ONE-YEAR OUTCOMES OF KAHOOK DUAL BLADE VS GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY IN OPEN-ANGLE GLAUCOMA

This study compares the 12-month efficacy and safety of Kahook Dual Blade (KDB) goniotomy and gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma.

This retrospective study involved patients who underwent KDB goniotomy (23 eyes) or GATT (25 eyes) between January and June 2024 and were followed for at least 12 months at a tertiary eye center.

Postoperative mean intraocular pressure (IOP), the number of antiglaucomatous medications were compared between groups. Complete success was defined as an IOP of 5–18 mmHg without medication; the same IOP with or without medication was defined as overall success. Surgical failure was defined as IOP >18 mmHg or <5 mmHg, significant vision loss, or the requirement for additional surgical intervention. Postoperative fibrin reaction, hyphema, and intra- or postoperative complications were recorded. Kaplan–Meier estimated cumulative success, and log-rank compared groups.

The mean age was 60.9 ± 17.5 years in the KDB group and 58.6 ± 11.8 in the GATT group. There were no baseline differences in age, preoperative visual acuity, preoperative IOP, preoperative mean number of antiglaucoma medications or glaucoma stage (p>0.05 for all). The mean number of antiglaucoma medications and the mean IOP were lower in the GATT group during the first postoperative 6 months (p<0.05 for both). The rate of overall success was 52.2% (12 eyes) in the KDB group, 84% (21 eyes) in the GATT group (p=0.01), and the rate of complete success was 17.4% (4 eyes) in the KDB group, 48% (12 eyes) in the GATT group (p=0.03). Seven eyes (30.4%) in the KDB group needed additional glaucoma surgery, compared with 1 (4%) in the GATT group (p<0.05). The failure rate was higher in the KDB group (47.8%) than in the GATT group (16%) (p=0.01). The cumulative probability of overall success was 69.5%, 65.2%, and 52.2% at 3, 6, and 12 months, respectively, in the KDB group, and 92%, 88%, and 84% at 3, 6, and 12 months, respectively, in the GATT group (p<0.05). The rate of postoperative hyphema was 68% in the GATT group and 13% in the KDB group (p<0.01). A similar time to hyphema resolution was observed in both groups (p=0.9). One eye (4%) in the GATT group required anterior chamber washout; none of the others did. A postoperative fibrin reaction occurred in 12 eyes (48%) of the GATT group, and postoperative late hypotony was observed in 2 eyes ( 8%). In contrast, no cases of hypotony or fibrin reaction were observed in the KDB group (p<0.01).

GATT demonstrated superior surgical success compared with KDB at 12 months. Although hyphema and fibrin reaction were more frequent after GATT, they were self-limiting and did not compromise long-term outcomes. KDB was associated with fewer complications but also with a higher rate of surgical failure. These findings suggest that GATT may provide more effective IOP control, despite a higher incidence of complications.