Six-Month Outcomes of Combined Phacoemulsification and Kahook Dual Blade Excisional Goniotomy Surgery in Various Glaucoma Subtypes

Abstract

Objectives: To evaluate the efficacy and safety of the Kahook Dual Blade (KDB) excisional goniotomy procedure combined with phacoemulsification in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and primary angle-closure glaucoma (PACG). Materials and Methods: This retrospective study included 25 eyes of 25 patients (13 males, 12 females) who underwent combined phacoemulsification and KDB excisional goniotomy for early-to moderate-stage glaucoma. Pre-and postoperative intraocular pressure (IOP), number of antiglaucoma medications, and best-corrected visual acuity (BCVA) were evaluated. Postoperative complications and surgical success rates were analyzed during a 6-month follow-up period. Surgical success was defined as a >= 20% reduction in IOP from baseline and IOP <18 mmHg, with or without medication. Results: The patients' mean age was 67.0 +/- 11.9 years; 36% had POAG, 36% PEXG, and 28% PACG. The mean preoperative IOP was 22.7 +/- 6.0 mmHg, which significantly decreased to 12.8 +/- 2.2 mmHg at 6 months (p<0.05). The median number of medications decreased from 2 preoperatively to 0 postoperatively (p<0.05). There were no significant differences in 6-month IOP values (p=0.96) or IOP reduction rates (p=0.61) among glaucoma subtypes. BCVA improved from 0.5 +/- 0.4 to 0.1 +/- 0.1 logarithm of the minimum angle of resolution (p=0.001). The most common complications were transient hyphema (12%) and corneal edema (20%), all of which resolved with conservative/topical treatment. One patient required trabeculectomy at month 3, and 3 patients demonstrated less than 20% IOP reduction. The surgical success rate at month 6 was 84%. Conclusion: The KDB procedure combined with cataract surgery provided significant reductions in both IOP and the need for IOPlowering medications at 6 months of follow-up in patients with early and moderate POAG, PACG, and PEXG, while maintaining a very low rate of complications.