Outcomes of IStent Inject Versus Kahook Dual Blade Surgery in Glaucoma Patients Undergoing Cataract Surgery

Overview

Journal J Glaucoma

Date 2023 Jun 16

PMID 37327470

Authors

Anna Barkander

M A Economou

Gauti Johannesson

Affiliations

Soon will be listed here.

Abstract

Prcis: iStent Inject implantation (iStent) or Kahook Dual Blade goniotomy (KDB) in combination with phacoemulsification have a similar IOP-lowering effect in all stages of glaucoma, and medications are significantly reduced, especially after KDB.

Purpose: To compare the 2-year efficacy and safety of iStent or KDB in combination with phacoemulsification in eyes with mild to advanced open angle glaucoma.

Methods: A retrospective chart review of 153 patients that received iStent or KDB in combination with phacoemulsification at a single center between March 2019 and August 2020. The main outcome parameters at 2 years were: (1) intraocular pressure (IOP)-reduction ≥20%, with a postoperative IOP ≤18 mm Hg, and (2) a reduction of ≥1 medication. Results were stratified by glaucoma grade.

Results: After 2 years, mean IOP was reduced from 20.3±6.1 to 14.2±4.1 mm Hg in the phaco-iStent group ( P <0.001) and from 20.1±6.1 to 14.7±3.6 mm Hg in the phaco-KDB group ( P <0.001). The mean number of medications was reduced from 3.0±0.9 to 2.6±1.1 in the Phaco-iStent group ( P =0.001) and from 2.3±1.0 to 1.5±1.3 in the Phaco-KDB group ( P <0.001). Success regarding IOP-reduction ≥20% with a postoperative IOP ≤18 mm Hg was met by 46% in the phaco-iStent group and by 51% in the phaco-KDB group. A reduction of ≥1 medication was met by 32% in the phaco-iStent group and by 53% in the phaco-KDB group ( P =0.013). Eyes with mild to moderate and advanced glaucoma responded equally well to the success criteria.

Conclusions: iStent and KDB, in combination with phacoemulsification, both lowered IOP effectively in all stages of glaucoma. More medications were reduced after KDB, suggesting that it may be a more effective procedure compared with iStent.

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References

Arriola-Villalobos P, Martinez-de-la-Casa J, Diaz-Valle D, Garcia-Vidal S, Fernandez-Perez C, Garcia-Sanchez J . Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract. Br J Ophthalmol. 2013; 97(10):1250-5. DOI: 10.1136/bjophthalmol-2012-302394. View

Dorairaj S, Kahook M, Williamson B, Seibold L, ElMallah M, Singh I . A multicenter retrospective comparison of goniotomy versus trabecular bypass device implantation in glaucoma patients undergoing cataract extraction. Clin Ophthalmol. 2018; 12:791-797. PMC: 5933398. DOI: 10.2147/OPTH.S158403. View

Falkenberry S, Singh I, Crane C, Haider M, Morgan M, Grenier C . Excisional goniotomy vs trabecular microbypass stent implantation: a prospective randomized clinical trial in eyes with mild to moderate open-angle glaucoma. J Cataract Refract Surg. 2020; 46(8):1165-1171. DOI: 10.1097/j.jcrs.0000000000000229. View

Melancia D, Abegao Pinto L, Marques-Neves C . Cataract surgery and intraocular pressure. Ophthalmic Res. 2015; 53(3):141-8. DOI: 10.1159/000377635. View

Damji K, Konstas A, Liebmann J, Hodge W, Ziakas N, Giannikakis S . Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol. 2006; 90(8):1014-8. PMC: 1857224. DOI: 10.1136/bjo.2006.091447. View

Leske M, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E . Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003; 121(1):48-56. DOI: 10.1001/archopht.121.1.48. View

Ammar D, Seibold L, Kahook M . Preclinical Investigation of Goniotomy Using Four Different Techniques. Clin Ophthalmol. 2020; 14:3519-3525. PMC: 7604930. DOI: 10.2147/OPTH.S281811. View

Clement C, Howes F, Ioannidis A, Shiu M, Manning D . One-year outcomes following implantation of second-generation trabecular micro-bypass stents in conjunction with cataract surgery for various types of glaucoma or ocular hypertension: multicenter, multi-surgeon study. Clin Ophthalmol. 2019; 13:491-499. PMC: 6420788. DOI: 10.2147/OPTH.S187272. View

Pillunat L, Erb C, Junemann A, Kimmich F . Micro-invasive glaucoma surgery (MIGS): a review of surgical procedures using stents. Clin Ophthalmol. 2017; 11:1583-1600. PMC: 5587165. DOI: 10.2147/OPTH.S135316. View

10.

Nichani P, Popovic M, Schlenker M, Park J, Ahmed I . Microinvasive glaucoma surgery: A review of 3476 eyes. Surv Ophthalmol. 2020; 66(5):714-742. DOI: 10.1016/j.survophthal.2020.09.005. View

11.

Lee D, King J, Thomsen S, Hirabayashi M, An J . Comparison Of Surgical Outcomes Between Excisional Goniotomy Using The Kahook Dual Blade And iStent Trabecular Micro-Bypass Stent In Combination With Phacoemulsification. Clin Ophthalmol. 2019; 13:2097-2102. PMC: 6818539. DOI: 10.2147/OPTH.S224109. View

12.

ElMallah M, Seibold L, Kahook M, Williamson B, Singh I, Dorairaj S . 12-Month Retrospective Comparison of Kahook Dual Blade Excisional Goniotomy with Istent Trabecular Bypass Device Implantation in Glaucomatous Eyes at the Time of Cataract Surgery. Adv Ther. 2019; 36(9):2515-2527. PMC: 6822852. DOI: 10.1007/s12325-019-01025-1. View

13.

Widder R, Lappas A, Rennings C, Hild M, Roessler G, Dietlein T . Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification. Graefes Arch Clin Exp Ophthalmol. 2020; 258(11):2483-2487. PMC: 7584552. DOI: 10.1007/s00417-020-04894-3. View

14.

Murakami-Kojima S, Takahashi E, Eguchi-Matsumoto M, Saruwatari J, Nakashima K, Inoue T . Risk factors for intraocular pressure elevation in a six-month period after ab interno trabeculotomy using a Kahook Dual Blade. BMC Ophthalmol. 2022; 22(1):327. PMC: 9338461. DOI: 10.1186/s12886-022-02545-1. View

15.

Civan M, Macknight A . The ins and outs of aqueous humour secretion. Exp Eye Res. 2004; 78(3):625-31. DOI: 10.1016/j.exer.2003.09.021. View

16.

Hirabayashi M, King J, Lee D, An J . Outcome of phacoemulsification combined with excisional goniotomy using the Kahook Dual Blade in severe glaucoma patients at 6 months. Clin Ophthalmol. 2019; 13:715-721. PMC: 6488161. DOI: 10.2147/OPTH.S196105. View

17.

Iwasaki K, Takamura Y, Orii Y, Arimura S, Inatani M . Performances of glaucoma operations with Kahook Dual Blade or iStent combined with phacoemulsification in Japanese open angle glaucoma patients. Int J Ophthalmol. 2020; 13(6):941-945. PMC: 7270257. DOI: 10.18240/ijo.2020.06.13. View

18.

Salinas L, Chaudhary A, Berdahl J, Lazcano-Gomez G, Williamson B, Dorairaj S . Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes. J Glaucoma. 2018; 27(10):849-855. DOI: 10.1097/IJG.0000000000001019. View

19.

Salimi A, Watt H, Harasymowycz P . Three-Year Outcomes of Second-generation Trabecular Micro-bypass Stents (iStent inject) With Phacoemulsification in Various Glaucoma Subtypes and Severities. J Glaucoma. 2020; 30(3):266-275. DOI: 10.1097/IJG.0000000000001716. View

20.

Neuhann R, Neuhann T . Second-generation trabecular micro-bypass stent implantation: Retrospective analysis after 12- and 24-month follow-up. Eye Vis (Lond). 2020; 7:1. PMC: 6953161. DOI: 10.1186/s40662-019-0169-7. View