Serious Postoperative Complications Of Cataract Phacoemulsification Combined With Ab Interno Goniotomy

To analyze the incidence and clinical management of serious complications following cataract phacoemulsification with in-the-bag IOL implantation combined with ab interno goniotomy using the Kahook Dual Blade.

Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, ul. Ujejskiego 75, 85-168 Bydgoszcz, Poland

This retrospective study included 834 eyes that underwent the combined procedure between 2018 and 2025, performed by two experienced surgeons. All cataract surgeries were uneventful, and the Schlemm’s canal was opened over 100–120°. The follow-up period was 6 months.

During the initial postoperative days, an IOP spike exceeding 40 mmHg with a poor response to topical treatment was observed in 10 eyes (1.2%). Among these cases, six eyes (0.72%) required laser cyclodestruction, while four eyes (0.48%) underwent trabeculectomy. Postoperative hypotony caused by a cyclodialysis cleft was noted in 4 eyes (0.48%), and in all such instances, cyclopexy was performed, achieving successful anatomical restoration and an increase in aqueous humor production. Regarding hemorrhagic complications, massive hemorrhage into the anterior chamber exceeding half of its volume occurred in 2 cases (0.24%), with one instance (0.12%) extending into the vitreous chamber and necessitating a posterior vitrectomy.

Ab interno goniotomy performed concurrently with cataract phacoemulsification is associated with serious complications in only a small percentage of patients. Although the majority of these complications require secondary surgical interventions, the overall prognosis remains favorable.