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Kahook Dual Blade Goniotomy vs iStent inject: Long-Term Results in Patients with Open-Angle Glaucoma

Authors Arnljots TS, Economou MA

Received 16 October 2020

Accepted for publication 21 December 2020

Published 11 February 2021 Volume 2021:15 Pages 541—550


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Thorsteinn S Arnljots,1 Mario A Economou2,3

1Anterior Segment Department, St. Erik Eye Hospital, Stockholm, Sweden; 2Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 3Department of Ophthalmology, Sophiahemmet Hospital, Stockholm, Sweden

Correspondence: Thorsteinn S Arnljots Sankt Eriks Ögonsjukhus, Eugeniavägen 12, Solna, Stockholm, 171 64 Tel +46-8-672 30 63

Purpose: Efficacy and safety evaluation of Kahook Dual Blade (KDB) goniotomy vs iStent inject implantation.
Materials and Methods: Retrospective study in patients that underwent goniotomy with KDB or iStent inject implantation, stand-alone or combined with cataract surgery. Main outcome parameters were intraocular pressure (IOP), number of glaucoma medications, proportion of eyes achieving > 20% IOP reduction and number of eyes with postoperative IOP < 19 mmHg at last follow-up.
Results: A total of 29 patients (30 eyes) were included in the iStent inject group and 30 patients (32 eyes) in the KDB group. Mean follow-ups were 20.9± 6.5 (KDB-alone) to 29.5± 7.6 (phaco-iStent inject) months. Pre- and post-operative IOPs were 22.2± 5.8 mmHg and 15.9± 4.3 mmHg (P=0.004) in the KDB-alone, 24.2± 6.8 mmHg and 16.2± 6.7 mmHg (P=0.001) in the phaco-KDB, 20.6± 5.4 mmHg and 20.9± 6.8 mmHg (P=0.598) in the iStent inject-alone as well as 20.9± 5.5 mmHg and 15.6± 3.4 mmHg (P=0.003) in the phaco-iStent inject subgroups. No major complications occurred.
Conclusion: All KDB and iStent subgroups except the stand-alone iStent inject subgroup showed a clinically significant IOP-lowering effect as a stand-alone procedure or combined with cataract surgery. Goniotomy with KDB in this setting seems to offer an advantageous IOP reduction compared to iStent inject.

Keywords: MIGS, iStent inject, Kahook Dual Blade, glaucoma surgery, goniotomy

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