Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy.

BACKGROUND: Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma. This risk is further increased with combined filtering procedures. Indeed, there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery (MIGS). Here, we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade (KDB) goniotomy. METHODS: Retrospective chart review of 385 glaucomatous eyes of 281 patients, which underwent either phacoemulsification alone (n = 309) or phacoemulsification with KDB goniotomy (n = 76, phaco-KDB) at the University of Colorado. The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than ±0.5 Diopter (D). RESULTS: Refractive surprise greater than ±0.5 D occurred in 26.3% of eyes in the phaco-KDB group and 36.2% in the phacoemulsification group (p = 0.11). Refractive surprise greater than ±1.0 D occurred in 6.6% for the phaco-KDB group and 9.7% for the phacoemulsification group (p = 0.08). There was no significant difference in risk of refractive surprise when pre-operative IOP, axial length, keratometry or performance of KDB goniotomy were assessed in univariate analyses. CONCLUSION: There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.

Optimum time for angle visualization during ab interno glaucoma surgery: Before or after phacoemulsification.

PURPOSE: To determine whether it is more advantageous to perform ab interno glaucoma surgeries involving the angle before or after phacoemulsification. SETTING: University of Colorado Health Eye Center, Aurora, USA. DESIGN: Retrospective case series. METHODS: Video recordings were taken of eyes having phacoemulsification with or without angle surgery. From the videos, still images of the angle before and after cataract surgery were obtained. Four glaucoma physicians independently reviewed the images and were masked to whether the images presented side-by-side were captured before or after cataract surgery. The reviewers used a 5-point rating scale to assess which of the 2 presented images showed the best visualization of the angle. Patient and ocular characteristics were analyzed to determine predictive factors for better view before or after phacoemulsification. RESULTS: Twenty side-by-side comparisons (20 eyes of 20 patients) were reviewed and rated. The mean rating of all surgeons was 2.93, nearing the "3-no difference" response. The most common response was "3-no difference" between each photograph (32.5%), followed by "4-post phacoemulsification image somewhat better" (30%), and "2-pre-phacoemulsification image somewhat better" (27.5%). No ocular characteristic, including anterior chamber depth, angle pigmentation, or cumulative dissipation energy, was found to be predictive of surgeon preference. CONCLUSION: In combination phacoemulsification and angle-based glaucoma procedures, there appears to be no significant angle visualization difference whether the surgeon chooses to complete angle surgery before or after phacoemulsification; therefore, the decision of surgical order should rely on surgeon preference.

Outcomes of Kahook Dual Blade Goniotomy with and without Phacoemulsification Cataract Extraction.

PURPOSE: To determine the effectiveness and safety of Kahook Dual Blade (KDB) goniotomy in reducing intraocular pressure (IOP) and medication need in glaucoma patients when combined with phacoemulsification or as a standalone procedure. DESIGN: Retrospective study. PARTICIPANTS: A total of 197 eyes from 143 patients were reviewed. METHODS: Thirty-two eyes underwent KDB goniotomy alone and 165 eyes underwent KDB goniotomy combined with phacoemulsification cataract surgery (phaco-KDB). MAIN OUTCOME MEASURES: Surgical success, defined as IOP reduction of at least 20% from baseline at 12 months, and/or reduction of at least 1 glaucoma medication. RESULTS: At 12 months, the success rate was 71.8% for the phaco-KDB group and 68.8% for the KDB-alone group. In the phaco-KDB group at 12 months (n = 124), mean IOP was significantly reduced from 16.7 (standard error [SE] 0.4) mmHg on 1.9 (SE 0.1) medications to 13.8 (SE 0.4) mmHg on 1.5 (SE 0.1) medications. In the KDB-alone group at 12 months (n = 16), mean IOP was significantly reduced from 20.4 (SE 1.3) mmHg on 3.1 (SE 0.2) medications to 14.1 (SE 0.9) mmHg on 2.3 (SE 0.4) medications. The most common complications were transient hyphema (17.3% at day 1) and IOP spike >10 mmHg from baseline at 1 week (10.2%). LogMAR visual acuity at 12 months was unchanged from baseline in the KDB-alone group (0.218 [SE 0.07] and 0.306 [SE 0.09], respectively, P = 0.244) and significantly improved in the phaco-KDB group (0.184 [SE 0.02] and 0.340 [SE 0.03], P < 0.001). CONCLUSIONS: Goniotomy with the KDB has a favorable safety profile and is an effective procedure at reducing IOP and medication burden as a standalone procedure or combined with phacoemulsification.