Six months' follow-up of combined phacoemulsification-kahook dual blade excisional goniotomy

Nicole Mechleb; Karim Tomey; Daniel Cherfan; Antony Nemr; Georges Cherfan; Syril Dorairaj; Ziad Khoueir

doi:10.4103/sjopt.sjopt_151_21

Six months' follow-up of combined phacoemulsification-kahook dual blade excisional goniotomy

Saudi J Ophthalmol. 2022 Aug 29;36(2):195-200. doi: 10.4103/sjopt.sjopt_151_21. eCollection 2022 Apr-Jun.

Authors

Nicole Mechleb^{1

2}, Karim Tomey^{2

3}, Daniel Cherfan², Antony Nemr¹, Georges Cherfan^{1

2}, Syril Dorairaj⁴, Ziad Khoueir^{1

2

4}

Affiliations

¹ Faculty of Medicine, Saint-Joseph University, Byblos, Lebanon.
² Department of Glaucoma, Beirut Eye and ENT Specialist Hospital, Byblos, Lebanon.
³ Lebanese American University, Gilbert and Rose-Mary Chagoury School of Medicine, Byblos, Lebanon.
⁴ Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA.

Abstract

Purpose: This study reports on the combination of excisional goniotomy and cataract extraction in the management of glaucoma in terms of intraocular pressure (IOP) and glaucoma medication reduction.

Methods: This is a retrospective case series. Twenty-eight eyes of 22 patients with the diagnosis of cataract and ocular hypertension or glaucoma of any stage underwent combined phacoemulsification and Kahook Dual Blade (KDB) goniotomy, between March 2019 and September 2020. The parameters evaluated were postoperative best-corrected visual acuity, mean IOP reduction, number of IOP-lowering medications, and the surgical success rate defined as IOP reduction >20% and/or reduction in glaucoma medications >1.

Results: The mean IOP reduction at 6 months was 4.5 mmHg (P = 0.0007), which translates to 24.9% reduction from preoperative IOP. The mean preoperative number of glaucoma medications was 2.9 ± 1.0 (median of 3). It was reduced to 1.1 ± 1.1 (median of 1.5), 1.46 ± 1.17 (median of 2), 1.44 ± 1.28 (median of 2), and 1.56 ± 1.28 (median of 2) at 1 week, 1 month, 3 months, and 6 months, respectively. Twenty-nine percent (8/28) of the patients were off glaucoma medications at 6 months and 46% (13/28) had a reduction of more than 50% of their glaucoma medications.

Conclusion: Combined phacoemulsification-KDB excisional goniotomy may be an effective and safe alternative to more invasive filtering surgery in glaucoma patients of any stage.

Keywords: Glaucoma; Kahook Dual Blade; goniotomy; phacoemulsification.