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Twelve-month outcomes of Kahook dual blade goniotomy combined with cataract surgery in Latino patients

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Abstract

Purpose

To evaluate 12 month surgical outcome of Kahook Dual Blade (KDB) goniotomy in combination with cataract surgery in Latino patients with open angle glaucoma (OAG) and ocular hypertension (OHT).

Methods

This retrospective study included 45 eyes of 40 patients who underwent KDB goniotomy combined with cataract extraction from January 2016 to September 2020 at two centers in South America. Primary outcome was surgical success defined as ≥ 20% intraocular pressure (IOP) reduction or ≥ 1 medication reduction from preoperative without additional IOP-lowering procedures and an IOP ≥ 5 mmHg or ≤ 21 mmHg. Additionally, we used 2 cutoffs values for success of IOP ≤ 18 and ≤ 15 mmHg. Secondary outcomes included: IOP, medication use, best corrected visual acuity, complications and failure-associated factors.

Results

Success rates at 12 months with cutoff limits of 21, 18 and 15 mmHg were 84.3%, 75.6% and 58.7%, respectively. At 12 months, mean preoperative IOP significantly decreased from 19.23 ± 0.65 mmHg on 2.3 ± 1.0 medications to 14.33 ± 0.66 mmHg on 0.6 ± 0.9 medications (p < 0.001) , with 62% of eyes free of hypotensive medication. Eyes that developed postoperative IOP spikes showed a higher risk for failure using the cutoff limit of IOP ≤ 18 mmHg with a hazard ratio of 3.6 (95% confidence interval [CI], 1.80–7.13; p < 0.001). There were no serious ocular adverse events.

Conclusions

KDB combined with cataract extraction showed safety and efficacy for decreasing IOP in OAG and OHT Latino patients. Additionally, dependence on medications was reduced significantly after surgery.

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References

  1. Varma R, Ying-Lai M, Francis BA, Nguyen BB, Deneen J, Wilson MR, Azen SP, & Los Angeles Latino Eye Study Group (2004) Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the los angeles latino eye study. Ophthalmology 111(8):1439–1448. https://doi.org/10.1016/j.ophtha.2004.01.025

    Article  Google Scholar 

  2. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK, Wilson MR, Gordon MO (2002) The ocular hypertension treatment study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120(6):701–13. https://doi.org/10.1001/archopht.120.6.701

    Article  PubMed  Google Scholar 

  3. Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M et al (2002) Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol 120(10):1268–1279. https://doi.org/10.1001/archopht.120.10.1268

    Article  PubMed  Google Scholar 

  4. Carreon T, van der Merwe E, Fellman RL, Johnstone M, Bhattacharya SK (2017) Aqueous outflow—a continuum from trabecular meshwork to episcleral veins. Prog Retin Eye Res 57:108–133. https://doi.org/10.1016/j.preteyeres.2016.12.004

    Article  PubMed  Google Scholar 

  5. Kass MA, Gordon M, Morley RE, Meltzer DW, Goldberg JJ (1987) Compliance with topical timolol treatment. Am J Ophthalmol 103(2):188–193. https://doi.org/10.1016/s0002-9394(14)74225-4

    Article  CAS  PubMed  Google Scholar 

  6. Robin AL, Novack GD, Covert DW, Crockett RS, Marcic TS (2007) Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol 144(4):533–40.e2. https://doi.org/10.1016/j.ajo.2007.06.012

    Article  PubMed  Google Scholar 

  7. Stone JL, Robin AL, Novack GD, Covert DW, Cagle GD (2009) An objective evaluation of eyedrop instillation in patients with glaucoma. Arch Ophthalmol 127(6):732–736. https://doi.org/10.1001/archophthalmol.2009.96

    Article  PubMed  Google Scholar 

  8. Kholdebarin R, Campbell RJ, Jin Y-P, Buys YM (2008) Multicenter study of compliance and drop administration in glaucoma. Can J Ophthalmol 43(4):454–461. https://doi.org/10.1139/i08-076

    Article  PubMed  Google Scholar 

  9. Reardon G, Schwartz GF, Mozaffari E (2004) Patient persistency with topical ocular hypotensive therapy in a managed care population. Am J Ophthalmol 137(1):S3-12. https://doi.org/10.1016/j.ajo.2003.10.035

    Article  PubMed  Google Scholar 

  10. Robin AL, Muir KW (2019) Medication adherence in patients with ocular hypertension or glaucoma. Expert Rev Ophthalmol 14(4–5):199–210. https://doi.org/10.1080/17469899.2019.1635456

    Article  CAS  Google Scholar 

  11. Kaštelan S, Tomić M, Metež Soldo K, Salopek-Rabatić J (2013) How ocular surface disease impacts the glaucoma treatment outcome. Biomed Res Int 2013:696328. https://doi.org/10.1155/2013/696328

    Article  PubMed  PubMed Central  Google Scholar 

  12. Shah M (2019) Micro-invasive glaucoma surgery – an interventional glaucoma revolution. Eye Vis (Lond) 6:29. https://doi.org/10.1186/s40662-019-0154-1

    Article  PubMed  Google Scholar 

  13. Shah M, Law G, Ahmed IIK (2016) Glaucoma and cataract surgery. Curr Opin Ophthalmol 27(1):51–57. https://doi.org/10.2147/OPTH.S247910

    Article  PubMed  Google Scholar 

  14. Seibold LK, SooHoo JR, Ammar DA, Kahook MY (2013) Preclinical investigation of Ab interno trabeculectomy using a novel dual-blade device. Am J Ophthalmol 155(3):524–29.e2. https://doi.org/10.2147/OPTH.S247910

    Article  PubMed  Google Scholar 

  15. SooHoo JR, Seibold LK, Kahook MY (2015) Ab interno trabeculectomy in the adult patient. Middle East Afr J Ophthalmol 22(1):25–29. https://doi.org/10.4103/0974-9233.148345

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sieck EG, Epstein RS, Kennedy JB, SooHoo JR, Pantcheva MB, Patnaik JL et al (2018) Outcomes of Kahook Dual Blade goniotomy with and without phacoemulsification cataract extraction. Ophthalmol Glaucoma 1(1):75–81. https://doi.org/10.1016/j.ogla.2018.06.006

    Article  PubMed  Google Scholar 

  17. Berdahl JP, Gallardo MJ, ElMallah MK, Williamson BK, Kahook MY, Mahootchi A et al (2018) Six-Month outcomes of goniotomy performed with the Kahook Dual Blade as a stand-alone glaucoma procedure. Adv Ther 35(11):2093–2102. https://doi.org/10.1007/s12325-018-0803-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kornmann HL, Fellman RL, Feuer WJ, Butler MR, Godfrey DG, Smith OU et al (2019) Early results of goniotomy with the Kahook Dual Blade, a novel device for the treatment of glaucoma. Clin Ophthalmol 13:2369–2376. https://doi.org/10.2147/OPTH.S224643

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Dorairaj SK, Seibold LK, Radcliffe NM, Aref AA et al (2018) 12 Month outcomes of goniotomy performed using the Kahook Dual Blade combined with cataract surgery in eyes with medically treated glaucoma. Adv Ther 35(9):1460–1469. https://doi.org/10.1007/s12325-018-0755-4

    Article  PubMed  PubMed Central  Google Scholar 

  20. Grover DS, Smith O, Fellman RL, Godfrey DG, Gupta A, Montes de Oca I et al (2018) Gonioscopy-assisted transluminal trabeculotomy: an Ab interno circumferential trabeculotomy: 24 months follow-up. J Glaucoma 27(5):393–401. https://doi.org/10.1097/IJG.0000000000000956

    Article  PubMed  Google Scholar 

  21. Nesterov AP (1986) Pathological physiology of primary open angle glaucoma: the aqueous circulation. In: Cairns JE (ed) Glaucoma, vol I. Grune and Stratton, New York, pp 335–336

    Google Scholar 

  22. Ibrahim LF, Pereira AFR, de Terenzi LA, O, Vianello MP, Dorairaj SK, Prata TS, et al (2021) Phacoemulsification with Kahook Dual Blade goniotomy in eyes with medically treated glaucoma: analysis of surgical outcomes and success predictors. Arq Bras Oftalmol 85(4):359–363. https://doi.org/10.5935/0004-2749.20220046

    Article  PubMed  Google Scholar 

  23. Laroche D, Nkrumah G, Ugoh P, Ng C (2021) Real world outcomes of Kahook Dual Blade goniotomy in black and afro-latinx adult patients with glaucoma: a 6 month retrospective Study. J Natl Med Assoc 113(2):230–236. https://doi.org/10.1016/j.jnma.2020.09.147

    Article  PubMed  Google Scholar 

  24. ElMallah MK, Seibold LK, Kahook MY, Williamson BK, Singh IP, Dorairaj SK (2019) 12 Month retrospective comparison of Kahook Dual Blade excisional goniotomy with istent trabecular bypass device implantation in glaucomatous eyes at the time of cataract surgery. Adv Ther 36(9):2515–2527. https://doi.org/10.1007/s12325-019-01025-1

    Article  PubMed  PubMed Central  Google Scholar 

  25. Castro ANBV, Mesquita WA (2009) Noncompliance with drug therapy of glaucoma: a review about intervening factors. Braz J Pharm 45(3):453–459. https://doi.org/10.1590/s0004-27492008000200014

    Article  Google Scholar 

  26. Chen J, Wang YE, Quan A, Grajewski A, Hodapp E, Vanner EA, Chang TC (2020) Risk factors for complications and failure after gonioscopy-assisted transluminal trabeculotomy in a young cohort. Ophthalmol Glaucoma 3(3):190–195. https://doi.org/10.1016/j.ogla.2020.02.002

    Article  PubMed  Google Scholar 

  27. Shi Y, Wang H, Oatts JT, Xin C, Yin P, Zhang L, Tian J, Zhang Y, Cao K, Han Y, Wang N (2022) A prospective study of intraocular pressure spike and failure after gonioscopy-assisted transluminal trabeculotomy in juvenile open-angle glaucoma: a prospective study of GATT in JOAG. Am J Ophthalmol 236:79–88. https://doi.org/10.1016/j.ajo.2021.10.009

    Article  PubMed  Google Scholar 

  28. Qiao Y, Tan C, Chen X et al (2021) Gonioscopy-assisted transluminal trabeculotomy versus goniotomy with Kahook dual blade in patients with uncontrolled juvenile open-angle glaucoma: a retrospective study. BMC Ophthalmol 21(1):395. https://doi.org/10.1186/s12886-021-02159-z

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mansberger SL, Gordon MO, Jampel H et al (2012) Reduction in intraocular pressure after cataract extraction: the ocular hypertension treatment study. Ophthalmology 119(9):1826–1831. https://doi.org/10.1016/j.ophtha.2012.02.050

    Article  PubMed  Google Scholar 

  30. Shingleton BJ, Pasternack JJ, Hung JW et al (2006) Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma 15(6):494–498. https://doi.org/10.1097/01.ijg.0000212294.31411.92

    Article  PubMed  Google Scholar 

  31. Samuelson TW, Katz LJ, Wells JM et al (2011) Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology 118(3):459–467. https://doi.org/10.1016/j.ophtha.2010.07.007

    Article  PubMed  Google Scholar 

  32. Shrivastava A, Singh K (2014) The impact of cataract surgery on glaucoma care. Curr Opin Ophthalmol 25(1):19–25. https://doi.org/10.1097/ICU.0000000000000010

    Article  PubMed  Google Scholar 

  33. Van Buskirk EM (1976) Changes in the facility of aqueous outflow induced by lens depression and intraocular pressure in excised human eyes. Am J Ophthalmol 82(5):736–740. https://doi.org/10.1016/0002-9394(76)90011-8

    Article  PubMed  Google Scholar 

  34. Shute T, Green W, Liu J, Sheybani A (2022) An alternate technique for goniotomy: description of procedure and preliminary results. J Ophthalmic Vis Res 17(2):170–175. https://doi.org/10.18502/jovr.v17i2.10787

    Article  PubMed  PubMed Central  Google Scholar 

  35. Laroche D, Okaka Y, Ng C (2019) A novel low cost effective technique in using a 23 gauge straight cystotome to perform goniotomy: making micro-invasive glaucoma surgery (MIGS) accessible to the africans and the diaspora. J Natl Med Assoc 111(2):193–197. https://doi.org/10.1016/j.jnma.2018.09.006

    Article  PubMed  Google Scholar 

  36. Omoto T, Fujishiro T, Asano-Shimizu K, Sugimoto K, Sakata R, Murata H, Asaoka R, Honjo M, Aihara M (2021) Comparison of 12 month surgical outcomes of ab interno trabeculotomy with phacoemulsification between spatula-shaped and dual-blade microhooks. Jpn J Ophthalmol 65(3):402–408. https://doi.org/10.1007/s10384-020-00806-4

    Article  PubMed  Google Scholar 

  37. Laroche D (2021) Affordable sinskey hook goniotomy for glaucoma

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Acknowledgements

No Acknowledgements to declare for the present study.

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Authors and Affiliations

  1. Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander, Colombia

    Gustavo Espinoza, Andres Arango & Sylvia Villamizar

  2. Fundación Oftalmológica de Santander FOSCAL, Ave. El No 23-60, TMS, Cañaveral, Tv. El Bosque Floridablanca, Bucaramanga, Santander, Colombia

    Gustavo Espinoza

  3. Clínica de ojos Norte, Santa Cruz de la Sierra, Bolivia

    Manuel Jose Justiniano

  4. Instituto Oftalmológico Fernández-Vega, University of Oviedo, Oviedo, Spain

    Ignacio Rodriguez-Una

  5. Grupo de investigación Salud Visual y ocular Unbosque, Universidad del Bosque, Bogotá D.C., Colombia

    Fernando Godin

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  1. Gustavo Espinoza
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Contributions

GE, MJ and IRU: conceptualization; GE, IRU and FG: wrote the main manuscript; SV: formal analysis; GE, MJ and AA: investigation; SV and GE: prepared figure 1 and tables 1–4; GE and IRU: review and editing. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Gustavo Espinoza.

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GE (consultant and speaker for New World Medical). The authors report no other conflicts of interest in this work.

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Espinoza, G., Justiniano, M.J., Rodriguez-Una, I. et al. Twelve-month outcomes of Kahook dual blade goniotomy combined with cataract surgery in Latino patients. Int Ophthalmol 44, 44 (2024). https://doi.org/10.1007/s10792-024-03024-w

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