Comparative Outcomes Of Kahook Dual Blade, Omni, And Itrack Procedures Combined With Cataract Surgery: A One-Year Retrospective Analysis

Micro-invasive glaucoma surgery (MIGS) offers safer, less invasive alternatives to traditional glaucoma surgery, but comparative data on different MIGS techniques combined with cataract surgery are limited.This study was conducted to compare 12‑month IOP, medication burden, and safety after phacoemulsification combined with Kahook Dual Blade, Omni, or iTrack in eyes with open‑angle glaucoma, providing evidence to guide individualized MIGS selection and optimize outcomes based on patient-specific treatment goals.

Augenzentrum Harburg (AZH), Hamburg, Germany.

This retrospective, single-center study included 69 eyes (23 per group) with primary open angle glaucoma undergoing phacoemulsification combined with either:

Kahook Dual Blade (KDB) goniotomy (3–4 clock hours trabecular meshwork excision), OMNI 360° canaloplasty with Healon Pro™ and 180° goniotomy, or iTrack 360° ab interno canal viscodilation with Healon Pro™ 30–40 clicks along the entire Schlemm’s canal.

Pre- & postoperative intraocular pressure, number of glaucoma medications, and best corrected visual acuity were recorded up to 12 months. Visual field mean deviation, retinal nerve fiber layer thickness, and intra- and postoperative complications were also assessed. Paired t-tests were used to compare the outcomes with baseline values.

At 12 months, significant IOP reductions were observed in all cohorts. Mean IOP decreased from 16.3 ± 4.9 to 14.1 ± 3.2 mmHg in the KDB group, from 15.6 ± 2.5 to 13.5 ± 2.3 mmHg in the iTrack group, and from 15.4 ± 2.7 to 12.8 ± 2.3 mmHg in the OMNI group.

Medication burden significantly dropped in all cohorts at one year:

-KDB: 1.1 ± 0.8 to 0.6 ± 0.9 (p = 0.0004)

-iTrack: 1.2 ± 0.5 to 0.3 ± 0.6 (p < 0.0001)

-OMNI: 1.0 ± 0.7 to 0.1 ± 0.3 (p < 0.0001)

At the final follow-up, a high percentage of patients in the OMNI and iTrack groups achieved complete medication independence (0 drops). Visual field MD, RNFL thickness, and visual acuity remained stable across all cohorts. No serious intra- or postoperative complications were observed.

KDB, OMNI and iTrack combined with phacoemulsification demonstrated comparable long-term efficacy, with all 3 groups achieving clinically significant IOP and medication reductions at 1 year. The absence of serious intra- or postoperative complications across all cohorts underscores the safety of these techniques. While OMNI and iTrack showed slightly lower medication counts at 12 months, the overall difference in IOP lowering between the 3 groups was modest. These findings suggest that all 3 procedures are effective "plus" interventions during cataract surgery. Surgeons can confidently select between them based on their surgical preference and specific patient needs, as each offers a favorable safety-to-efficacy ratio for managing glaucoma.