Kahook dual blade goniotomy combined with phacoemulsification in eyes with primary open angle glaucoma and pseudoexfoliation glaucoma: comparative study.

Purpose: To compare outcomes of phacoemulsification combined with a Kahook Dual Blade (KDB) goniotomy in eyes with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).

Methods: This retrospective comparative study was conducted in a tertiary medical center. Sixty eyes of 60 patients (27 with POAG, 33 with PXG) underwent phacoemulsification combined with a KDB goniotomy. Intraocular pressure (IOP), number of medications used, best corrected visual acuity preoperatively and at 1 day, 1 week and 1, 3, 6 and12 months postoperatively, surgical success, and surgical complications were reviewed. If IOP reduction was >%30 or postoperative IOP < 18 mmHg, the procedure was considered as surgical success.

Results: The mean IOP reduced from 26.4 ± 5.9 mmHg at baseline to 17.9 ± 6.1mmHg at 12 months for POAG (p < 0.01) and from 27.1 ± 7.9 at baseline to 15.1 ± 2.3 mmHg at 12 months for PXG (p < 0.01). Medication use reduced from 3.4 ± 0.9 to 2.0 ± 1.3 for POAG (p < 0.01) and from 3.7 ± 0.5 to 1.8 ± 1.3 for PXG (p < 0.01) at 12 months. Mean IOP was significantly lower in PXG than POAG at week 1 and months 1, 3, 6 and 12 (all p < 0.05). Surgical success rate was 74% for POAG and 84% for PXG (p = 0.30) at 12 months. No vision-threatening complications occurred.

Conclusion: KDB goniotomy combined with cataract surgery was safe and effectively reduced the IOP and drug burden in patients with POAG and PXG. In the first year, significantly lower IOPs were noted in PXG compared with POAG.