Abstract
Purpose :
To compare the outcomes between the use of iStent Inject, iStent, and Kahook dual blade goniotomy in combination with cataract surgery in mild to moderate primary open angle glaucoma (POAG).
Methods :
This was a retrospective chart review of patients with POAG who had a primary intervention of iStent Inject (n=10), iStent (n=14), or Kahook goniotomy (n=18) at UT Health San Antonio. Patients required no prior surgical intervention for POAG and had at least 3 months post-op follow-up and vision of LP or better. Intraocular pressure (IOP) was the primary outcome measure. Statistical analysis was performed using the Mann-Whitney U test.
Results :
Pre-op IOP for iStent inject, iStent, and Kahook were 16.9 ± 2.7, 14.2 ± 2.5, and 15.2 ± 4.7 mmHg (p=0.13), respectively. The IOP at POM3 for the Kahook group (12.2 ± 1.7) was lower than the iStent inject and iStent groups (15.3 ± 2.6, 13.4 ± 2.8, respectively; p = 0.01). LogMAR acuity was not statistically different at all time points except POD1, when the LogMAR for the iStent inject, iStent, and Kahook were 0.15 ± 0.07, 0.14 ± 0.23, and 0.32 ± 0.22 (p=0.003), respectively. There was no difference in the number of glaucoma medications at any time point between groups. The number of patients who experienced IOP spikes at POD1 were 0, 1, and 3 for the iStent inject, iStent, and Kahook groups, respectively. One patient in the iStent inject group experienced a post-op hyphema and one patient in the iStent group had rebound iritis.
Conclusions :
The safety profile was excellent in each group and the Kahook goniotomy showed a lower IOP at POM3. IOP, LogMAR acuity, and number of glaucoma drops were not statistically significant at all other time points between each group. Weaknesses of the study include limited post-op follow up and small sample size. The intervention of iStent inject, iStent, and Kahook goniotomy along with cataract surgery all represent effective and safe interventions in patients with POAG, with Kahook goniotomy showing better IOP at POM3.
This is a 2020 ARVO Annual Meeting abstract.