Citation Information :
Pratte EL, Cho J, Landreneau JR, Hirabayashi MT, An JA. Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification. J Curr Glaucoma Pract 2022; 16 (1):47-52.
Aim: To identify factors that were significant predictors of Kahook Dual Blade (KDB) excisional goniotomy outcomes.
Materials and methods: One hundred and thirty-two eyes from 99 adult glaucoma patients who underwent combined KDB and phacoemulsification (KDB-phaco) with a minimum 6-month follow-up were assessed for baseline patient characteristics to determine correlation to the success of KDB-phaco at 6 and 12 months postoperatively. Success was defined as ≥20% intraocular pressure (IOP) reduction or ≥1 medication reduction as well as IOP ≤18 mm Hg without any additional IOP-lowering procedures after KDB-phaco.
Results: 63.6% (84/132) and 46.1% (41/89) of cases were successful at the 6- and 12-month follow-ups, respectively. KDB-phaco reduced patient\'s preoperative IOP (in mm Hg) from 17.6 ± 4.6 to 14.9 ± 3.2 at 6 months (15.3%, p < 0.001) and 15.4 ± 4.7 at 12 months (12.5%, p = 0.001). KDB-phaco reduced patient\'s preoperative IOP-lowering medications from 2 ± 1.2 to 1.1 ± 1.2 at 6 months (45%, p < 0.001) and 1.32 ± 1.3 at 12 months (34%, p < 0.001). At 6 months, patients on >1 IOP lowering medication had a greater chance of meeting our success criteria (p = 0.037). Visually significant postoperative hyphema was not associated with the use of anticoagulation (p = 0.943) but was significantly associated with postoperative day 1 IOP ≤ 10 mm Hg (p = 0.011).
Conclusion: Patients who underwent KDB-phaco significantly reduced their IOP and medication burden at both 6 and 12 months compared with their baseline preoperative values. KDB-phaco outcome was associated with higher baseline IOP-lowering medications and increased rate of hyphema was associated with lower postoperative day 1 IOP, regardless of anticoagulation status. Age, ethnicity, prior laser trabeculoplasty, type and severity of glaucoma, and baseline preoperative IOP were not associated with surgical success.
Clinical significance: Patients with a higher number of baseline medications may experience a greater probability of success following KDB-phaco.
Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081–2090. DOI: 10.1016/j.ophtha.2014.05.013
Newman-Casey PA, Robin AL, Blachley T, et al. The most common barriers to glaucoma medication adherence: a cross-sectional survey. Ophthalmology. 2015;122(7):1308–1316. DOI: 10.1016/j.ophtha.2015.03.026
An JA, Kasner O, Samek DA, et al. Evaluation of eyedrop administration by inexperienced patients after cataract surgery. J Cataract Refract Surg 2014;40(11):1857–1861. DOI: 10.1016/j.jcrs.2014.02.037
Schwartz GF, Hollander DA, Williams JM. Evaluation of eye drop administration technique in patients with glaucoma or ocular hypertension. Curr Med Res Opin 2013;29(11):1515–1522. DOI: 10.1185/03007995.2013.833898
Harasymowycz P, Birt C, Gooi P, et al. Medical management of glaucoma in the 21st century from a Canadian perspective. J Ophthalmol 2016;2016:6509809. DOI: 10.1155/2016/6509809
Lichter PR, Musch DC, Gillespie BW, et al. Interim clinical outcomes in the collaborative initial glaucoma treatment study comparing initial treatment randomized to medications or surgery. Ophthalmology. 2001;108(11):1943–1953. DOI: 10.1016/s0161-6420(01)00873-9
Berdahl JP, Gallardo MJ, ElMallah MK, et al. Six-month outcomes of goniotomy performed with the kahook dual blade as a stand-alone glaucoma procedure. Adv Ther 2018;35(11):2093–2102. DOI: 10.1007/s12325-018-0803-0
ElMallah MK, Berdahl JP, Williamson BK, et al. Twelve-month outcomes of stand-alone excisional goniotomy in mild to severe glaucoma. Clin Ophthalmol. 2020;14:1891–1897. DOI: 10.2147/OPTH.S256423
Sieck EG, Epstein RS, Kennedy JB, et al. Outcomes of kahook dual blade goniotomy with and without phacoemulsification cataract extraction. Ophthalmol Glaucoma 2018;1(1):75–81. DOI: 10.1016/j.ogla.2018.06.006
Dorairaj SK, Seibold LK, Radcliffe NM, et al. 12-Month outcomes of goniotomy performed using the kahook dual blade combined with cataract surgery in eyes with medically treated glaucoma. Adv Ther 2018;35(9):1460–1469. DOI: 10.1007/s12325-018-0755-4
Hirabayashi MT, King JT, Lee D, et al. Outcome of phacoemulsification combined with excisional goniotomy using the kahook dual blade in severe glaucoma patients at 6 months. Clin Ophthalmol 2019;13:715–721. DOI: 10.2147/OPTH.S196105
Lee D, King J, Thomsen S, et al. Comparison of surgical outcomes between excisional goniotomy using the kahook dual blade and iStent trabecular micro-bypass stent in combination with phacoemulsification. Clin Ophthalmol 2019;13:2097–2102. DOI: 10.2147/OPTH.S224109
Salinas L, Chaudhary A, Berdahl JP, et al. Goniotomy using the kahook dual blade in severe and refractory glaucoma: 6-month outcomes. J Glaucoma 2018;27(10):849–855. DOI: 10.1097/IJG.0000000000001019
Hirabayashi MT, Lee D, King JT, et al. Comparison of surgical outcomes of 360 degrees circumferential trabeculotomy versus sectoral excisional goniotomy with the kahook dual blade at 6 months. Clin Ophthalmol 2019;13:2017–2024. DOI: 10.2147/OPTH.S208468
Greenwood MD, Seibold LK, Radcliffe NM, et al. Goniotomy with a single-use dual blade: short-term results. J Cataract Refract Surg 2017;43(9):1197–1201. DOI: 10.1016/j.jcrs.2017.06.046
Harvey MM, Schmitz JW. Use of ab interno kahook dual blade trabeculectomy for treatment of primary congenital glaucoma. Eur J Ophthalmol 2020;30(1):NP16–NP20. DOI: 10.1177/1120672118805873
Dorairaj S, Tam MD. Kahook dual blade excisional goniotomy and goniosynechialysis combined with phacoemulsification for angle-closure glaucoma: 6-month results. J Glaucoma 2019;28(7):643–646. DOI: 10.1097/IJG.0000000000001256
Dorairaj S, Tam MD, Balasubramani GK. Twelve-month outcomes of excisional goniotomy using the kahook dual blade((R)) in eyes with angle-closure glaucoma. Clin Ophthalmol 2019;13:1779–1785. DOI: 10.2147/OPTH.S221299
Grant WM. Clinical measurements of aqueous outflow. AMA Arch Ophthalmol 1951;46(2):113–131. DOI: 10.1001/archopht.1951.01700020119001
Tamm ER. The trabecular meshwork outflow pathways: structural and functional aspects. Exp Eye Res 2009;88(4):648–655. DOI: 10.1016/j.exer.2009.02.007
Swaminathan SS, Monsalve P, Zhou XY, et al. Histologic analysis of trabecular meshwork obtained from kahook dual blade goniotomy. Am J Ophthalmol 2018;192:198–205. DOI: 10.1016/j.ajo.2018.05.028
Gillmann K, Mansouri K. Minimally invasive glaucoma surgery: where is the evidence? Asia Pac J Ophthalmol (Phila) 2020;9(3):203–214. DOI: 10.1097/APO.0000000000000294
El Sayed Y, Esmael A, Mettias N, et al. Factors influencing the outcome of goniotomy and trabeculotomy in primary congenital glaucoma. Br J Ophthalmol 2019(9):1250–1255. DOI: 10.1136/bjophthalmol-2018-313387
Mattox C, How to Code for Different Stages of Glaucoma Using ICD-10 Codes 2014
Kahook Dual Blade - Instructions for Use: New World Medical; 2015 [Available from: https://www.newworldmedical.com/wp-content/uploads/2020/07/KDB-IFU-50-0069-Rev-F.pdf
Godfrey DG, Fellman RL, Neelakantan A. Canal surgery in adult glaucomas. Curr Opin Ophthalmol 2009;20(2):116–121. DOI: 10.1097/ICU.0b013e32831eef65
Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg 1999;25(3):316–322. DOI: 10.1016/s0886-3350(99)80078-9
Wakil SM, Birnbaum F, Vu DM, et al. Efficacy and safety of kahook dual blade goniotomy: 18-month results. J Cataract Refract Surg 2020(10). DOI: 10.1097/j.jcrs.0000000000000263
Kornmann HL, Fellman RL, Feuer WJ, et al. Early results of goniotomy with the kahook dual blade, a novel device for the treatment of glaucoma. Clin Ophthalmol 2019;13:2369–2376. DOI: 10.2147/OPTH.S224643
Missouri Census United States Census Bureau: U.S. Department of Commerce; July 2019
D'Souza N, Hashimoto DA, Gurusamy K, et al. Comparative outcomes of resident vs attending performed surgery: a systematic review and meta-analysis. J Surg Educ 2016;73(3):391–399. DOI: 10.1016/j.jsurg.2016.01.002
Bostan C, Harasymowycz P. Episcleral venous outflow: a potential outcome marker for iStent surgery. J Glaucoma 2017;26(12):1114–1119. DOI: 10.1097/IJG.0000000000000799
Dorairaj SK, Kahook MY, Williamson BK, et al. A multicenter retrospective comparison of goniotomy versus trabecular bypass device implantation in glaucoma patients undergoing cataract extraction. Clin Ophthalmol 2018;12:791–797. DOI: 10.2147/OPTH.S158403
Seibold LK, Soohoo JR, Ammar DA, et al. Preclinical investigation of ab interno trabeculectomy using a novel dual-blade device. Am J Ophthalmol 2013;155(3):524–529.e2. DOI: 10.1016/j.ajo.2012.09.023
SooHoo JR, Seibold LK, Kahook MY. Ab interno trabeculectomy in the adult patient. Middle East Afr J Ophthalmol 2015;22(1):25–29. DOI: 10.4103/0974-9233.148345
Sit AJ, McLaren JW. Measurement of episcleral venous pressure. Exp Eye Res 2011;93(3):291–298. DOI: 10.1016/j.exer.2011.05.003
Gong JL, Al-Wesabi SA, Zhao Y, et al. Positive correlation between blood reflux in Schlemm's canal and the decrease of intraocular pressure after selective laser trabeculoplasty in primary open-angle glaucoma. Exp Ther Med 2018;15(6):5065–5069. DOI: 10.3892/etm.2018.6051
Mastropasqua L, Carpineto P, Ciancaglini M, et al. Intraocular pressure changes after phacoemulsification and foldable silicone lens implantation using Healon GV. Ophthalmologica. 1998;212(5):318–321. DOI: 10.1159/000027315
Devgan U, The Angle Sweep Technique to Remove Viscoelastic 2018 [Available from: https://cataractcoach.com/2018/11/19/the-angle-sweep-technique-to-remove-viscoelastic/
Tran VT, Mansouri K, Mermoud A. Goniowash: a new surgical approach combined with cataract surgery to lower intraocular pressure in pseudoexfoliation syndrome. Int Ophthalmol 2020;41(5):1563–1571. DOI: 10.1007/s10792-020-01459-5