Long-Term Efficacy Of Successful Excisional Goniotomy With The Kahook Dual Blade

To characterize the reductions in intraocular pressure (IOP) and IOP-lowering medication use through 5 years following successful excisional goniotomy with the Kahook Dual Blade (KDB).

An academic hospital based practice.

Retrospective analysis of eyes meeting the following criteria: diagnosed with open-angle glaucoma, underwent excisional goniotomy with the KDB either as a standalone procedure or in combination with phacoemulsification, five years of uninterrupted follow-up, and no secondary surgical interventions within the five-year postoperative period.

52 eyes of 28 subjects were analyzed; 41 underwent combined surgery and 11 underwent standalone surgery. Mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0-13.7 mmHg, representing mean reductions of 7.3-8.0 mmHg (34.7-38.3%; p<0.0001 at every time point). Similarly, mean medication use ranged from 0.4-0.6 medications per eye, representing mean reductions of 1.2-1.4 medications (66.0-75.5%; p<0.0001 at every time point). Mean logMAR best-corrected visual acuity improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p<0.0001).

In eyes not requiring secondary surgical procedures (long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through 5 years of follow-up. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.