Comparison Of The Efficacy Of Kahook Dual Blade (Kdb ) With Bent Ab Interno Needle Goniotomy (Bang) In Controlling The Iop.

Micro invasive glaucoma surgery (MIGS) is one of the ways to control the Intraocular pressure which was practised to fulfill the unmet treatment gap in glaucoma . MIGS procedures can also be used to reduce drop dependence at the time of traditional phacoemulsification surgery. There are many MIG surgical techniques. We aim to compare the efficacy of Kahook Dual Blade (KDB ) and Bent Ab interno Needle Goniotomy (BANG).

This was a prospective study done after ethics approval by a single experienced glaucoma surgeon. Patients with mild to moderate glaucoma who were  not compliant with medicines and had cataract were included in the study. Patients with severe glaucoma were excluded from the study. All patients underwent a complete ophthalmic and glaucoma examination. Patients were randomised to two groups and were subjected to either BANG or KDB.

After performining phacoemulsification the angle structures are visualised with a surgical gonio lens. The patients are randomised in to two groups and the MIGS was performed. The KDB group underwent goniotomy with the disposible KDB blade and a bent 26 needle was used to the goniotomy in the second group. The primary outcome measure was reduction in Intraocular pressure(IOP)at 1 month and 3 month follow up. Secondary outcome measure was the reduction in Antiglaucoma medication(AGM). The intraoperative and post operative complications were documented. Both the group patients were given the same post operative medications. The anti glaucoma medications were given based on their glaucoma status.

Our study had 20 patients in BANG group and 20 patients in KDB group. Average age of BANG group was 67 years and KDB group was 66 years.Comparative outcomes of BANG and KDB was observed as 95.83% and 87.5%. Reduction in number of anti-glaucoma medications was observed in 83.3% of BANG procedures but only in 46.8% of KDB procedures. This difference in proportions was found to be significant when tested with Fisher's exact test ( _p_ = 0.006)

BANG can be considered as one of the cost effective alternative of MIGS for patients who are non compliant to medications and  non tolerable to medicines. It can be combined with Phacoemulsification reducing the need for another surgery.