Long Term Outcome of Combined Phacoemulsification and Excisional Goniotomy with the Kahook Dual Blade in Different Subtypes of Glaucoma

Purpose: To characterize changes in intraocular pressure (IOP), IOP-lowering medications, and visual acuity (VA) through 3 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma, by a single surgeon (A.H.) in King Fahd Hospital of the University, Dammam, Saudi Arabia. Methods: Prospective, non-comparative, uncontrolled, non-randomized interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Subgroup analysis of glaucoma subtypes was performed. Results: Fifty-seven eyes (48 patients) including 29 eyes with primary open-angle glaucoma, 15 with pseudoexfoliation glaucoma, and 13 with angle-closure glaucoma, were enrolled. Mean (standard error) baseline IOP was 20.3 (0.7) mmHg and through up to 36 months of follow-up (minimum 12 months, mean 26.2 [1.0] months) ranged from 13.5-14.0 mmHg (13.7 mmHg at Month 36); significant reductions (p < 0.0002) of 23.6-29.9% were achieved at every time point. Medications were reduced from a mean of 3.3 (0.1) to 0.2-1.9 (reduction 51.4-94.7%; p<0.0001 at every time point). Mean logMAR VA improved from 0.97 (0.11) preoperatively to 0.25 (0.04) by Month 6 (p<0.0001), remaining stable thereafter. Outcomes were similar in POAG, pseudoexfoliation, and ACG subgroups. Hyphema occurred and resolved spontaneously in 6 eyes; 1 eye had elevated IOP on postoperative day 1. Conclusions: Phaco-KDB significantly improved VA, lowered IOP ~25-30%, and lowered medications by >50% through 36 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication without compromising visual rehabilitation in eyes with cataract and glaucoma.