Evaluation of iStent Micro-Bypass vs. Kahook Dual Blade Goniotomy with Phacoemulsification in Open-Angle Glaucoma: A Systematic Review

Abstract

Background/Objectives: Glaucoma refers to a group of eye diseases that damage the optic nerve, causing irreversible vision loss. It typically begins with peripheral vision impairment and, in severe cases, leads to complete blindness. A major advancement in glaucoma treatment is Microinvasive Glaucoma Surgery (MIGS), including trabecular bypass and ab interno trabeculectomy, which are generally used for mild to moderate glaucoma. This review aimed to evaluate the efficacy and safety of iStent micro-bypass implantation and Kahook Dual Blade (KDB) goniotomy combined with phacoemulsification in patients with open-angle glaucoma (OAG). Methods: A review of recent studies was conducted using PubMed, Google Scholar, Scopus, Web of Science, and Embase. Both prospective and retrospective clinical studies were included. These MIGS methods were compared for reducing intraocular pressure (IOP) and medication burden at baseline and endpoint. Results: Eleven studies involving 1925 eyes were analyzed. All studies showed that iStent (first- and second-generation) micro-bypass implantation and KDB goniotomy reduced IOP, favoring the phaco-KDB group. Antiglaucoma medication use also decreased significantly. The success rate was sufficient and most complications were minimal. Conclusions: In conclusion, iStent implantation and KDB goniotomy offer a high safety profile, meaningful IOP reduction, a minimally invasive approach, and quick recovery.

Keywords: Kahook Dual Blade; iStent; intraocular pressure; minimally invasive glaucoma surgery; open-angle glaucoma; phacoemulsification.

Figure 1

PRISMA flowchart of the study selection procedure.