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Outcomes and risk factors for ab interno trabeculotomy with a Kahook Dual Blade

  • Glaucoma
  • Published:
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Abstract

Purpose

To verify the surgical results and risk factors for ab interno trabeculotomy using a Kahook Dual Blade (KDB-LOT) in patients with various glaucoma types.

Methods

This study was a retrospective case series of 205 eyes that underwent KDB-LOT. For Kaplan–Meier survival analysis, criterion A was defined as a ≤ 20% reduction in intraocular pressure (IOP) from baseline. Criteria B, C, and D were IOPs of ≤ 21, 18, and 15 mmHg, respectively. The Cox proportional hazard (CPH) model investigated prognostic factors.

Results

The mean (SD) IOP decreased from 24.7 (7.98) to 17.6 (4.80) mmHg in all cases, from 21.3 (6.88) to 17.8 (3.52) mmHg in primary open-angle glaucoma (POAG), from 25.4 (7.32) to 17.1 (4.65) mmHg in exfoliation glaucoma, from 30.6 (8.88) to 17.8 (8.29) mmHg in uveitic glaucoma, and from 30.8 (7.29) to 17.3 (0.83) mmHg in steroid-induced glaucoma at 1 year after KDB-LOT. The Kaplan–Meier survival analysis showed that patients with POAG had the best prognosis under criteria B and C, and the 1-year survival rate in patients under criterion D was less than 35% for any disease type. CPH analysis revealed that age and KDB-LOT with phacoemulsification were good prognostic factors. Risk factors for surgical failure were previous cataract surgery, selective laser trabeculoplasty, and postoperative peripheral anterior synechiae.

Conclusion

KDB-LOT was effective in treating patients with several glaucoma types but showed difficulty in pushing IOP below 15 mmHg. Prognostic factors should be considered when making decisions regarding surgical indications.

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References

  1. Tham Y-C, Li X, Wong TY et al (2014) Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121:2081–2090. https://doi.org/10.1016/j.ophtha.2014.05.013

    Article  Google Scholar 

  2. Lavia C, Dallorto L, Maule M et al (2017) Minimally invasive glaucoma surgeries (MIGS) for open angle glaucoma: a systematic review and meta-analysis. PLoS ONE 12:e0183142. https://doi.org/10.1371/journal.pone.0183142

    Article  CAS  Google Scholar 

  3. Francis BA, See RF, Rao NA et al (2006) Ab interno trabeculectomy: development of a novel device (Trabectome) and surgery for open-angle glaucoma. J Glaucoma 15:68–73. https://doi.org/10.1097/01.ijg.0000196653.77836.af

    Article  Google Scholar 

  4. Seibold LK, SooHoo JR, Ammar DA, Kahook MY (2013) Preclinical investigation of ab interno trabeculectomy using a novel dual-blade device. Am J Ophthalmol 155:524-529.e2. https://doi.org/10.1016/j.ajo.2012.09.023

    Article  Google Scholar 

  5. Dorairaj SK, Seibold LK, Radcliffe NM et al (2018) 12-month outcomes of goniotomy performed using the Kahook Dual Blade combined with cataract surgery in eyes with medically treated glaucoma. Adv Ther 35:1460–1469. https://doi.org/10.1007/s12325-018-0755-4

    Article  Google Scholar 

  6. ElMallah MK, Berdahl JP, Williamson BK et al (2020) Twelve-month outcomes of stand-alone excisional goniotomy in mild to severe glaucoma. Clin Ophthalmol 14:1891–1897. https://doi.org/10.2147/OPTH.S256423

    Article  Google Scholar 

  7. Miller VJ, Young CEC, SooHoo JR et al (2019) Efficacy of goniotomy with Kahook Dual Blade in Patients with uveitis-associated ocular hypertension. J Glaucoma 28:744–748. https://doi.org/10.1097/IJG.0000000000001298

    Article  Google Scholar 

  8. Epstein R, Taravella M, Pantcheva MB (2020) Kahook Dual Blade goniotomy in post penetrating keratoplasty steroid-induced ocular hypertension. Am J Ophthalmol Case Rep 19:100826. https://doi.org/10.1016/j.ajoc.2020.100826

    Article  Google Scholar 

  9. Acott TS, Kelley KJ (2008) Extracellular matrix in the trabecular meshwork. Exp Eye Res 86:543–561. https://doi.org/10.1016/j.exer.2008.01.013

    Article  CAS  Google Scholar 

  10. Wang K, Read AT, Sulchek T, Ethier CR (2017) Trabecular meshwork stiffness in glaucoma. Exp Eye Res 158:3–12. https://doi.org/10.1016/j.exer.2016.07.011

    Article  CAS  Google Scholar 

  11. Swaminathan SS, Monsalve P, Zhou XY et al (2018) Histologic analysis of trabecular meshwork obtained from Kahook Dual Blade goniotomy. Am J Ophthalmol 192:198–205. https://doi.org/10.1016/j.ajo.2018.05.028

    Article  Google Scholar 

  12. Laroche D, Nkrumah G, Ugoh P, Ng C (2021) Real world outcomes of Kahook Dual Blade goniotomy in black and Afro-Latinx adult patients with glaucoma: a 6-month retrospective study. J Natl Med Assoc 113:230–236. https://doi.org/10.1016/j.jnma.2020.09

    Article  Google Scholar 

  13. Porter M, Garza A, Gattardo M (2020) Excisional goniotomy in Latino patients with open-angle glaucoma: outcomes through 24 months. Clin Ophthalmol 14:3619–3625. https://doi.org/10.2147/OPTH.S271923

    Article  Google Scholar 

  14. Berdahl JP, Gallardo MJ, ElMallah MK et al (2018) Six-month outcomes of goniotomy performed with the Kahook Dual Blade as a stand-alone glaucoma procedure. Adv Ther 35:2093–2102. https://doi.org/10.1007/s12325-018-0803-0

    Article  CAS  Google Scholar 

  15. Hirabayashi MT, King JT, Lee D, An JA (2019) Outcome of phacoemulsification combined with excisional goniotomy using the Kahook Dual Blade in severe glaucoma patients at 6 months. Clin Ophthalmol 13:715–721. https://doi.org/10.2147/OPTH.S196105

    Article  Google Scholar 

  16. Salinas L, Chaudhary A, Berdahl JP et al (2018) Goniotomy using the Kahook Dual Blade in severe and refractory glaucoma: 6-month outcomes. J Glaucoma 27:849–855. https://doi.org/10.1097/IJG.0000000000001019

    Article  Google Scholar 

  17. Ventura-Abreu N, Garccía-Feijoo J, Pazos M et al (2021) Twelve-month results of ab interno trabeculectomy with Kahook Dual Blade: an interventional, randomized, controlled clinical study. Graefes Arch Clin Exp Ophthalmol 259:2771–2781. https://doi.org/10.1007/s00417-021-05213-0

    Article  Google Scholar 

  18. Klug E, Chachanidze M, Nirappel A et al (2022) Outcomes of phacoemulsification and endoscopic cyclophotocoagulation performed with dual blade ab interno trabeculectomy or trabecular micro-bypass stent insertion. Eye (Lond) 36:424–432. https://doi.org/10.1038/s41433-021-01475-4

    Article  CAS  Google Scholar 

  19. Omoto T, Sugiura A, Fujishiro T et al (2021) Twelve-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy in Japanese patients with open-angle glaucoma. PLoS One 16:e0245015. https://doi.org/10.1371/journal.pone.0245015

    Article  CAS  Google Scholar 

  20. Honjo M, Tanihara H, Inatani M, Honda Y (2000) External trabeculotomy for the treatment of steroid-induced glaucoma. J Glaucoma 9:483–485. https://doi.org/10.1097/00061198-200012000-00011

    Article  CAS  Google Scholar 

  21. Mansberger SL, Gordon MO, Jampel H et al (2012) Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology 119:1826–1831. https://doi.org/10.1016/j.ophtha.2012.02.050

    Article  Google Scholar 

  22. Kawai M, Inoue T, Inatani M et al (2012) Elevated levels of monocyte chemoattractant protein-1 in the aqueous humor after phacoemulsification. Invest Ophthalmol Vis Sci 53:7951–7960. https://doi.org/10.1167/iovs.12-10231

    Article  CAS  Google Scholar 

  23. Tsuboi N, Inoue T, Kawai M et al (2012) The effect of monocyte chemoattractant protein-1/CC chemokine ligand 2 on aqueous humor outflow facility. Invest Ophthalmol Vis Sci 53:6702–6707. https://doi.org/10.1167/iovs.12-10376

    Article  CAS  Google Scholar 

  24. Gulati V, Fan S, Gardner BJ et al (2017) Mechanism of action of selective laser trabeculoplasty and predictors of response. Invest Ophthalmol Vis Sci 58:1462–1468. https://doi.org/10.1167/iovs.16-20710

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Japan

    Natsumi Murata, Eri Takahashi, Sachi Kojima & Toshihiro Inoue

  2. Division of Pharmacology & Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto City, Japan

    Junji Saruwatari

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  1. Natsumi Murata
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  2. Eri Takahashi
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  3. Junji Saruwatari
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Correspondence to Eri Takahashi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Kumamoto University Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards, and written informed consent was obtained.

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Murata, N., Takahashi, E., Saruwatari, J. et al. Outcomes and risk factors for ab interno trabeculotomy with a Kahook Dual Blade. Graefes Arch Clin Exp Ophthalmol 261, 503–511 (2023). https://doi.org/10.1007/s00417-022-05799-z

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  • DOI: https://doi.org/10.1007/s00417-022-05799-z

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