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Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-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 Studies

Purpose: The purpose of the study is 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% 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 >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 with 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.

Conclusions: 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

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

Vance Thompson Vision, Sioux Falls, SD

§Asociacion para Evitar la Ceguera

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

Williamson Eye, Center Baton Rouge, LA

Mayo Clinic, Jacksonville

**Medical Eye Associates, South Miami

‡‡Eye Institute, Melbourne

∥∥The Eye Clinic of Florida, Zephyrhills, FL

#University of Colorado School of Medecine, Aurora

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

††University of Illinois, Chicago, IL

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

K.M.: Santen (C), Sensimed (C), Topcon (S), Alcon (S), Allergan (S), Optovue (S); ImplanData (C); A.M.: Iridex, Imprimis Pharma, New World Medical, Valeant, Ellex (C, S); A.A.A.: NWM (C); B.K.W.: Alcon, Allergan, Glaukos, NWM, Sight Sciences (C, S); L.K.S.: Allergan, Sensimed, NWM (C); J.P.B.: Alcon, Allergan, Glaukos, NWM (C); S.K.D., J.K.D., G.S.L.-G., and J.J.R.: NWM (C). The remaining authors declare that they have nothing to disclose.

Disclosure: J.P.B., G.S.L.-G., B.K.W., S.K.D., L.K.S., A.A.A., and A.M. are consultants for New World Medical. The remaining authors declare no conflict of interest.

Reprints: Kaweh Mansouri, MD, MPH, Glaucoma Research Center, Montchoisi Clinic, Swiss Vision Network, Chemin des Allinges 16, 1006 Lausanne, Switzerland (e-mail:

Received March 13, 2018

Accepted June 16, 2018

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