Retrospective Comparison Of Trabecular Micro-Bypass Stent Vs Excisional Goniotomy Combined With Cataract Surgery

Minimally invasive glaucoma surgery (MIGS) combined with cataract extraction has increased the surgical options for patients with mild-moderate glaucoma plus visually significant cataract. In the US, insurance reimbursement changes have decreased access to trabecular micro-bypass stent (iStent) over the past 18 months, therefore excisional goniotomy (Kahook Dual Blade) was substituted for those patients. We sought to determine the outcome of KDB goniotomy vs iStent combined with cataract surgery during this time period.

Wills Eye Hospital, Philadelphia PA USA and nearby private clinics.

140 patients who underwent combined iStent inject or KDB gonitomy for mild-moderate glaucoma combined with cataract surgery were identified between 1 Jan 2021 – 31 Dec 2022.  Visual acuity (VA), intraocular pressure (IOP) and number of glaucoma medications were obtained preoperatively and at 1 day, 1-2 weeks, 3, 6 and 12 months postop. Complications, total operative time, secondary interventions, and subjective visual complaints were also recorded. Statistical analysis was performed using t-test and ANOVA to compare the 2 groups.

64 patients underwent iStent and 76 patients underwent 30 degree KDB goniotomy combined with phaco cataract extraction / IOL implantation. Significant IOP reduction was achieved in both groups (2.3mmHg iStent vs 2.7mmHg KDB) at the 6 month visit, with average medications reduced in both groups. These differences were not statistically significant. There was also no significant difference in postop hyphema (<3%) and prolonged postop inflammation beyond 1 month (<4%).

Combined phacoemulsification CE plus iStent trabecular micro-bypass stent or KDB goniotomy yielded similar results in terms of IOP reduction, decrease in glaucoma medications required, and postop complications.