Abstract
Purpose :
Minimally invasive glaucoma surgery (MIGS) has emerged as an alternative option compared with traditional glaucoma surgery. Few studies directly compare MIGS outcomes. This is a retrospective, comparative clinical study that compared effectiveness and safety of Kahook Dual Blade goniotomy and Trabectome ab-interno trabeculotomy.
Methods :
All patients who underwent minimally invasive glaucoma surgery in University of Virginia, from January 2012- September 2018 were identified in surgical logbooks of three surgeons. All patients treated with phacoemulsification combined with Kahook Dual Blade goniotomy (phaco-KDB) and phacoemulsification combined with ab-interno trabeculotomy with Trabectome (phaco-Trabectome) were reviewed. Surgical success was defined as intraocular pressure (IOP) of ≤ 21 mmHg and IOP reduction of at least 20% from baseline at 12 months, or reduction of at least 1 glaucoma medication.
Results :
A total of 73 eyes of 56 patients were reviewed, with 38 eyes in the phaco-KDB group and 35 eyes in the phaco-Trabectome group. Mean baseline IOP decreased from 16.0 ± 4.6 mmHg on 2.0 ± 0.90 medications, to 14.8 ± 2.6 on 0.5 ± 1.01 medications, at 12 months postoperatively for the phaco-KDB group. Mean baseline IOP decreased from 18.7 ± 6.4 mmHg on 2.4 ±1.04 medications, to 15.8 ± 3.9 mmHg on 0.95 ± 1.04 medications, at 12 months postoperatively for the phaco-Trabectome group. IOP reduction from baseline reached statistical significance in the phaco-Trabectome group (p=0.002) but not in the phaco-KDB group (p=0.192). The decrease in the number of medications was significant for both groups. Success rates by reduction of medications were 88.9% and 77.3%, while success rates by reduction of IOP were 33.3% and 40.9% for phaco-KDB and phaco-Trabectome groups, respectively. The most common complication was postoperative day 1 IOP spike, in 23.7% of patients from the phaco-KDB group and 17.1% from the phaco-Trabectome group.
Conclusions :
Combined cataract surgery with Kahook Dual Blade goniotomy and ab-interno trabeculotomy with Trabectome lead to similar reduction of IOP, and are both effective techniques in reducing the medication burden in glaucoma patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.