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

• Main Authors: Dorairaj S, Tam MD, Balasubramani GK
• Format: Article
• Language: English
• Published: Dove Medical Press 2019-09-01
• Series: Clinical Ophthalmology
• Subjects: glaucoma; angle closure; synechialysis; goniotomy; MIGS
• Online Access: https://www.dovepress.com/twelve-month-outcomes-of-excisional-goniotomy-using-the-kahook-dual-bl-peer-reviewed-article-OPTH

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, USACorrespondence: Syril DorairajDepartment of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USATel [phone]Email [e-mail]: 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