24-month outcomes of a combined 180-degree phacogoniotomy with KDB procedure

Abstract

Purpose We aimed to evaluate the 24-month efficacy and safety of combined 180-degree phacogoniotomy with Kahook Dual Blade (KDB) in patients with various forms of glaucoma. Methods This retrospective, single-centre study included 66 eyes from 66 patients who underwent combined phacogoniotomy with KDB surgery at Rochdale Infirmary, UK, between November 2021 and January 2023. Patients with moderate-to-advanced open-angle, secondary, or narrow-angle glaucoma were included. Primary outcomes were changes in mean intraocular pressure (IOP) and number of IOP-lowering medications from baseline to 24 months. Secondary outcomes included surgical success, defined according to the criteria of Dorairaj et al. and the American Academy of Ophthalmology (AAO) criteria. Results Mean IOP significantly decreased from 19.4 ± 6.6 mmHg at baseline to 14.1 ± 4.3 mmHg at 24 months, representing a mean reduction of 5.3 mmHg (27%) (p < 0.0001). The mean number of IOP-lowering medications was reduced from 3.0 ± 0.7 to 1.7 ± 1.2 at 24 months, a mean reduction of 1.3 medications (43%) (p < 0.0001). At 24 months, 92% of eyes achieved success by Dorairaj’s criteria, and 76% achieved qualified success and 19% absolute success according to AAO standards. Visual acuity improved slightly but not significantly. Conclusion Combined 180-degree phacogoniotomy with KDB provides a significant and sustained 24-month reduction in intraocular pressure and medication burden, with a favourable safety profile. These findings support phacogoniotomy with KDB as an effective minimally invasive option for patients with coexisting cataract and glaucoma.