ABSTRACT
PURPOSE: Efficacy and safety evaluation of Kahook Dual Blade (KDB) goniotomy vs iStent inject implantation. MATERIALS AND METHODS: Retrospective study in patients that underwent goniotomy with KDB or iStent inject implantation, stand-alone or combined with cataract surgery. Main outcome parameters were intraocular pressure (IOP), number of glaucoma medications, proportion of eyes achieving >20% IOP reduction and number of eyes with postoperative IOP <19 mmHg at last follow-up. RESULTS: A total of 29 patients (30 eyes) were included in the iStent inject group and 30 patients (32 eyes) in the KDB group. Mean follow-ups were 20.9±6.5 (KDB-alone) to 29.5±7.6 (phaco-iStent inject) months. Pre- and post-operative IOPs were 22.2±5.8 mmHg and 15.9±4.3 mmHg (P=0.004) in the KDB-alone, 24.2±6.8 mmHg and 16.2±6.7 mmHg (P=0.001) in the phaco-KDB, 20.6±5.4 mmHg and 20.9±6.8 mmHg (P=0.598) in the iStent inject-alone as well as 20.9±5.5 mmHg and 15.6±3.4 mmHg (P=0.003) in the phaco-iStent inject subgroups. No major complications occurred. CONCLUSION: All KDB and iStent subgroups except the stand-alone iStent inject subgroup showed a clinically significant IOP-lowering effect as a stand-alone procedure or combined with cataract surgery. Goniotomy with KDB in this setting seems to offer an advantageous IOP reduction compared to iStent inject.
ABSTRACT
PURPOSE: The purpose of this study was to evaluate frequency, safety, and efficacy of needling in patients that underwent XEN Gel Stent implantation. METHODS: Retrospective case review of 19 eyes of 57 consecutive patients (61 eyes) with primary open-angle glaucoma or pseudoexfoliative glaucoma that previously underwent implantation of XEN45 alone or in combination with cataract surgery followed by needling procedure with 5-FU. Success was defined at 2 IOP levels: ≤21 mm Hg and ≤15 mm Hg, with or without additional glaucoma medications. Treatment failure was defined as IOP>21 mm Hg or <5 mm Hg, need for additional glaucoma surgery or loss of light perception. RESULTS: Totally 19 of 61 eyes that underwent XEN gel implantation had subsequent needling and were included. Preneedling IOP was 26.2±9.5 and postneedling IOP at last follow-up 15.4±3.7 mm Hg (P=0.0001). Overall success rates of 17 (90%) and 13 eyes (69%) were observed at the ≤21 mm Hg and ≤15 mm Hg level, respectively. Preneedling and postneedling visual acuity and number of medications remained unchanged (P>0.05). Two eyes (10%) were categorized as treatment failures. No major complications occurred. Mean follow-up was 203.8±142.2 (range, 22 to 456) days. CONCLUSIONS: Needling revision following XEN gel stent implantation showed a good IOP-lowering effect without significant increase in number of antiglaucoma medications, decrease in visual acuity, nor any major complications. Further studies with long-term follow-up and a larger number of patients are needed to fully assess the safety and efficacy of this procedure.
Subject(s)
Exfoliation Syndrome/surgery , Gels/administration & dosage , Glaucoma Drainage Implants , Glaucoma/surgery , Stents , Aged , Aged, 80 and over , Female , Fluorouracil/therapeutic use , Glaucoma/physiopathology , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Retrospective Studies , Visual Acuity/physiologyABSTRACT
PURPOSE: The purpose of this study is to present a case of cystoid macular edema (CME) as a potential complication following uncomplicated stand-alone Kahook Dual Blade (KDB) goniotomy in a patient with pseudoexfoliative glaucoma. METHODS: A 71-year-old woman who developed CME following KDB goniotomy subsequently treated with topical nonsteroidal anti-inflammatory (NSAID) therapy. RESULTS: The CME successfully regressed following a standard course of topical NSAID therapy. CONCLUSIONS: This case report describes the first case of CME following uneventful stand-alone KDB goniotomy and highlights the importance of postoperative topical NSAID therapy with regard to both prophylaxis and treatment.
