Real World Outcomes of Kahook Dual Blade Goniotomy in Black and Afro-Latinx Adult Patients with Glaucoma: A 6-Month Retrospective Study

Abstract

Introduction: To determine the efficacy and safety of Kahook Dual Blade (KDB) goniotomy alone or combined with phacoemulsification cataract surgery to lower intraocular pressure and medication burden in Black and Afro-Latinx patients with open angle glaucoma (OAG).

Materials and method: A retrospective, single center case series of patients with OAG who were managed with medications and underwent phacoemulsification combined with goniotomy (PE + KDB) using Kahook Dual Blade or goniotomy alone (KDB alone) in pseudophakic patients. Indications for glaucoma surgery included reduction of intraocular pressure (IOP) and reduction of medication burden. Our study parameters included pre- and postoperative information on IOP, the use of IOP-lowering medications, visual field, and adverse events through 6 months of follow-up.

Results: Among all 63 eyes of 63 patients undergoing surgery, Kahook goniotomy with or without phacoemulsification, mean IOP was significantly reduced from 17.4 mmHg at baseline to 14.0 mmHg at month 6 (P = 0.0012), a 19.5% reduction (KDB alone -26.4%, PE + KDB -16.6%). The mean number of topical IOP-lowering medications was reduced from 2.6 at baseline to 1.6 ± 0.3 at month 6 (P = 0.0012), a 38.5% reduction (Kahook alone -10.7%, PE + Kahook -48.0%). Mean visual fields were stable in the PE + KDB group and progressed in the KDB alone group. Postoperative adverse events were mild and included transient hyphema, IOP spikes, posterior capsule opacification, tearing, glare and mild pain.

Conclusion: Phacoemulsification combined with Kahook dual blade goniotomy significantly lowers both IOP and medication burden in Black and Afro-Latinx patients with open angle glaucoma. In pseudophakic patients with advanced glaucoma medication burden is not significantly reduced and visual field progression occurred. Adverse events were not sight-threatening and self limited.

Keywords: Cataract surgery; Glaucoma; Goniotomy; Kahook dual blade (KDB); Micro-invasive glaucoma surgery.