyes with medically treated open angle glaucoma (OAG).

Methods : A multicenter, prospective, interventional case series was carried out. Consecutive patients with medically treated OAG and coexistent visually significant cataract underwent PHACO+KDB surgery. Indications for glaucoma surgery included reduction of IOP and reduction of IOP-lowering medications.Post-operative visits werescheduled at days 1, 7, and at months 1, 3, 6 and 12. Preoperative and postoperative IOP, number of antiglaucoma medications, best-corrected visual acuity, surgical complications, and any subsequent related events or procedures were recorded through follow-up. Success was defined as IOP reduction>20% and/or ≥1 medication reduction from baseline (as long as post-operative IOP values were kept within 2 mmHg from baseline). Inputs from the study was provided by the company that produces the KDB.

Results : Among 34 patients(mean age, 67.3±16.2 years) undergoing surgery, mean IOP was significantly reduced from 17.5±4.2 mmHg at baseline to 13.3±4.2 mmHg at month 6. The mean number of topical IOP-lowering medications was reduced from 2.1 to 0.7. Overall, success rate at 6 months was 82%. Age, visual field mean deviation index, type of glaucoma and preoperatorynumber of medications were not significant success predictors (p≥0.51). Finally, one eye had postoperative hypotony. No other serious complications were reported. Two cases presented uncontrolled IOP: one required trabeculectomy and the other was successfully managed through laser goniopuncture.

Conclusions : KDB-assisted goniotomy combined with cataract surgery significantly lowers both IOP and dependence on IOP-lowering medications in eyes with medically-treated open angle glaucoma. Sight-threatening adverse events were uncommon. Further follow-up data might reveal possible success predictors that were not determined in these initial results.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.