Abstract
Purpose :
To determine the efficacy of Kahook Dual Blade (KDB) goniotomy with and without phacoemulsification (PE) in an urban population, we performed a retrospective, observational clinical study and examined longitudinal changes to intraocular pressure (IOP) and number of IOP-lowering medications (ILMs).
Methods :
This retrospective study includes 61 eyes of 61 patients with glaucoma, 77% with primary open angle glaucoma (POAG), treated by KDB goniotomy with and without PE. IOP and ILMs were assessed at baseline and follow-up visits for up to 42 months. Patients were categorized into lower (Group A) and higher (Group B) IOP groups. IOP goals for Group A, with baseline IOP ≤ the study population median baseline IOP of 15 mm Hg, were defined as ≤ their baseline IOP. Group B, with baseline IOP >15 mmHg, were designated IOP reduction goals of ≥20% or reaching ≤18 mm Hg if baseline IOP is ≤22 or >22, respectively. Assessing Group A primarily by lowering post-operative ILMs was reasoned to be an appropriate endpoint. Complete-success was defined by the following three principles: (1) reaching post-operative IOP goal, (2) achieving 0 ILMs, and (3) lacking additional IOP-lowering intervention or hypotony during follow-up. We also defined qualified-success with the following criteria: (1) reaching post-operative IOP goal, (2) for Group B, maintaining or improving baseline ILMs, and for Group A, if baseline ILMs is ≤3 or >3, then improving ILMs by at least 1 or 2, respectively, and (3) lacking additional IOP-lowering intervention or hypotony during follow-up. If the patient had two or more consecutive visits failing to meet the success criteria above, the patient would fail at the first of the two visits. Survival analysis was performed using Kaplan-Meier curves.
Results :
Reduction in IOP from baseline was statistically significant at day 1, week 1, and months 3, 12, 24, and 30. Reduction in ILM burden from baseline was statistically significant at 1 day through 24 months of follow-up. Survival analysis based on complete- and qualified-success criteria demonstrated approximately 50% survival for both criteria at 3 months and 25% survival by 6 months and 18 months, respectively.
Conclusions :
KDB with and without PE is effective at reducing IOP up to 30 months and ILM burden up to 24 months in an urban setting. Limitations of our study include attrition due to the length of follow-up.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.