Outcomes of Phacoemulsification With or Without Kahook Dual Blade Goniotomy for Glaucoma Patients with Cataract

Loubna Radwan; Jana Dib El Jalbout; Khalid Trad; Lama Radwan; Lulwa El Zein; Ann Brearley; Ziou Jiang; Wassef Chanbour

doi:10.1097/IJG.0000000000002429

Outcomes of Phacoemulsification With or Without Kahook Dual Blade Goniotomy for Glaucoma Patients with Cataract

J Glaucoma. 2024 May 16. doi: 10.1097/IJG.0000000000002429. Online ahead of print.

Authors

Loubna Radwan¹, Jana Dib El Jalbout², Khalid Trad², Lama Radwan³, Lulwa El Zein⁴, Ann Brearley⁵, Ziou Jiang⁵, Wassef Chanbour⁴

Affiliations

¹ Department of Ophthalmology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
² Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
³ School of Pharmacy, Lebanese University, Hadath, Lebanon.
⁴ Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.
⁵ Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA.

PMID: 38747724
DOI: 10.1097/IJG.0000000000002429

Abstract

Precis: This meta-analysis examines the comparative efficacy of phacoemulsification with and without Kahook Dual Blade Goniotomy in individuals with glaucoma and cataract, aiming to elucidate optimal surgical approaches for coexisting conditions.

Purpose: The purpose of this current study is to compare the effect of combining Kahook Dual Blade (KDB) goniotomy with phacoemulsification versus phacoemulsification alone on intraocular pressure (IOP) and medication reduction in patients with glaucoma and cataract.

Methods: We conducted a systematic review and meta-analysis utilizing computer databases, including Embase (OVID), MEDLINE (OVID and PubMed), CINHAL (EBSCO), and the Cochrane Library (Wiley). We included studies examining the IOP-lowering effect of KDB goniotomy combined with phacoemulsification and studies that examined the IOP-lowering effect of phacoemulsification alone in patients with open angle glaucoma or ocular hypertension. The mean reduction of IOP and the reduction in topical glaucoma eye drops after surgery were determined.

Results: A total of 26 studies were included reporting on 1659 patients, 684 patients underwent phacoemulsification alone and 975 underwent combined phacoemulsification and KDB goniotomy. A 9.62% IOP reduction from baseline occurred following phacoemulsification as a solo procedure compared to 22.74% following combined KDB goniotomy with phacoemulsification. Similarly, the combination of the procedures caused a significant drop in the mean number of glaucoma eye drops used (mean reduction=1.35, 95% CI [1.08, 1.61]) compared to phacoemulsification alone (mean reduction=0.36, 95% CI [0.06, 0.66]). Funnel plots suggested the absence of publication bias.

Conclusion: Both phacoemulsification alone or combined with KDB goniotomy result in a significant decrease in post-op IOP and topical glaucoma eye drops. The combination of these two procedures outperforms phacoemulsification alone in terms of both parameters.