Combined Phacoemulsification and 360-Degree Endocyclophotocoagulation with and without a Kahook Dual Blade in Patients with Primary Open-Angle Glaucoma

Abstract

Purpose

The present study aimed to compare the outcomes of combined phacoemulsification and 360-degree endocyclophotocoagulation with and without goniotomy using a Kahook Dual Blade in patients with glaucoma.

Patients and Methods

We enrolled 37 patients, 21 of whom underwent combined phacoemulsification with 360-degree endocyclophotocoagulation and goniotomy using a Kahook Dual Blade (tri-modal therapy (T-MT) group). The remaining 16 patients underwent phacoemulsification with endocyclophotocoagulation (bi-modal therapy (B-MT) group). Visual acuity, intraocular pressure, and number of glaucoma medications were recorded before the study and postoperatively on the first day, at week 1, and at 1, 3, 6, 9, and 12 months. Surgical success was defined as an IOP ≤12 mmHg and ≥6 mmHg or an at least 20% reduction in IOP from baseline with (qualified success) or without medications (complete success).

Results

Forty-nine eyes were included. Baseline mean IOP was 16.96±3.66 mmHg and 15.64±4.88 mmHg in the T-MT and B-MT groups (p=0.122), respectively. At the 12-month follow-up, mean IOP values were 11.44±2.15 mmHg and 12.45±1.90 mmHg (p=0.031) in the T-MT and B-MT groups, respectively. Complete success rates were 37% in the T-MT group and 31% in the B-MT group, while qualified success rates were 74% and 50%, respectively. Glaucoma medications decreased from 2.0±1.4 to 0.8±1.0 (p<0.001) in the T-MT group and from 1.5±1.3 to 1.0±1.5 in the B-MT group (p=0.032). Similar improvements in visual acuity were observed in both groups. Complications were mild and resolved without intervention.

Conclusion

The tri-modal treatment is safe and may be more effective in reducing IOP and glaucoma medication requirements than bi-modal treatment.

Keywords:

• micro-incisional glaucoma surgery
• glaucoma surgery
• MIGS
• trabecular meshwork

Abbreviations

T-MT, tri-modal therapy; B-MT, bi-modal therapy; MIGS, minimally invasive glaucoma surgery; OAG, open-angle glaucoma; IOP, intraocular pressure; ECP, endoscopic cyclophotocoagulation; KDB, Kahook Dual Blade; BCVA, best-corrected visual acuity; LogMAR, logarithm of the minimum angle of resolution.

Data Sharing Statement

The datasets used and analyzed during this study are available via the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

The study was approved by the Ethics Committee of the Instituto de Ojos Oftalmosalud. All research was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to enrolment. This report does not contain any personal information that could lead to patient identification. We do not require any administrative permissions and/or licenses to access the data used in our research.

Acknowledgments

We wish to thank Jose Chauca and Carmen Maldonado for statistical analysis and technical support.

Author Contributions

All authors made a significant contribution to the work reported in the following areas: study conception, study design, study execution, acquisition of data, analysis and interpretation of data, drafting/writing of the manuscript, substantial revision or critical review of the article, agreement on the journal to which the article will be submitted. All authors have reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. We agree to take responsibility and be accountable for the contents of the article.

Disclosure

The authors report no conflicts of interest related to this work.