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Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: Six Month Outcomes

Salinas, Lauriane, MD*,†; Chaudhary, Ankita, MD*; Berdahl, John P., MD; Lazcano-Gomez, Gabriel S., MD§; Williamson, Blake K., MD, MPH, MS; Dorairaj, Syril K., MD; Seibold, Leonard K., MD#; Smith, Sanjay, MD**; Aref, Ahmad A., MD††; Darlington, Jason K., MD‡‡; Jimenez-Roman, Jesus, MD§§; Mahootchi, Ahad, MD∥∥; Boucekine, Mohamed, PhD¶¶; Mansouri, Kaweh, MD, MPH*,##

doi: 10.1097/IJG.0000000000001019
Original Study: PDF Only

Purpose: To describe short-term efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma.

Method: Retrospective multicentric case series of 53 eyes with severe or refractory glaucoma as defined by ICD-10 conducted in the United States, Mexico and Switzerland. Primary efficacy outcome was a 20% or more decrease in intraocular pressure (IOP) from baseline at 6 months. Secondary efficacy outcome measures were probability of achieving an IOP ≤14 or 18▒mm Hg at 6 months and the mean IOP change from baseline at 6 months. Medication use required to obtain target IOP at last follow-up and adverse effects were analyzed.

Results: The proportion of eyes achieving an IOP reduction of more than 20% from preoperative baseline at 6 months was 57.7% (n=30). The mean IOP decreased from 18.4±6.1▒mm Hg at baseline to 13.9±3.5▒mm Hg at month 6 (23.9% reduction, P<0.001). At 6 months, 63.5% and 92.3% achieved an IOP ≤14 and ≤18▒mm Hg, respectively, and the mean number of glaucoma medications was reduced by 1.2±1.3 (36.6%) compared to baseline (P<0.001). The most common adverse event was hyphema (n=29, 34.9%) with spontaneous resolution in all cases. No severe complications were reported. One case presented with uncontrolled IOP and required glaucoma drainage device surgery at 1 month.

Conclusion: Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.

*Glaucoma Research Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland

Department of Ophthalmology, North University Hospital Center, Marseille, France

Vance Thompson Vision, Sioux Falls, South Dakota, USA

§Asociacion para Evitar la Ceguera, Mexico City, Mexico

Williamson Eye, Center Baton Rouge, LA,USA

Mayo Clinic, Jacksonville, USA

#University of Colorado School of Medecine, Aurora, Colorado, USA

**Medical Eye Associates, South Miami, FL, USA

††University of Illinois, Chicago, Illinois, USA

‡‡Eye Institute, Melbourne, Florida, USA

§§Hospital Dr. Luis Sanchez Bulnes, Mexico City, Mexico

∥∥The Eye Clinic of Florida, Zephyrhills, FL, USA

¶¶Aix-Marseille University, EA 3279 - Chronic Diseases and Quality of Life, Research Unit and Department of Public Health, Marseille, France

##Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA

Supported in part by the Swiss Glaucoma Research Foundation, Lausanne, Switzerland.

Financial Disclosures: Mansouri K: Santen (C), Sensimed (C), Topcon (S), Alcon (S), Allergan (S), Optovue (S); ImplanData (C); Mahootchi A: Iridex, Imprimis Pharma, New World Medical, Valeant, Ellex (C, S); Aref A: NWM (C); Williamson B : Alcon, Allergan, Glaukos, NWM, Sight Sciences (C, S); Seibold L : Allergan, Sensimed, NWM (C); Berdahl J: Alcon, Allergan, Glaukos, NWM (C); Dorairaj S, Darlington J, Lazcano G, Jimenez-Roman : NWM (C).

No financial disclosures: Salinas L, Chaudhary A, Boucekine M.

Disclosure: The authors declare no conflict of interest.

Reprints: Kaweh Mansouri, MD, MPH, Glaucoma Research Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland (e-mail: kwmansouri@gmail.com).

Received March 13, 2018

Accepted June 16, 2018

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