Abstract
Purpose :
Kahook Dual Blade (KDB) Goniotomy and gonioscopy-assisted transluminal trabeculotomy (GATT) both target the trabecular meshwork to increase aqueous outflow. We aimed to compare the efficacy and safety of KDB and GATT in patients with open angle glaucoma (OAG) with at least one year of follow-up.
Methods :
A retrospective chart review was performed of adult patients at two centers who underwent KDB or GATT (with or without phacoemulsification) for treatment of OAG with at least one year of follow-up. Data collected included visual acuity, intraocular pressure (IOP), glaucoma medications, visual field results, diagnosis, adverse events, and additional glaucoma procedures. The primary outcome included surgical success (defined as 20% or more IOP reduction). T-test and chi-squares were used for analysis.
Results :
Forty-four eyes were enrolled in the study, with 22 eyes in each group. Age, gender, and other demographics were similar in both groups. The mean preoperative IOP was 17.9 + 7.1 mm Hg and 22 +7.8 mmHg (p= 0.041) on 2.6 + 0.9 and 3.8 +0.8 medications (p<0.001) in the KDB and GATT groups, respectively. At 1 year, the mean IOP reduction 0.5 ± 7.1 mm Hg and 8.4 ± 7.7 mm Hg (p=0.05) in the KDB and GATT group, respectively. KDB eyes had 38.5% success while GATT eyes had 84.6% success. At 6 months, the mean medication reduction was 0.47 + 1.07 and 1.32 + 1.14 (p=0.02) in the KDB and GATT groups respectively. At 1 year, mean medication reduction was 0.568± 1.56 in the KDB group and 0.15± 0.55 (p=0.088) in the GATT group. There was no statistically significant difference in adverse events between the two groups.
Conclusions :
Our study showed both KDB and GATT are safe and can effectively lower IOP and reduce medication burden. At one-year follow up, GATT appears to be show greater IOP reduction and more likely to achieve at least 20% reduction in IOP at 1 year despite a higher preoperative IOP and medication burden than KDB. There was no significant difference in medical reduction between the two groups, though it is notable the GATT group had a higher preoperative drop burden. This is the first study to show a significant difference in IOP reduction and surgical success between GATT and KDB with one year of follow up. A more extensive study is warranted to study this difference further.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.