Impact of Surgical Sequence on Outcomes of Combined Phacoemulsification and Kahook Dual Blade KDB Goniotomy: A 1-Year Prospective Comparative Study.

Purpose: To compare the effect of surgical sequence during combined excisional KDB goniotomy using the Kahook Dual Blade (KDB) and phacoemulsification. Methods: In this prospective comparative randomized cohort we included patients that underwent combined phacoemulsification and excisional KDB goniotomy with KDB. Eye were randomized into 2 groups: group PG underwent phacoemulsification followed by KDB goniotomy and GP KDB followed by phacoemulsification. Results: A total of 47 patients (59 eyes) were included: 27 eyes (46%) in group PG and 32 eyes (54%) in GP. Post-operative efficacy outcomes were comparable for IOP, number of medications, decrease in IOP at all the follow-up periods regardless of surgical sequence. Post-operative IOP and number of medications significantly decreased in both groups. Surgical success was achieved in 82% and 73% of eyes at 6- and 12-month follow-up respectively. Postoperative hyphema at day 1 was more frequent in group PG (52% vs. 19%, p=0.008). This difference did not reach statistical significance at day 7 (26% vs. 13%, p=0.16). Conclusion: Combined Phacoemulsification-KDB KDB goniotomy has a good safety and efficacy profile. If KDB goniotomy is performed before phacoemulsification, the occurrence of early postoperative hyphema is significantly lower without affecting surgical success in terms of IOP decrease and reduction in glaucoma medication.