Long-Term Efficacy of Successful Excisional Goniotomy with the Kahook Dual Blade

Abstract

Purpose

To report clinical outcomes of successful excisional goniotomy with the Kahook Dual Blade (KDB), through 60 months.

Patients and methods

This was a noncomparative, single-surgeon, retrospective review of eyes receiving successful KDB goniotomy with or without concomitant phacoemulsification between October 2015 and January 2016 with five years of uninterrupted follow-up. Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), and complications were recorded. Primary outcomes included changes from baseline in IOP, medication use, and BCVA, through five years.

Results

Fifty-two eyes of 28 patients were analyzed. Most eyes had mild primary open angle glaucoma (73%). Of the eyes analyzed, 41 underwent combined surgery and 11 underwent standalone surgery. With all eyes combined, mean (standard deviation) baseline IOP was 21.0 (4.1) mmHg and mean baseline medication use was 1.8 (1.1) medications per eye. Across time points at months 6, 12, 24, 36, 48, and 60, mean postoperative IOP ranged from 13.0 to 13.7 mmHg, representing mean reductions of 7.3–8.0 mmHg (34.7–38.3%; p <0.0001 at every time point). Similarly, mean medication use ranged from 0.4 to 0.6 medications per eye, representing mean reductions of 1.2–1.4 medications (66–75.5%; p <0.0001 at every time point). Mean logMAR BCVA improved from 0.321 (0.177) preoperatively to 0.015 (0.035) at month 60 (p < 0.0001).

Conclusion

In eyes not requiring secondary surgical procedures (eg, long-term surgical successes), excisional goniotomy provided clinically and statistically significant reductions in both IOP and the need for medications that were highly consistent through five years of follow-up. KDB goniotomy appears to be highly successful in Caucasian patients with open angle glaucoma on ≥1 IOP-lowering medications at baseline and with no history of prior ocular surgery. Successful excisional goniotomy with the KDB can be expected to improve long-term glaucoma-related visual outcomes through IOP reduction and to improve quality of life through medication reduction.

Keywords:

• glaucoma
• goniotomy
• intraocular pressure
• IOP-lowering medications
• phacoemulsification
• minimally invasive glaucoma surgery

Data Sharing Statement

The author’s institution (Mayo Clinic Florida) does not authorize data sharing. Queries and requests should be handled by the corresponding author (SD).

Consent for Publication

This retrospective study was performed in accordance with the tenets of the Declaration of Helsinki. Patient consent was waived by the Mayo Clinic IRB. All data and images have been deidentified.

Acknowledgments

The authors acknowledge Ms. Joyce Baker for her generous contribution to the Mayo Clinic Ophthalmology Department. Without her, the publication of this article would not have been possible.

Author Contributions

All listed authors made a significant contribution to this work in multiple areas including conception, study design, execution, data acquisition, analysis, interpretation, drafting, and/or critical review. All authors gave final approval of the version to be published, agreed on the journal of submission, and agreed to be accountable for all aspects of the work.

Disclosure

All authors report no conflicts of interest in this work.

Additional information

Funding

No grant support was obtained.