Analysis of the 36-month efficacy and safety of Kahook dual blade goniotomy combined with phacoemulsification in Chinese patients with open-angle glaucoma.

purposeTo evaluate the efficacy and safety of Kahook dual blade (KDB) goniotomy combined with phacoemulsification for open-angle glaucoma in Chinese patients.

methodsWe retrospectively enrolled 78 Chinese patients (100 eyes) with open-angle glaucoma who underwent KDB goniotomy combined with phacoemulsification at the Third People's Hospital of Dalian, Liaoning Province, China, between September 2021 and December 2024, of whom 63 eyes had primary open-angle glaucoma (POAG) and 37 eyes had pseudoexfoliation glaucoma (PXFG). Intraocular pressure (IOP), the number of glaucoma medications used preoperatively and at 1 day, 1 week, 1 month, 3, 6, 12, and 36 months postoperatively, surgical success rates, and surgical complications were recorded. Surgical success was defined as: Criterion A (IOP reduction ≥ 20% with IOP ≤ 21 mmHg), Criterion B (IOP reduction ≥ 20% with IOP ≤ 18 mmHg), and Criterion C (IOP reduction ≥ 20% with IOP ≤ 15 mmHg).

resultsThe mean IOP reduced from 25.25 ± 6.54 mmHg at baseline to 14.09 ± 3.48 mmHg at 36 months (P < 0.01). The number of medications decreased from 3.0 (2.0, 4.0) to 1.0 (0.0, 2.0) at 36 months (P < 0.01). Surgical success rates at 36 months, defined by Criteria A, B, and C, were 76.32%, 67.11%, and 48.68%. The mean IOP reduced from 24.57 ± 5.71 mmHg at baseline to 14.83 ± 3.35 mmHg at 36 months for POAG (P < 0.01) and from 26.41 ± 7.70 mmHg at baseline to 12.90 ± 3.40 mmHg at 36 months for PXFG (P < 0.01).The number of medications decreased from 3.0 (2.0, 4.0) to 1.0 (0.0, 2.0) for POAG (P < 0.01) and from 3.0 (2.0, 4.0) to 0.0 (0.0, 1.0) for PXFG (P < 0.01) at 36 months. Between the two groups, IOP showed no statistical difference at baseline, 3 months, and 36 months (P > 0.05). At 1 day, 1 week, 1 month, 6 months, 12 months, and 24 months, IOP in the PXFG group was significantly lower than that in the POAG group (P < 0.05). From 3 months to 36 months, the number of medications in the PXFG group was significantly lower than that in the POAG group (P < 0.05). Surgical success rates at 36 months according to Criterion A were 72.34% in POAG and 82.76% in PXFG (P = 0.127); according to Criterion B, 59.57% vs. 79.31% (P = 0.087); and according to Criterion C, 42.55% vs. 62.07% (P = 0.036). Twenty-four-hour IOP fluctuations at 12 months were 4.02 ± 2.01 mmHg in POAG and 3.69 ± 1.31 mmHg in PXFG, both significantly decreased compared with baseline (10.02 ± 3.58 mmHg and 10.39 ± 3.32 mmHg, respectively; P < 0.01 for both groups). Common surgical complications included hyphema and IOP spike.

conclusionsKDB goniotomy combined with phacoemulsification was safe and effectively reduced IOP and the medication burden in patients with POAG and PXFG. In the first and second year, significantly lower IOP was noted in PXFG compared with POAG.