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Twelve-month outcomes of excisional goniotomy using the Kahook Dual Blade in eyes with angle-closure glaucoma

Authors Dorairaj S, Tam MD, Balasubramani GK

Received 29 June 2019

Accepted for publication 28 August 2019

Published 10 September 2019 Volume 2019:13 Pages 1779—1785


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Syril Dorairaj,1 Mai Dang Tam,2 Goundappa K Balasubramani3

1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Glaucoma Department, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam; 3University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA

Correspondence: Syril Dorairaj
Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
Tel +1 201 704 7896

Purpose: To characterize clinical outcomes following Kahook Dual Blade (KDB)-assisted goniosynechialysis and excisional goniotomy combined with phacoemulsification in eyes with angle-closure glaucoma and cataract.
Setting: Two clinical practices.
Methods: In this retrospective analysis of existing health records, data were collected from 42 eyes of 24 subjects from preoperative, operative, and postoperative encounters through 12 months of follow-up. Outcomes included changes in mean IOP, IOP-lowering medications, and logMAR best-corrected visual acuity (BCVA), as well as the proportions of patients achieving IOP reductions ≥20%, IOP ≤18 mmHg, and a reduction of ≥1 medication.
Results: Preoperative, mean (standard error) IOP was 25.5 (0.7) mmHg and at Month 12 was reduced by 12.3 (0.73) mmHg (−47.2%; p<0.0001). The mean number of IOP-lowering medications used was 2.3 (0.1) preoperatively and was reduced at Month 12 by 2.2 (0.12) (−91.7%; p<0.0001). At Month 12, 92.9% of eyes achieved IOP ≤18 mmHg, 100% achieved IOP reduction of ≥20%, 95.2% required ≥1 fewer medications for IOP control, and 85.7% (36/42) were medication-free. Mean LogMAR BCVA improved from 0.547 (0.06) at baseline to 0.159 (0.07) at Month 12.
Conclusion: KDB-assisted goniosynechialysis and excisional goniotomy at the time of phacoemulsification safely provide significant reductions in both IOP and IOP-lowering medication burden in eyes with angle-closure glaucoma, while simultaneously improving visual acuity.

Keywords: glaucoma, angle closure, synechialysis, goniotomy, MIGS

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