Combined Phacoemulsification and 360-Degree Endocyclophotocoagulation with and without a Kahook Dual Blade in Patients with Primary Open-Angle Glaucoma

Abstract

Purpose: The present study aimed to compare the outcomes of combined phacoemulsification and 360-degree endocyclophotocoagulation with and without goniotomy using a Kahook Dual Blade in patients with glaucoma.

Patients and methods: We enrolled 37 patients, 21 of whom underwent combined phacoemulsification with 360-degree endocyclophotocoagulation and goniotomy using a Kahook Dual Blade (tri-modal therapy (T-MT) group). The remaining 16 patients underwent phacoemulsification with endocyclophotocoagulation (bi-modal therapy (B-MT) group). Visual acuity, intraocular pressure, and number of glaucoma medications were recorded before the study and postoperatively on the first day, at week 1, and at 1, 3, 6, 9, and 12 months. Surgical success was defined as an IOP ≤12 mmHg and ≥6 mmHg or an at least 20% reduction in IOP from baseline with (qualified success) or without medications (complete success).

Results: Forty-nine eyes were included. Baseline mean IOP was 16.96±3.66 mmHg and 15.64±4.88 mmHg in the T-MT and B-MT groups (p=0.122), respectively. At the 12-month follow-up, mean IOP values were 11.44±2.15 mmHg and 12.45±1.90 mmHg (p=0.031) in the T-MT and B-MT groups, respectively. Complete success rates were 37% in the T-MT group and 31% in the B-MT group, while qualified success rates were 74% and 50%, respectively. Glaucoma medications decreased from 2.0±1.4 to 0.8±1.0 (p<0.001) in the T-MT group and from 1.5±1.3 to 1.0±1.5 in the B-MT group (p=0.032). Similar improvements in visual acuity were observed in both groups. Complications were mild and resolved without intervention.

Conclusion: The tri-modal treatment is safe and may be more effective in reducing IOP and glaucoma medication requirements than bi-modal treatment.

Keywords: MIGS; glaucoma surgery; micro-incisional glaucoma surgery; trabecular meshwork.

Figure 1

Ab interno goniotomy with a Kahook Dual Blade. (A) Visualization of angle structures with a surgical angle lens. (B) The KDB was engaged in the pigmented trabecular meshwork and then advanced at 120° parallel toward the wall of Schlemm’s canal. (C) Blood reflux in the angle at the end of the procedure.

Figure 2

Comparison of mean IOP over time in the T-MT and B-MT groups. The figure shows a reduction in IOP at every visit during the 12-month follow-up.

Figure 3

Comparison of number of glaucoma medications over time in the T-MT and B-MT groups. The figure shows a decrease in the number of glaucoma medications at every visit and during the 12-month follow-up.

Figure 4

Comparison of best-corrected visual acuity (BCVA) in both groups over time. The figure shows the changes in BCVA during the study period for both groups.