Outcomes of Kahook Dual Blade Goniotomy with and without Phacoemulsification Cataract Extraction

To determine the effectiveness and safety of Kahook Dual Blade (KDB) goniotomy in reducing intraocular pressure (IOP) and medication need in glaucoma patients when combined with phacoemulsification or as a standalone procedure. Retrospective study. A total of 197 eyes from 143 patients were reviewed. Thirty-two eyes underwent KDB goniotomy alone and 165 eyes underwent KDB goniotomy combined with phacoemulsification cataract surgery (phaco-KDB). Surgical success, defined as IOP reduction of at least 20% from baseline at 12 months, and/or reduction of at least 1 glaucoma medication. At 12 months, the success rate was 71.8% for the phaco-KDB group and 68.8% for the KDB-alone group. In the phaco-KDB group at 12 months (n = 124), mean IOP was significantly reduced from 16.7 (standard error [SE] 0.4) mmHg on 1.9 (SE 0.1) medications to 13.8 (SE 0.4) mmHg on 1.5 (SE 0.1) medications. In the KDB-alone group at 12 months (n = 16), mean IOP was significantly reduced from 20.4 (SE 1.3) mmHg on 3.1 (SE 0.2) medications to 14.1 (SE 0.9) mmHg on 2.3 (SE 0.4) medications. The most common complications were transient hyphema (17.3% at day 1) and IOP spike >10 mmHg from baseline at 1 week (10.2%). LogMAR visual acuity at 12 months was unchanged from baseline in the KDB-alone group (0.218 [SE 0.07] and 0.306 [SE 0.09], respectively, P = 0.244) and significantly improved in the phaco-KDB group (0.184 [SE 0.02] and 0.340 [SE 0.03], P < 0.001). Goniotomy with the KDB has a favorable safety profile and is an effective procedure at reducing IOP and medication burden as a standalone procedure or combined with phacoemulsification.