Abstract
Intraocular pressure defects remain a significant problem in the medical field. Several methods have been employed to help reduce the effect of intraocular pressure (IOP), all of which have their merits and demerits. Considered in this paper are surgery and the Kahook Dual Blade (KDB; Kahook, New World Medical, Inc., Rancho Cucamonga, CA) process invented and tested during previous studies to reduce IOP. This study examines both methods; first, in combination with cataract surgery, and then, separately, to assess their effectiveness in reducing IOP.
Objective
The focus of the research is to establish the effectiveness and safety associated with goniotomy while utilizing the Kahook Dual Blade (KDB) procedure for reducing IOP and bringing down the reliance on hypotensive agents in a variety of glaucoma types, either independently or when combined with phacoemulsification (phaco) within the follow-up duration (four to seven months).
Methods and design
The setting was the outpatient clinics in Al-Maghrabi Hospital in Medina. It involved the use of a retrospective study for the study design. Fifty eyes from a total of 45 patients were reviewed. There was KDB in 10 eyes while KDB was integrated with the cataract surgical procedure in 40 eyes.
The de-identified clinical data have been collected by data collectors, who took into account IOP measurements both postoperatively and preoperatively, types of treatment used, side effects, and whether or not there was additional surgery required during the four to seven months observation period.
Results
Seventy percent of the cases in this research had primary open-angle glaucoma. Additional diagnoses were close-angle, normal-tension, pseudoexfoliative glaucoma, and pigmentary. There was a decline in the value of the mean baseline IOP from the earlier 20.66 mmHg +/- 7.89 (SD) to a staggering 14.66 +/- 3.9 mmHg within the postoperative period (four to seven months) for all 50 eyes, and there was a reduction in hypotensive medication use from 1.54 +/- 1.26 to 0.22 +/- 0.51 (SD) (P<0.05 and P =.005) for all 50 eyes. In the KDB + phaco group, the mean baseline IOP decreased from 20.75 +/- 8.1 (SD) to 13.8 +/- 3.7 (P < 0.05 and P =.000), respectively, and the medications used decreased from 1.32 +/- 1.18 (SD) to 0.22 +/- 0.48 (SD), whereas in KDB goniotomy alone, the mean baseline IOP decreased from 20.30 +/- 7.3 (SD) to 18.0 +/- 3.0 (SD) (P<0.05 and P = 0.00) and there was a reduction in the amount of medications from 2.4 +/- 1.26 (SD) to 0.2 +/- 0.63 (P< 0.05 and P = 0.000).
Eye irritation occurred the most in the KDB + Phaco group, representing 8%, which is resolved within 24 hours postoperatively. As for the KDB only group, hazy vision occurred the most, representing 22% but subsided between two to five days for all patients.
Conclusion
Affirming the results of the study, the safety and effectiveness of goniotomy with the KDB procedure is certain towards the reduction of IOP and medication usage, either independently or when combined with phacoemulsification during four to seven months of follow-up.