Combining Business With Pleasure: A Particularly Successful Case Of Kahook Dual Blade® Goniotomy Performed Along Cataract Surgery

Glaucoma is the second leading cause of vision loss worldwide, and its prevalence is increasing with the global aging population. The reduction of intraocular pressure remains the backbone of its therapy. The Kahook Dual Blade® (KDB) is a single-use ophthalmic instrument, with two parallel blades, designed to perform goniotomy by removing a strip of trabecular meshwork tissue and the inner wall of Schlemm’s canal. The purpose of this work is to report a case in which this technique was particularly successful, and allowed a patient to become independent of the use of eye drops.

This case report was based on the retrospective assessment of the clinical records regarding the surgical procedure, pre and postoperative follow-up, slit-lamp photography, and multimodal retinal imaging. The surgical procedure, as well as the pre and postoperative follow-up, took place in the ophthalmology department of Hospital Pedro Hispano, in Matosinhos, Portugal.

A 75-year-old caucasian man, diagnosed with primary open-angle glaucoma in 2012, managed by topical therapy with tafluprost, timolol and dorzolamide, was referred to right eye (OD) cataract surgery, due to progressive worsening of his visual acuity (VA) due to a nuclear cataract. Before the procedure, he had a VA of 5/10 in his OD and an intraocular pressure (IOP) of 12 mmHg. Central corneal thickness of 478 µm and fundus examination showed glaucomatous discs, with a cup-to-disc ratio of 0,8 in the OD, and thinning of the neuroretinal rim. During the surgery, 90º nasal goniotomy was performed with KDB. He was medicated with pilocarpine for 3 days postoperatively, as well as the usual postoperative drops. He had no immediate postoperative complications. One week after the surgery, he had an uncorrected VA of 0,9 and an IOP of 11. After 26 months of follow-up, the patient maintained controlled IOPs, ranging from 10-12mmHg, without any hypotensive therapy.

The KDB goniotomy technique can be combined with conventional cataract surgery, providing a simple and safe procedure to lower the IOPs in glaucomatous patients. In some cases, as the one described, the IOP-lowering effect may be high enough to allow withdrawal of eye drops, with all the added benefits, including improved quality of life, and concerns about therapy compliance.