Analysis of the 12-Month Efficacy and Safety of Kahook dual blade goniotomy Combined with Phacoemulsification in Chinese Patients with Open-Angle Glaucoma

Purpose To evaluate the efficacy and safety of Kahook dual-blade (KDB) goniotomy combined with phacoemulsification for open-angle glaucoma in Chinese patients. Methods We retrospectively enrolled 33 Chinese patients (43 eyes) with open-angle glaucoma who underwent KDB goniotomy combined with phacoemulsification at the Third People's Hospital of Dalian University of Technology, Liaoning Province, China between September 2021 and May 2023. Of these, 29 eyes had primary open-angle glaucoma (POAG) and 14 had pseudoexfoliation glaucoma (PXFG). All patients underwent examinations preoperatively and 1 d, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. The intraocular pressure (IOP), number of glaucoma medications, surgical success rates, and procedure-related 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). Results The 43 eyes included had a mean preoperative IOP of 24.91 ± 6.68 mmHg, which decreased to 15.16 ± 2.98 mmHg at 12 months postoperatively (P < 0.01). The mean number of preoperative glaucoma medications decreased from 1.51 ± 1.18 to 0.30 ± 0.56 at 12 months postoperatively (P < 0.01). The surgical success rates at 12 months, defined by Criteria A, B, and C, were 76.74%, 69.77%, and 55.81%, respectively. Preoperative IOP and the number of glaucoma medications used were not significantly different between the POAG and PXFG groups. At 12 months, mean IOP in the POAG group was 15.72 ± 2.74 mmHg, compared at 23.41 ± 5.68 mmHg preoperatively (P < 0.05), whereas in the PXFG group, the mean IOP decreased from 26.14 ± 8.51 mmHg preoperatively to 14.00 ± 3.23 mmHg postoperatively at 12 months(P < 0.05). Twenty-four-hour IOP fluctuations at 12 months were 4.53 ± 1.86 mmHg in POAG and 4.03 ± 1.23 mmHg in PXFG, both significantly lower than preoperative values (9.47 ± 3.60 mmHg and 9.59 ± 3.64 mmHg, respectively; P < 0.01 for both groups). The mean number of glaucoma medications used at 12 months postoperatively was 0.34 ± 0.61 in the POAG group and 0.27 ± 0.47 in the PXFG group, both significantly lower than preoperative values (1.31 ± 1.10 and 1.93 ± 1.27, respectively; P < 0.05 for both groups). Surgical success rates at 12 months according to Criterion A were 72.41% for POAG and 85.71% for PXFG (P = 0.456); according to Criterion B, 62.07% vs. 85.71% (P = 0.164); and according to Criterion C, 44.82% vs. 78.57% (P = 0.052). Common surgical complications include hyphema and IOP spikes. Conclusions KDB goniotomy combined with phacoemulsification effectively lowered intraocular pressure (IOP) and reduced the number of glaucoma medications for open-angle glaucoma in Chinese patients, demonstrating favorable safety.