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. 2024 Mar 7:18:713-721.
doi: 10.2147/OPTH.S451002. eCollection 2024.

Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade

Isabella V Wagner  1 , Nithya Boopathiraj  1 , Connor Lentz  1 , Emily Aashna Dorairaj  2 , Christian Draper  3 , Devesh Kumar  4 , Leticia Checo  1 , Darby D Miller  1 , Chelsey Krambeer  1 , Syril Dorairaj  1
Affiliations

Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade

Isabella V Wagner et al. Clin Ophthalmol. .

Abstract

Purpose: To report clinical outcomes of successful excisional goniotomy with the Kahook Dual Blade (KDB), through 60 months.

Patients and methods: This was a noncomparative, single-surgeon, retrospective review of eyes receiving successful KDB goniotomy with or without concomitant phacoemulsification between October 2015 and January 2016 with five years of uninterrupted follow-up. Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), and complications were recorded. Primary outcomes included changes from baseline in IOP, medication use, and BCVA, through five years.

Results: Fifty-two eyes of 28 patients were analyzed. Most eyes had mild primary open angle glaucoma (73%). Of the eyes analyzed, 41 underwent combined surgery and 11 underwent standalone surgery. With all eyes combined, mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0 to 13.7 mmHg, representing mean reductions of 7.3-8.0 mmHg (34.7-38.3%; p <0.0001 at every time point). Similarly, mean medication use ranged from 0.4 to 0.6 medications per eye, representing mean reductions of 1.2-1.4 medications (66-75.5%; p <0.0001 at every time point). Mean logMAR BCVA improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p < 0.0001).

Conclusion: In eyes not requiring secondary surgical procedures (eg, long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through five years of follow-up. KDB goniotomy appears to be highly successful in Caucasian patients with open angle glaucoma on ≥1 IOP-lowering medications at baseline and with no history of prior ocular surgery. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.

Keywords: IOP-lowering medications; glaucoma; goniotomy; intraocular pressure; minimally invasive glaucoma surgery; phacoemulsification.

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Conflict of interest statement

All authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Gonioscopic view of a persistent opening (indicated by red arrows) on the goniotomy site (yellow outline).
Figure 2
Figure 2
Ultrasound biomicroscopy image of a goniotomy opening (yellow outline) with a widened iridocorneal angle (indicated by red arrow).
Figure 3
Figure 3
Mean IOP over time in the study cohort. Error bars represent standard deviation. Reductions from baseline were significant (p < 0.0001) at every time point.
Figure 4
Figure 4
Mean medication use over time in the study cohort. Error bars represent standard deviation. Reductions from baseline were significant (p < 0.0001) at every time point.
See this image and copyright information in PMC

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