VAULT: vault accuracy using deep learning technology: new image-based artificial intelligence model for predicting implantable collamer lens postoperative vault.

PURPOSE: To develop an accurate deep learning model to predict postoperative vault of phakic implantable collamer lenses (ICLs). SETTING: Parkhurst NuVision LASIK Eye Surgery, San Antonio, Texas. DESIGN: Retrospective machine learning study. METHODS: 437 eyes of 221 consecutive patients who underwent ICL implantation were included. A neural network was trained on preoperative very high-frequency digital ultrasound images, patient demographics, and postoperative vault. RESULTS: 3059 images from 437 eyes of 221 patients were used to train the algorithm on individual ICL sizes. The 13.7 mm size was excluded because of insufficient data. A mean absolute error of 66.3 µm, 103 µm, and 91.8 µm were achieved with 100%, 99.0%, and 96.6% of predictions within 500 µm for the 12.1 mm, 12.6 mm, and 13.2 mm sizes, respectively. CONCLUSIONS: This deep learning model achieved a high level of accuracy of predicting postoperative ICL vault with the overwhelming majority of predictions successfully within a clinically acceptable margin of vault.

Solving STODS-Surgical Temporary Ocular Discomfort Syndrome.

The term STODS (Surgical Temporary Ocular Discomfort Syndrome) has been coined to describe the ocular surface perturbations induced by surgery. As one of the most important refractive elements of the eye, Guided Ocular Surface and Lid Disease (GOLD) optimization is fundamental to success in achieving refractive outcomes and mitigating STODS. Effective GOLD optimization and the prevention/treatment of STODS requires an understanding of the molecular, cellular, and anatomic factors that influence ocular surface microenvironment and the associated perturbations induced by surgical intervention. By reviewing the current understanding of STODS etiologies, we will attempt to outline a rationale for a tailored GOLD optimization depending on the ocular surgical insult. With a bench-to-bedside approach, we will highlight clinical examples of effective GOLD perioperative optimization that can mitigate STODS' deleterious effect on preoperative imaging and postoperative healing.

Spherical Aberration of Cataractous Eyes and Its Relationship With Age, Ocular Biometry, and Various IOL Platforms.

PURPOSE: To determine the median spherical aberration (SA) of the cataractous population, how it relates to biometry, and the theoretical effect of different intraocular lens (IOL) platforms. METHODS: A retrospective chart review of patients undergoing cataract surgery evaluation with a high quality Pentacam (Oculus Optikgeräte GmbH) were included. Age, gender, Q-value, mean total SA, higher order aberration root mean square wavefront error, and equivalent keratometry were collected from the Holladay report and axial length and anterior chamber depth (ACD) from the IOLMaster 700 (Carl Zeiss Meditec AG). RESULTS: Data from 1,725 eyes of 999 patients were collected. SA had a median of 0.37 µm (95% confidence interval: 0.36 to 0.38. Age (r = .136, P < .001), Q-factor (r = .743, P < .001), and higher order aberration root mean square wavefront error (r = .307, P < .001) were positively correlated with SA. Average equivalent keratometry (r = -.310, P < .001) was negatively correlated with SA. Axial length (r = -0.037, P = .120) and ACD (r = .004, P = .856) had no association with SA. Up to 1,499 (86.9%) theoretically had SA moved closer to zero with IOLs that had negative SA. Up to 102 (5.9%) had SA theoretically worsened. CONCLUSIONS: SA is not normally distributed, suggesting that there may be no "average" SA that IOLs should aim to correct. Patients might benefit from tailoring IOL choice to individual SA. Without access to SA data, eyes with steeper average keratometry or younger patients may have less SA, which could influence IOL choice. [J Refract Surg. 2023;39(2):89-94.].

Effect of Selective Laser Trabeculoplasty on the Fellow Eye.

Aim: Determine if selective laser trabeculoplasty (SLT) affects the fellow eye's intraocular pressure (IOP). Materials and methods: A retrospective review of 76 pairs of eyes from 76 adult glaucoma patients who underwent SLT in one eye with at least 2 months between treatments were evaluated for IOP and medication reduction in the untreated fellow eye. Success was defined as ≥20% IOP reduction or ≥1 medication reduction without any additional IOP lowering procedures or medication. The primary outcome measures were success, IOP, and medication reduction in the untreated fellow eye at 6 months. Results: At 6 months after SLT treatment, 48.7% (38/76) treated eyes and 36.8% (28/76) untreated fellow eyes met success criteria. IOP reduction in the treated eye was 2.6 ± 5.8 (14.1%; p < 0.002) and 0.8 ± 4.3 (5.1%, p = 0.122) in the fellow eye. The fellow eye was significantly more likely to meet success criteria if the treated eye was successful [odds ratio (OR): 6.00, 95% confidence interval (CI) (2.11-17.06), p < 0.002]. Conclusion: After a unilateral treatment with SLT, over one-third of the fellow eyes experienced either ≥20% IOP reduction or medication reduction. Additionally, fellow eyes were six times as likely to meet success criteria if this was observed in the treated eye. These findings may support the proposed biochemical mechanism for the therapeutic action of SLT. Clinical significance: The implication for clinicians is that SLT treatment in one eye may allow the fellow eye to benefit and provide a prediction on the fellow eye's response without subjecting both eyes to the rare but present complications of SLT. How to cite this article: Hirabayashi M, Mellencamp E, Duong S, et al. Effect of Selective Laser Trabeculoplasty on the Fellow Eye. J Curr Glaucoma Pract 2023;17(4):175-177.

Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification.

Aim: To identify factors that were significant predictors of Kahook Dual Blade (KDB) excisional goniotomy outcomes. Materials and methods: One hundred and thirty-two eyes from 99 adult glaucoma patients who underwent combined KDB and phacoemulsification (KDB-phaco) with a minimum 6-month follow-up were assessed for baseline patient characteristics to determine correlation to the success of KDB-phaco at 6 and 12 months postoperatively. Success was defined as ≥20% intraocular pressure (IOP) reduction or ≥1 medication reduction as well as IOP ≤18 mm Hg without any additional IOP-lowering procedures after KDB-phaco. Results: 63.6% (84/132) and 46.1% (41/89) of cases were successful at the 6- and 12-month follow-ups, respectively. KDB-phaco reduced patient's preoperative IOP (in mm Hg) from 17.6 ± 4.6 to 14.9 ± 3.2 at 6 months (15.3%, p < 0.001) and 15.4 ± 4.7 at 12 months (12.5%, p = 0.001). KDB-phaco reduced patient's preoperative IOP-lowering medications from 2 ± 1.2 to 1.1 ± 1.2 at 6 months (45%, p < 0.001) and 1.32 ± 1.3 at 12 months (34%, p < 0.001). At 6 months, patients on >1 IOP lowering medication had a greater chance of meeting our success criteria (p = 0.037). Visually significant postoperative hyphema was not associated with the use of anticoagulation (p = 0.943) but was significantly associated with postoperative day 1 IOP ≤ 10 mm Hg (p = 0.011). Conclusion: Patients who underwent KDB-phaco significantly reduced their IOP and medication burden at both 6 and 12 months compared with their baseline preoperative values. KDB-phaco outcome was associated with higher baseline IOP-lowering medications and increased rate of hyphema was associated with lower postoperative day 1 IOP, regardless of anticoagulation status. Age, ethnicity, prior laser trabeculoplasty, type and severity of glaucoma, and baseline preoperative IOP were not associated with surgical success. Clinical significance: Patients with a higher number of baseline medications may experience a greater probability of success following KDB-phaco. How to cite this article: Pratte EL, Cho J, Landreneau JR, et al. Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification. J Curr Glaucoma Pract 2022;16(1):47-52.

Response to netarsudil in goniotomy-treated eyes and goniotomy-naïve eyes: a pilot study.

PURPOSE: To compare the intraocular pressure (IOP)-lowering effects of netarsudil on goniotomy-treated eyes versus goniotomy-naïve control eyes. METHODS: Retrospective cohort study of 70 eyes from 49 adult glaucoma patients treated with netarsudil. Thirty-five eyes received sectoral goniotomy using Kahook Dual Blade (KDB) combined with cataract surgery with minimum of 3 months prior to netarsudil treatment. Thirty-five eyes in the control cohort received only cataract surgery prior to netarsudil. Primary outcome was treatment success, defined as ≥ 20% decrease in IOP at minimum 1 month follow-up. Secondary outcome measures included percent of IOP reduction, adverse effects of medication, medication discontinuation rate, and relationship between KDB goniotomy response and netarsudil response. RESULTS: Eighty-three percent of KDB-treated eyes achieved netarsudil treatment success compared to 54% of control eyes (P = .012). IOP reduction was 30.3 ± 16.2% (IQR 21-38%) in KDB-treated eyes and 19.4 ± 12.4% (IQR 9.2-30.8) in control eyes (P = .007). History of prior KDB increased the likelihood of success to netarsudil treatment compared to eyes without prior KDB, regardless of surgical response to KDB (odds ratio 4.51, 95% CI 1.34-15.14, P = .015). The overall rate of adverse effects of netarsudil was 42%, most commonly reported as conjunctival hyperemia, allergy, and blurred vision. CONCLUSIONS: Netarsudil had a greater IOP-lowering effect in eyes treated with prior goniotomy and may serve as a promising adjunctive ocular hypotensive agent to further reduce IOP in eyes with prior goniotomy.

Outcomes of initial and repeat micro-pulse transscleral cyclophotocoagulation in adult glaucoma patients.

BACKGROUND: Micro-pulse transscleral cyclophotocoagulation (MP-TSCPC) has continued to gain popularity as a treatment in adult glaucoma patients. Thus far there is limited evidence reporting the efficaciousness and safety of retreatment. OBJECTIVE: To evaluate safety and efficacy of primary and repeat MP-TSCPC procedures. METHODS: Thirty-four of 67 eyes who failed to achieve target IOP from initial MP-TSCPC underwent repeat MP-TSCPC and followed for a minimum of 6 months. All treatments were performed using the laser power of 2000 or 2250 mW, duration of 100-200 s, and a velocity 16-20 s per hemisphere swipe. Success criteria were defined as intraocular pressure (IOP) reduction of greater than 20% from baseline or any medication reduction without additional glaucoma procedures at 6 months after repeat MP-TSCPC. The 6-month success rate after repeat MP-TSCPC was also compared to that of initial MP-TSCPC in the same group of eyes. RESULTS: Mean baseline IOP before the repeat MP-TSCPC was 23.0 + /- 5.3 on 3.0 + /- 1.4 medications. At 6 months, mean post-op IOP was 18.2 + /- 5.4 (21.9% reduction, p < 0.002), with mean medication staying relatively the same (p = .976). Success rate was increased from 23.5% to 44.1% with the repeat procedure compared to that of initial procedure (p = 0.123). Mean IOP reduction was also greater after repeat MP-TSCPC (18.7%, p < 0.002) when compared to initial MP-TSCPC (10.4%). No adverse events occurred. CONCLUSIONS: MP-TSCPC is a safe and effective non-invasive means to lower IOP in a variety of glaucoma patients. While over 50% (34/67) of eyes required repeat MP-TSCPC, repeat treatment resulted in greater success rates and IOP reduction without any adverse events when using the total energy between 112 and 150 J.

Relationship between selective laser trabeculoplasty and excisional goniotomy outcomes in glaucomatous eyes.

OBJECTIVE: To evaluate the relationship between intraocular pressure (IOP)-lowering success with selective laser trabeculoplasty (SLT) and Kahook Dual Blade (KDB) goniotomy in eyes with glaucoma. DESIGN: Retrospective chart review. PARTICIPANTS: 30 eyes of 24 patients undergoing phacoemulsification combined with a KDB with 6 months follow-up and who had previously undergone SLT in the same eye. METHODS: Data collected from electronic health records included demographic and glaucoma status, IOP and IOP-lowering medication after SLT and KDB. SLT and KDB success were defined as IOP reduction ≥20% or medication reduction ≥1 at 2 and 6 months, respectively. MAIN OUTCOME: Association between SLT success and KDB success. RESULTS: Overall, SLT was successful in 17 of 30 eyes (56.7%) at 2 months, and KDB was successful in 18 of 30 eyes (60%) at 6 months. Nine of 17 eyes (52.9%) with prior successful SLT had successful subsequent KDB, whereas 9 of 13 (69.2%) with prior unsuccessful SLT had successful KDB. There was no significant relationship between SLT and KDB outcome in these 30 eyes (p = 0.465 by Fisher's exact test). CONCLUSION: No relationship between success of SLT and subsequent KDB was observed. However, patients with history of failed SLT still benefited from subsequent KDB.

Comparison of Outcomes for Laser Trabeculoplasty after Kahook Dual Blade Goniotomy Versus in Goniotomy-Naive Eyes.

INTRODUCTION: This was a comparison of laser trabeculoplasty (LTP) outcomes in eyes with prior Kahook Dual Blade (KDB) goniotomy versus in goniotomy-naive control eyes. METHODS: This was a retrospective matched comparative case series. We identified a cohort of patients undergoing LTP between February 2017 and July 2020 at University of Missouri. Patients were grouped by history of KDB goniotomy versus goniotomy-naivety as a control group. Inclusion criteria included age at least 18 years, minimum of 6 months follow-up after LTP, and minimum period of 6 months between KDB goniotomy and LTP. All KDB procedures were combined with uncomplicated phacoemulsification. Patients who had any additional intraocular pressure (IOP)-lowering procedures between KDB goniotomy and LTP were excluded. Patients in the control group received a single LTP procedure. Primary outcome consisted of the comparison of LTP success, defined as IOP reduction of at least 20% or reduction of glaucoma medications from pre-LTP baseline. Secondary outcomes included IOP and medication reduction from pre-LTP baseline. RESULTS: Twenty-one eyes of 19 patients with history of KDB goniotomy and 42 eyes of 36 control patients without previous angle or laser procedures were included. Baseline characteristics including age, gender, ethnicity, type and severity of glaucoma, baseline IOP, and baseline medications were matched between groups. The LTP success rate was higher in the control group, but was not statistically significant (64% vs 57%, p = 0.58). IOP reduction was only significant in the control eyes (2.50 ± 4.0 mmHg, p = 0.01 vs 2.35 ± 4.7 mmHg, p = 0.08). The number of glaucoma medications was not significantly reduced in either group. CONCLUSION: LTP may have a limited IOP- and medication-lowering effect in eyes with a history of KDB goniotomy compared to goniotomy-naive eyes.

Effect of Excisional Goniotomy with the Kahook Dual Blade (KDB) on Surgically Induced Astigmatism.

PURPOSE: To determine the effect of Kahook Dual Blade goniotomy with phacoemulsification (Phaco-KDB) compared to phacoemulsification alone (Phaco) on surgically induced astigmatism (SIA). DESIGN: Prospective study. PARTICIPANTS: Forty eyes of 28 patients treated with Phaco-KDB and 20 eyes of 13 patients treated with Phaco between 12/27/16 and 7/23/19 with a minimum 1 month follow-up were prospectively enrolled. METHODS: Corneal astigmatism was assessed pre- and post-operatively using the simulated K (simK) values from the Pentacam Holladay report. MAIN OUTCOME MEASURES: SIA was compared between Phaco-KDB and Phaco groups using mean magnitude SIA, rate of ≥0.50 D SIA, and SIA centroids. RESULTS: The difference in mean magnitude SIA was not statistically significant between Phaco-KDB and Phaco (mean = 0.28 D and 0.25 D, respectively, P = 0.621). The difference in the rate of ≥0.50 D SIA was not statistically significant between Phaco-KDB and Phaco (11.6% and 10.0%, respectively, P = 1.00). The SIA centroid for Phaco-KDB was 0.05 D @ 51° ± 0.40 D and 0.07 D @ 3° ± 0.32 D for Phaco. CONCLUSION: Neither the mean magnitude SIA nor the rate of astigmatic change ≥0.50 D was significantly different between Phaco-KDB and Phaco groups. SIA centroids between groups showed comparable and negligible effect on corneal astigmatism. KDB combined with phacoemulsification may not significantly affect SIA compared to phacoemulsification alone based on postoperative topography and is likely an astigmatically neutral procedure.

Predictive Factors for Outcomes of Selective Laser Trabeculoplasty.

We sought to  determine predictive factors for selective laser trabeculoplasty (SLT) outcome. 252 eyes from 198 adult patients with open-angle glaucoma who underwent SLT between July 2016 and February 2018 with a minimum 6 month follow up were reviewed. We defined success as ≥20% IOP reduction or ≥1 medication reduction without an IOP lowering procedure. We also evaluated the relationship of these factors to postoperative IOP elevation >5 mmHg (IOP spikes). Our primary outcome measure was association between age, type and severity of glaucoma, pigmentation of the trabecular meshwork (PTM), total energy delivered, and baseline intraocular pressure (IOP) with success. At 2 and 6 months, 33.6% (76/226) and 38.5% (97/252) of eyes met success criteria respectively. Baseline IOP > 18 mmHg was significantly associated with success both at 2 and 6 months, reducing IOP by 5.4 ± 5.3 mmHg (23.7% reduction), whereas those with lower baseline remained at -0.7 ± 4.6 mmHg (4.9% increase) at 6 months (P < 0.001). No other baseline characteristics significantly predicted success or IOP spikes. Patients with higher baseline IOPs had greater success rates and mean IOP reduction at both 2 and 6 months following SLT. Age, type and severity of glaucoma, PTM, or total energy delivery had no association with procedural success or IOP spikes. Patients with higher baseline IOP may experience greater lowering of IOP after SLT. However, SLT may be equally successful for patients with a variety of other characteristics.

Comparison Of Surgical Outcomes Of 360° Circumferential Trabeculotomy Versus Sectoral Excisional Goniotomy With The Kahook Dual Blade At 6 Months.

PURPOSE: To compare reductions in intraocular pressure (IOP) and IOP-lowering medication use following sectoral excisional goniotomy with the Kahook Dual Blade (KDB) or 360° trabeculotomy (via either Trab360 or gonioscopy-assisted transluminal trabeculotomy [GATT]) in eyes with open-angle glaucoma (OAG) undergoing phacoemulsification cataract surgery. METHODS: A retrospective review was conducted to collect data from adult subjects with early to advanced primary or secondary OAG undergoing phacoemulsification combined with either KDB or 360° trabeculotomy (Trab360 or GATT) between August 1, 2016 and July 30, 2018 for which 6-month follow-up was available. Data collected included IOP, glaucoma medications, adverse events, and additional IOP-lowering procedures. The primary outcome measure was surgical success (≥20% IOP or ≥1 medication reduction without additional IOP-lowering procedures) at 6 months. RESULTS: Data were collected from 74 eyes of 61 subjects undergoing KDB excisional goniotomy and 27 eyes of 25 subjects undergoing 360° trabeculotomy (19 eyes of 17 subjects undergoing Trab360 and 8 eyes of 8 subjects undergoing GATT). At 6 months, 81.7% (58/71) of KDB eyes and 84.6% (22/26) of 360° trabeculotomy eyes achieved surgical successes (P=0.737). Mean IOP reductions and medication reductions were similar between groups at 6 months. However, more eyes undergoing KDB than Trab360/GATT achieved target IOP ≤18 mmHg (80.0% [56/70] vs 59.3% [16/27], P=0.040) and ≤15 mmHg (61.4% [43/70] vs 25.9% [7/27], P=0.003) without further IOP-lowering interventions at 6 months. The nature and frequency of adverse events were similar between groups. CONCLUSIONS: Both KDB and Trab360 or GATT procedures similarly lowered both IOP and the need for IOP-lowering medications during the first 6 postoperative months. More eyes undergoing KDB excisional goniotomy than 360° trabeculotomy attained target IOP ≤18 mmHg and ≤15 mmHg at 6 months. A full 360° trabecular bypass may not be necessary to achieve maximal efficacy from this class of micro-invasive glaucoma procedures.

Comparison Of Surgical Outcomes Between Excisional Goniotomy Using The Kahook Dual Blade And iStent Trabecular Micro-Bypass Stent In Combination With Phacoemulsification.

PURPOSE: To compare 6-month surgical outcomes of patients who underwent phacoemulsification (Phaco) combined with iStent implantation (iStent) versus excisional goniotomy using Kahook Dual Blade (KDB). METHODS: Retrospective comparative case series of 58 iStent-Phaco eyes and 44 KDB-Phaco eyes operated upon by a single surgeon between 2016 and 2018. Preoperative, intraoperative, and postoperative intraocular pressure (IOP) and IOP-lowering medication data were collected. The primary outcome was the proportion of eyes using ≥1 fewer IOP-lowering medication at Month 6 while maintaining IOP ≤ 18 mmHg. RESULTS: Baseline IOP was 17.2 (standard error 0.7) in the KDB-Phaco group using a mean of 1.9 (0.2) medications; at Month 6, mean IOP was 14.8 mmHg P=0.002) on 1.0 (0.2) medications (P<0.002). Baseline IOP was 16.7 (0.4) in the iStent-Phaco group using a mean of 1.4 (0.1) medications; at Month 6, mean IOP was 14.2 mmHg (P<0.002) on 1.4 (0.1) medications P=0.374). Changes in IOP and medications were not significantly different between groups (P>0.05). Significantly more KDB-Phaco eyes than iStent-Phaco eyes (43.2% vs 17.2%, P=0.004) were using ≥1 fewer medications while maintaining IOP ≤18 mmHg at Month 6. Adverse events were uncommon and similar in nature and frequency between groups with the exception that more KDB-Phaco eyes than iStent-Phaco eyes (8 [18.2%] versus 1 [1.7%]) experienced an IOP elevation presumed to be related to steroid use. CONCLUSION: KDB-Phaco and iStent-Phaco provided comparable IOP and medication reductions. The proportion of eyes able to discontinue 1 or more medications while maintaining IOP ≤ 18 mmHg was significantly greater in eyes undergoing KDB-Phaco.

Reversal of Toric Intraocular Lens-corrected Corneal Astigmatism after Kahook Dual Blade Goniotomy.

A 79-year-old man underwent phacoemulsification (phaco) with TORIC intraocular lens (IOL) insertion combined with Kahook dual blade (KDB) goniotomy of the right eye several months after a stand-alone phaco in the fellow eye. He had significant against-the-rule astigmatism in both eyes (2.41D @ 10° right, 2.40D @ 160° left) preoperatively. Postoperatively, nearly all corneal astigmatism disappeared in the right eye (0.60D @ 37°), while it remained the same in the left eye (2.00D @ 167°). Ophthalmologists should be aware that KDB may have an unreported effect of altering corneal astigmatism, which should be considered when inserting TORIC IOL. HOW TO CITE THIS ARTICLE: Hirabayashi MT, McDaniel LM, et al. Reversal of Toric Intraocular Lens-corrected Corneal Astigmatism after Kahook Dual Blade Goniotomy. J Curr Glaucoma Pract 2019;13(1):42-44.

Comparison of successful outcome predictors for MicroPulse® laser trabeculoplasty and selective laser trabeculoplasty at 6 months.

Purpose: To identify and compare factors predictive of successful outcome for MicroPulse® laser trabeculoplasty (MLT) and selective laser trabeculoplasty (SLT). Methods: 50 MLT-treated eyes and 50 SLT-treated eyes of open-angle glaucoma patients were reviewed for baseline characteristics, pre- and postoperative IOP and medications, and adverse events including postoperative IOP elevation >5 mmHg (IOP spikes) through 6 months of follow-up. Success was defined as ≥20% IOP reduction or ≥1 medication reduction without additional IOP lowering procedures at 6 months follow-up. Results: MLT and SLT had similar success rates (44% vs 40%, P=0.983). Older age predicted success for SLT (P=0.013) but not MLT (P=0.154). Both MLT and SLT led to greater IOP lowering in patients with baseline IOP >18 mmHg, but only for SLT did baseline IOP have a significant association with success (P=0.035 vs P=0.983). Number of laser shots was associated with success in MLT (P=0.031) but not in SLT (P=0.970). Glaucoma severity and pigmentation of the trabecular meshwork (PTM) were not associated with rate of success for either group. The rate of IOP spikes was significantly (P=0.022) higher in the SLT group (10%) compared to none in the MLT group. No other complications or visually significant adverse events occurred in either group. Conclusion: Although MLT and SLT resulted in similar success rates, older age and higher baseline IOP predicted success for SLT while MLT was equally efficacious regardless of these factors. Glaucoma severity and PTM were not associated with success of either laser procedures. 10% of SLT patients experienced IOP spike post procedure, whereas none in the MLT group did. MLT may be a safer alternative to SLT that is effective in lowering IOP and need for medications for a wider variety of patients with open angle glaucoma.

Outcome of phacoemulsification combined with excisional goniotomy using the Kahook Dual Blade in severe glaucoma patients at 6 months.

PURPOSE: The aim of this study was to describe 6-month rates of achieving target IOP without requiring additional glaucoma surgery after excisional goniotomy using the Kahook Dual Blade combined with phacoemulsification (phaco-KDB) in patients with severe-stage glaucoma. METHODS: Retrospective review of 42 eyes from 36 patients with severe glaucoma who received phaco-KDB. Primary and secondary open-angle and combined-mechanism glaucoma were included. Preoperative, intraoperative, and postoperative data were collected through the 6-month follow-up period. The primary outcome was proportion of patients achieving IOP ≤15 mmHg without additional glaucoma procedures. Secondary outcomes were mean change in IOP, reduction of glaucoma medications, additional glaucoma procedures needed, and adverse events. RESULTS: Preoperative baseline mean IOP was 17.1±4.8 mmHg (mean ± SD) and number of medications was 2.4±1.3. At 6 months, 64.3% (27/42) of eyes had achieved IOP ≤15 mmHg without additional glaucoma procedures, 45.2% (19/42) reached this target IOP on fewer medications, and 31.0% (13/42) on no medications. Mean IOP reduction was 2.1±4.67 mmHg (P=0.022) and mean medication reduction was 1.2±1.4 (P≤0.001). Visually significant complications were experienced by 7.1% (3/42) of eyes, and 7.1% (3/42) required additional IOP-lowering procedures within 6 months of surgery. CONCLUSION: Patients with severe-stage open-angle glaucoma achieved significant IOP and medication reductions following phaco-KDB. Notably, about two-thirds of eyes achieved an IOP of ≤15 mmHg at 6 months without additional glaucoma procedures. Complications and need for additional procedures were rare. Phaco-KDB may be an effective and safe alternative to more invasive filtering surgery in many patients with severe glaucoma.