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

Analysis of the 12-Month Efficacy and Safety of Kahook dual blade goniotomy Combined with Phacoemulsification in Chinese Patients with Open-Angle Glaucoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the 12-Month Efficacy and Safety of Kahook dual blade goniotomy Combined with Phacoemulsification in Chinese Patients with Open-Angle Glaucoma Jian Yu, Yachen Wang, Huan Guan, Lijun Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7140673/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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 no t significantly differen t 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. glaucoma goniotomy Kahook dual blade surgical outcomes Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In recent years, surgical approaches for glaucoma have evolved significantly with the introduction of minimally invasive ab-interno surgical techniques. These innovations have emerged as effective alternatives, demonstrating efficacy in reducing intraocular pressure (IOP) while circumventing complications inherent to conventional goniotomy, such as filtering blebs associated with traditional procedures [ 1 – 3 ] . The Kahook Dual Blade (KDB), a surgical technique pioneered by Professor Kahook at the University of Colorado School of Medicine, employs a single-use blade specifically engineered for trabecular meshwork excision. This device has received regulatory approval for glaucoma treatment in China in 2019 . The KDB technique enables ab interno excision of the trabecular meshwork tissue along the inner wall of Schlemm's canal across an extended arc, thereby creating direct aqueous humor outflow pathways into Schlemm's canal and collector channels. This mechanism increases the effective drainage area while reducing aqueous outflow resistance. Key procedural advantages include minimal corneal incision dimensions (< 1.5 mm), preservation of peri-trabecular anatomical integrity, elimination of conjunctival and scleral manipulation, and complete independence from filtering bleb formation [ 4 ][ 5 ] . Published studies have demonstrated the therapeutic efficacy of KDB goniotomy combined with phacoemulsification across diverse clinical subtypes of open-angle glaucoma [ 6 ]−[ 19 ] . However, there remains a paucity of data regarding the efficacy and safety profiles of this combined surgical approach (KDB goniotomy with phacoemulsification) in Chinese open-angle glaucoma patients. evaluate d the effectiveness and safety of KDB goniotomy combined with cataract surgery in Chinese patients with open-angle glaucoma, with a specific focus on conducting a comparative analysis of surgical outcomes between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXFG) subtypes. This investigation sought to validate the therapeutic performance of KDB in glaucoma surgical management through this targeted subgroup comparison. Materials and Methods Patient Selection This single-center retrospective cohort study enrolled patients from the Third People's Hospital of Dalian University of Technology (Liaoning Province, China). All surgical procedures were performed by a single senior ophthalmologist specializing in glaucoma surgery. The study protocol received ethical review and approval from the Institutional Review Board of the Hospital and strict ly adhere d to the ethical principles outlined in the Declaration of Helsinki. All patient data underwent rigorous de-identification processes, and the Ethics Committee waived the requirement for informed consent in accordance with national regulations governing retrospective analyses of anonymized clinical records. This study consecutively enrolled 33 patients (43 eyes) who underwent KDB goniotomy combined with phacoemulsification between September 2021 and May 2023. Inclusion Criteria: ①Age ≥ 18 years; ②Confirmed diagnosis of primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PXFG) with concomitant cataract meeting surgical intervention criteria;③Documented progression of glaucomatous optic neuropathy (elevated intraocular pressure and visual field deterioration) under maximal medical therapy;④Open anterior chamber angle confirmed by gonioscopy. Patients were excluded if they had: ①Corneal opacity or other anterior segment anomalies that impaired gonioscopic visualization;②Etiologies of secondary glaucoma (e.g., active uveitis, neovascular glaucoma, angle dysgenesis);③Systemic conditions associated with elevated episcleral venous pressure (e.g., Sturge-Weber syndrome); ④Sight-threatening retinal comorbidities (e.g., advanced diabetic retinopathy);⑤Inability to comply with the 12-month standardized follow-up protocol. Methods Preoperative Examination and Data Collection All patients underwent a standardized preoperative examination: (1) best-corrected visual acuity (BCVA) and logarithm of the minimal angle of resolution (logMAR). Eyes without form vision were classified into one of four low-vision categories, which were assigned decimal equivalents as follows: counting fingers 0.00500, hand motions 0.00250,light perception 0.00125, and no light perception 0.00010; (2) IOP measurement via non-contact tonometry (triplicate measurements averaged) ; (3)24-hour IOP monitoring with 2-hour interval measurements, calculating fluctuation as the difference between peak and trough values; and (4) visual field evaluation using the Humphrey Field Analyzer 24 − 2 strategy (Swedish Interactive Threshold Algorithm standard). We classified the severity of glaucoma into three stages using the mean defect (MD) score on Humphrey visual field tests (MD≥-6.0 dB, mild; -6.0 > MD ≥-12.0 dB, moderate; and MD <- 12.0 dB, severe). Preoperative IOP-lowering regimens comprised systemic medications (e.g., acetazolamide) and topical ophthalmic agents including beta-blockers, alpha-adrenergic agonists, topical carbonic anhydrase inhibitors, and prostaglandin analogs. Fixed combination formulations were systematically deconstructed and counted as individual pharmacological agents based on their active components for quantitative analysis. Surgical Procedure Following topical anesthesia, a 2.8 mm corneal limbal incision was created in the superotemporal quadrant to perform standard phacoemulsification with intraocular lens implantation. The surgeon then optimized the visualization of the angle structures by adjusting both the patient's head position and microscope tilt angle. The anterior chamber was filled with 1% sodium hyaluronate, a viscoelastic material. The Kahook Dual Blade (KDB) was introduced into the Schlemm's canal, and a continuous trabecular meshwork excision was performed along a 120-degree clockwise arc (4 to 8 o'clock positions). Finally, complete evacuation of viscoelastic material was achieved through irrigation/aspiration, followed by anterior chamber reformation with a balanced salt solution. The primary incision was hydrated to achieve a watertight closure. Postoperative Management and Treatment All patients received standardized postoperative topical pharmacotherapy comprising: ●0.3% gatifloxacin ophthalmic solution (QID for 2–3 weeks) ●1% prednisolone acetate ophthalmic suspension (initiated at QID with weekly tapering for 28 days) ●0.5% pilocarpine hydrochloride solution (TID for three months) Preoperative glaucoma medications were discontinued on the day of the surgery. Subsequent adjustments to IOP-lowering regimens were made during follow-up evaluations based on serial intraocular pressure measurements and anterior chamber reaction status. Follow-up Protocol and Data Collection All patients underwent examinations of best-corrected visual acuity, intraocular pressure, visual field, anterior segment of the eye, and fundus on the 1st day, 1st week, 1st month, 3rd month, 6th month, and 12th month postoperatively. We collected the number of glaucoma medications used and any postoperative complications.In terms of postoperative complications. Hyphema was defined as an anterior chamber blood accumulation exceeding 1 mm in vertical height within the first postoperative week [ 20 ] , and an IOP spike as an increase in IOP of > 10 mmHg above baseline within 1 month after surgery or IOP exceeding 30 mmHg during the first postoperative month [ 21 ] . Surgical Success Criteria The primary outcome was surgical success or failure, which was defined according to the IOP criteria. Success was defined according to the postoperative IOP level with or without glaucoma medication at ≥ 3 month s after surgery as follows : ≥20% reduction in the preoperative IOP value and ≤ 21 mmHg(Criterion A),≥20% reduction in the preoperative IOP value and ≤ 18 mmHg(Criterion B),≥20% reduction in the preoperative IOP value, and ≤ 15 mmHg(Criterion C). Statistical Methodology All statistical analyses were conducted using SPSS software (version 26.0 ; IBM Corp.), with continuous variables following a normal distribution expressed as mean ± standard deviation. Visual acuity measurements were converted from decimal notation s to logMAR equivalents for analytical consistency. Chi-square tests were performed to compare the number of intraocular pressure (IOP)-lowering medications used preoperatively and postoperatively. Paired-sample t-tests were used to evaluate longitudinal changes in logMAR visual acuity and IOP values across predefined follow-up intervals. Intergroup comparisons of IOP trajectories were assessed using one-way ANOVA, with Bonferroni-adjusted pairwise post-hoc analyses applied when significant between-group differences emerged. Survival analysis employed Kaplan-Meier curves to estimate cumulative surgical success rates across predefined criteria (A/B/C), while log-rank tests stratified by glaucoma subtype (POAG vs. PXFG) were used to compare survival distributions. A two-tailed significance threshold was uniformly set at P < 0.05, with Bonferroni correction applied to correct for multiple comparisons in post hoc analyses. Normality assumptions were verified using the Shapiro-Wilk test (α = 0.10), and patients requiring secondary surgical interventions were right-censored in the survival models. Results General Clinical Data Table 1. Descriptive statistics of patients' baseline data. Total POAG PXFG Number of Eyes (%) 43 29(67.4) 14(33.6) Age (years, mean ± sd) 70.42±8.81 67.21±8.41 77.07± 5.24 Gender Male 20 (46.5) 12(41.4) 8(57.1) Female 23 (53.5) 17(58.6) 6(42.9) Previous Surgery (%) 4（9.30） 4（13.8） 0 Stages of Glaucoma (%) Early 14(32.6) 12 (41.4) 2(14.3) Advanced 7(16.3) 6 (20.7) 1(7.2) Late 22(51.1) 11(37.9) 11（78.5） POAG: Primary Open - Angle Glaucoma. PXFG: Pseudoexfoliation Glaucoma. As detailed in Table 1, this study enrolled 33 patients (43 eyes) with glaucomatous pathologies, including 20 male eyes and 23 female eyes. The overall cohort had a mean age of 70.42 ± 8.81 years, with disease staging distributed as follows: 11 mild stage patients (14 eyes), 6 moderate stage patients (7 eyes), and 17 severe stage patients (22 eyes). The POAG subgroup consisted of 22 patients (29 eyes), among whom three individuals (four eyes) had prior goniotomy surgery. Within the POAG cohort, the disease severity was categorized as mild (9 patients, 12 eyes), moderate (5 patients, 6 eyes), and severe (9 patients, 11 eyes). The PXFG subgroup included 11 patients (14 eyes) with distribution across disease stages: mild (2 patients, 2 eyes), moderate (1 patient, 1 eye), and severe (9 patients, 11 eyes). Comparative Analysis of Visual Acuity, Intraocular Pressure, and Q uantity of G laucoma M edications U sed Table 2 and Figure 1 present the visual acuity, IOP, and number of glaucom a medications used by all the patients at each follow-up time point. Preoperatively, the BCVA (logMAR ) of all patients was 0.59 ± 0.53, which significantly improved to 0.31 ± 0.35 at 12 months after surgery (p < 0.001). Moreover, there were statistically significant differences (p < 0.001) in the IOP and the number of glaucoma medications in 43 eyes at each follow - up time point compared with the preoperative values. Table 2. Comparison of visual acuity, intraocular pressure and the quantity of anti-glaucoma medications used before and after surgery among all glaucoma patients. Preoperative 1 day 3 months 6 months 12 months BCVA (LogMAR) 0.59±0.53 NA NA NA 0.31±0.35 P value NA NA NA <0.001 Intraocular Pressure (mmHg, mean ± sd) 24.91 ± 6.68 19.74 ±9.11 15.45 ±4.30 14.77 ±2.69 15.16 ±2.98 P value <0.001 <0.001 <0.001 <0.001 Medications (mean ± sd) 1.51 ± 1.18 1.07 ±0.34 1.00 ± 0.31 0.07 ± 0.34 0.30 ± 0.56 P value 0.001 <0.001 <0.001 <0.001 BCVA: Best - Corrected Visual Acuity. As presented in Table 3 and Figure 2, comparisons were made between the POAG and PXFG groups, as well as between the severe POAG and severe PXFG subgroups, regarding longitudinal changes in the IOP and the number of glaucoma medications used throughout the follow-up period.In the POAG group, the preoperative mean IOP was 23.41 ± 5.68 mmHg, and the mean number of glaucoma medications used was 1.31 ± 1.11. These values significantly reduced to 15.72 ± 2.74 mmHg (p < 0.001) and 0.34 ± 0.61 (p < 0.001), respectively, 12 months postoperatively.Similarly, in the PXFG group, the preoperative mean IOP was 26.14 ± 8.51 mmHg, with a mean of 1.93 ± 1.27 glaucoma medications used. These parameters decreased significantly to 14.00 ± 3.23 mmHg (p < 0.001) and 0.21 ± 0.43 (p < 0.001) at 12 months postoperatively.For the severe POAG subgroup, the preoperative mean IOP was 24.45 ± 6.14 mmHg, and the mean number of glaucoma medications was 1.00 ± 1.10. These values significantly decreased to 15.45 ± 2.34 mmHg (p < 0.001) and 0.64 ± 0.81 (p < 0.001), respectively, 12 months postoperatively. Likewise, in the severe PXFG subgroup, the preoperative mean IOP was 27.82 ± 8.78 mmHg, with a mean of 2.18 ± 1.33 medications. Postoperative values significantly reduced to 14.64 ± 3.53 mmHg (p < 0.001) and 0.27 ± 0.47 (p < 0.001) at 12 months. Table 3. Intraocular pressure before and after surgery and the number of glaucoma medications before surgery and at the post operative follow-up visits. Baseline 1 day 1 week 1 months 3 months 6 months 12 months POAG IOP (mmHg, mean ± sd) 23.41±5.68 18.55±6.74 19.98±8.11 15.71±3.63 15.53±2.80 15.52±2.44 15.72±2.74 P <0.001 0.001 <0.001 <0.001 <0.001 <0.001 medications (mean ± sd) 1.31±1.11 1.03±0.19 1.07±0.26 1.07±0.26 0.97±0.33 0.03±0.19 0.34±0.61 P 0.045 0.08 0.08 0.013 <0.001 <0.001 PXFG IOP (mmHg, mean ± sd) 26.14±8.51 22.21±12.68 17.09±5.69 13.32±2.18 15.29±6.56 13.21±2.58 14.00±3.23 P 0.134 0.001 <0.001 <0.001 <0.001 <0.001 medications (mean ± sd) 1.93±1.27 1.14±0.54 1.29±0.73 1.21±0.58 1.07±0.27 0.14±0.54 0.21±0.43 P 0.003 0.015 0.007 0.001 <0.001 <0.001 Severe POAG IOP (mmHg, mean ± sd) 24.45±6.14 20.45±7.89 21.21±9.64 14.82±3.66 14.91±2.55 14.73±2.33 15.45±2.34 P 0.101 0.182 <0.001 <0.001 <0.001 <0.001 medications (mean ± sd) 1.00±1.10 1.00±0.00 1.00±0.00 1.00±0.00 0.82±0.41 0.00±0.00 0.64±0.81 P 1 1 1 0.43 <0.001 0.117 Severe PXFG IOP (mmHg, mean ± sd) 27.82±8.78 22.36±13.17 16.57±5.66 13.05±2.31 13.55±3.08 13.09±2.84 13.64±3.53 P 0.062 <0.001 <0.001 <0.001 <0.001 <0.001 medications (mean ± sd) 2.18±1.33 1.18±0.60 1.36±0.81 1.27±0.65 1.09±0.30 0.18±0.60 0.27±0.47 P 0.002 0.012 0.005 0.001 <0.001 <0.001 POAG: Primary Open - Angle Glaucoma. PXFG: Pseudoexfoliation Glaucoma. IOP: Intraocular pressure. Table 4 displays the 24-hour IOP fluctuations measured during preoperative monitoring and at the 12-month postoperative follow-up for both the POAG and PXFG groups. In the POAG group, the preoperative 24-hour IOP fluctuations averaged 9.47 ± 3.60 mmHg, which significantly decreased to 4.53 ± 1.86 mmHg 12 months postoperatively (p < 0.001). Similarly, the PXFG group showed a significant reduction, with the preoperative mean IOP fluctuation of 9.59 ± 3.64 mmHg dropping to 4.03 ± 1.23 mmHg at the 12-month follow-up (p < 0.001). Table 4.Comparison of 24h - hour IOP fluctuation of patients in the two groups before surgery and 12 months after surgery Preoperative 12 months P POAG (mmHg, mean ± sd) 9.47±3.60 4.53±1.86 <0.001 PXFG (mmHg, mean ± sd) 9.59±3.64 4.03±1.23 <0.001 POAG: Primary Open - Angle Glaucoma. PXFG: Pseudoexfoliation Glaucoma. IOP: Intraocular pressure. Comparison of Surgical Success Rates Figure 3 depicts the cumulative surgical success rates across the three criteria (A/B/C) using the Kaplan-Meier method. Cumulative success rates under Criterion A 83.7%, 81.4%, and 76.7% at 3, 6, and 12 months postoperatively, respectively. The corresponding values for Criterion B were 76.7%, 76.7%, and 69.8%, whereas Criterion C achieved cumulative success rates of 62.8%, 62.8%, and 55.8%, respectively, at the same intervals. Figure 4 illustrates the cumulative surgical success rates for the POAG and PXFG groups across the three criteria (A/B/C) using the Kaplan-Meier method. At 3 months postoperatively, the cumulative success rates in the POAG group were 82.76% (Criterion A), 70.83% (Criterion B), and 58.62% (Criterion C), compared to 85.71%, 85.71%, and 85.71% in the PXFG group, respectively. At 6 months, POAG achieved 79.31% (A), 75.86% (B), and 51.72% (C), whereas PXFG maintained 85.71% (A/B) and 71.43% (C). By 12 months, POAG success rates had decreased to 72.41% (A), 62.07% (B), and 44.82% (C), whereas PXFG retained higher rates of 85.71% (A/B) and 78.57% (C). Surgical Complications and Management Common postoperative complications include hyphema, IOP spike, and secondary glaucoma surgery due to uncontrolled IOP. Hyphema occurred in five eyes (11.63%, three POAG eyes and two PXFG eyes), among which three eyes developed transient IOP elevation. All hyphemas resolved spontaneously within one week, with corresponding normalization of IOP. IOP spikes occurred in 3 eyes (6.98%, 2 POAG eyes, and 1 PXFG eye). IOP elevation occurred in two eyes within 1 week postoperatively, both of which were controlled within the target IOP after 1-2 weeks of glaucoma medication. In the other eye, the IOP remained at 13-18 mmHg within 3 months postoperatively but measured 36 mmHg at the 3rd month postoperatively. Treatment with prostaglandin eye drops was initiated, and the IOP decreased to 18 mmHg after 1 week of use. From 6 to 12 months postoperatively, IOP remained stable at 15-17 mmHg without medication.. Among the patients in both groups, one eye in each group underwent goniotomy again one year after the initial surgery, and the intraocular pressure was well controlled after the surgery. None of the eyes included in the study developed severe complications such as shallow anterior chamber, malignant glaucoma, choroidal detachment, or endophthalmitis after the surgery. Discussion This study evaluated the 12-month surgical outcomes of KDB goniotomy combined with phacoemulsification in Chinese patients with open-angle glaucoma and compared the outcomes between the POAG and PXFG cohorts. The postoperative mean IOP and number of glaucoma medications were significantly lower than the preoperative values (P<0.01) in all 43 eyes. Surgical success rates at 12 months were 76.74% (Criterion A), 69.77% (Criterion B), and 55.81% (Criterion C), with no serious surgical complications observed. Published studies on KDB goniotomy for glaucoma of varying severity reported a 20% or greater IOP reduction from baseline in 58.3%–66.67% of patients [7] [8] [10] [22] , alongside a 21.1%–62.7% reduction in medication usage [7] [23] [24] [25] [26] , which is consistent with our findings. Barkander et al. reported similar surgical success rates between PXFG and POAG under Criterion A [19] , whereas other studies have demonstrated higher success rates in PXFG than in POAG [18] [25] . These discrepancies in reported success rates may be related to variations in disease severity, preoperative IOP levels, follow-up duration, and success criteria across studies. To further investigate these discrepancies, this study stratified surgical success into three criteria (A/B/C). Notably, PXFG consistently outperformed POAG across all the criteria. While no statistically significant differences were observed between the groups for Criteria A and B at 12 months postoperatively, Criterion C demonstrated success rates of 44.8% (POAG) versus 78.6% (PXFG) (P=0.052). This near-significant finding was limited by the sample size of the study. Future research with expanded enrollment is warranted, as narrowing the 95% confidence interval may yield statistically significant results. This study revealed no significant differences in the preoperative mean IOP or glaucoma medication count between the POAG and PXFG groups. At 12 months postoperatively, both groups demonstrated statistically significant reductions in mean IOP and glaucoma medication usage compared to the preoperative values (P<0.05 for all within-group comparisons). This study found no statistically significant difference in the mean IOP between the POAG and PXFG groups at 12 months postoperatively. However, the PXFG group demonstrated a greater reduction in IOP than the baseline. Similar results were observed in subgroup analyses of advanced-stage patients from both groups, consistent with previous reports [19][25][26] . Patients with PXFG demonstrated a poorer response to preoperative medications, which was characterized by a higher baseline IOP. This contributed to their greater IOP reduction magnitude and higher surgical success rates under Criterion C than those in POAG patients. Additionally, the primary pathophysiological mechanism driving elevated IOP in PXFG involves the accumulation of extracellular exfoliation material within the trabecular meshwork, which disrupts trabecular matrix metabolism and impairs phagocytic function of trabecular cells, ultimately obstructing aqueous outflow [26] . In patients with PXFG, KDB goniotomy allows complete resection of the diseased trabecular meshwork tissue, thereby enhancing aqueous outflow and reducing IOP..In contrast, some POAG cases demonstrate relatively lower IOP reduction and surgical success rates than PXFG due to posterior trabecular obstruction. Both POAG and PXFG patients exhibit significant 24-hour IOP fluctuations, which are major risk factors for glaucomatous progression [27] . To date have compared 24-hour IOP fluctuations between these two groups following KDB goniotomy combined with phacoemulsification. However, our study demonstrated that postoperative circadian IOP fluctuations were significantly reduced in both the POAG and PXFG groups compared to preoperative levels, indicating that this surgical approach effectively mitigates both mean IOP and 24-hour IOP fluctuations, which may contribute to better disease progression control. This study demonstrated similar incidence rates of hyphema and IOP spikes between the two groups. Published studies report hyphema incidence rates ranging from 8.4% to 34.9% and IOP spike rates of 1.0%–17.0% following KDB goniotomy [11] [17] [20] [25] [26] [28] , which aligns with the findings of the present study. Some authors suggest that IOP spike following micro invasive glaucoma surgery (MIGS) may be associated with postoperative hyphema and transient inflammatory responses [1][5] . Other authors have postulated that the abovementioned scenario may be associated with shallow ciliary body detachment or resolution of supraciliary effusion leading to IOP spike [29] , In conclusion, we recommend minimizing angle hemorrhage during surgery, intensifying postoperative anti-infective therapy, and performing early anterior segment OCT examinations to evaluate gonioscopic structures and detect ciliary body detachment. Published studies indicate that IOP spikes typically occur within the first postoperative month [1][7][25] . In our study, IOP spikes occurred in 2 eyes within 1 week and in 1 eye at 3 months postoperatively. All affected patients achieved the target IOP through the administration of glaucoma medications and close follow-up monitoring. This suggests that an IOP spike may occur within 3 months postoperatively, which does not necessarily represent persistent elevation of IOP, indicating surgical failure. Therefore, early secondary surgeries should be avoided. In this study, one eye from each subgroup of severe-stage patients in both groups failed to achieve target IOP and showed visual field progression despite maximal medical therapy, necessitating secondary surgery at 1 year postoperatively.These findings suggest that advanced-stage patients require close follow-up, as those with suboptimal postoperative IOP control may face an increased risk of secondary surgery. Additionally, this study included 4 eyes with uncontrolled IOP after trabeculectomy. After undergoing KDB goniotomy combined with phacoemulsification, all of them have successfully achieved the surgical goals of reducing IOP and the number of glaucoma medications by avoiding disruption of the conjunctiva and sclera while preserving the physiological structure of the majority of the trabecular meshwork. KDB goniotomy offers a viable treatment option for patients requiring subsequent filtering glaucoma surgery or those who have failed previous filtering procedures. The advantages of this study lie in its focus on the population of Chinese open-angle glaucoma patients, relatively long follow-up time, and comparison of the surgical effects of POAG and PXFG, especially through 24-hour IOP monitoring. The limitations of this study are that it was a retrospective study, and it is necessary to extend the follow-up time and increase the sample size to observe long-term effectiveness and safety. Conclusion In conclusion, KDB goniotomy combined with phacoemulsification achieved a significant reduction in IOP and number of glaucoma medications in Chinese patients with open-angle glaucoma, exhibiting favorable safety. Declarations Ethics approval and consent to participate The study was approved by the Medical Ethical Committee of the Third People's Hospital of Dalian University of Technology. Consent for publication Not applicable Data availability statements The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests No conflict of interest exists in the submission of this manuscript, and the manuscript has been approved by all authors for publication. The work described in this paper is original research that has not been published previously and is not under consideration for publication elsewhere, in whole or in part. Funding This work was supported by grants from the Scientific Research Start-up Fund Project of the Third People's Hospital of Dalian University of Technology (2023ky006), and the Medical Science Research Program Project of Dalian Municipal (2111007). Authors' contributions Dr. Jian Yu analyzed and interpreted the patient data. Yachen Wang and Huan Guan served as assistants in all the aforementioned surgical procedures, helped collate surgery-related data and materials, and recorded patients' follow-up information. Prof. Lijun Zhao was the supervisor of the project, and she contributed to the writing and revision of the paper. All authors have read and approved the final manuscript. Acknowledgments We would like to acknowledge our colleagues from the Third People's Hospital of Dalian University of Technology for their generous assistance with our research. References Sakamoto T, Nisiwaki H. Factors associated with 1-year outcomes and transient intraocular pressure elevation in minimally invasive glaucoma surgery using Kahook Dual Blades. Sci Rep. 2023 Sep 14;13(1):15206. doi: 10.1038/s41598-023-42575-3. PMID: 37710010; PMCID: PMC10502046. Arimura S, Iwasaki K, Gozawa M, Takamura Y, Inatani M. goniotomy followed by phacoemulsification versus goniotomy alone: The Collaborative Bleb-Related Infection Incidence and Treatment Study. PLoS One. 2019 Oct 24;14(10):e0223439. doi: 10.1371/journal.pone.0223439. PMID: 31647848; PMCID: PMC6812865. Carlo L , Laura D , Milena M ,et al.Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis[J].Plos One, 2017, 12(8):e0183142.DOI:10.1371/journal.pone.0183142. 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Mechleb N, Tomey K, Cherfan D, Nemr A, Cherfan G, Dorairaj S, Khoueir Z. Six months' follow-up of combined phacoemulsification-kahook dual blade excisional goniotomy. Saudi J Ophthalmol. 2022 Aug 29;36(2):195-200. doi: 10.4103/sjopt.sjopt_151_21. PMID: 36211310; PMCID: PMC9535917. Hirabayashi MT, King JT, Lee D, An JA. Outcome of phacoemulsification combined with excisional goniotomy using the Kahook Dual Blade in severe glaucoma patients at 6 months. Clin Ophthalmol. 2019 Apr 24;13:715-721. doi: 10.2147/OPTH.S196105. PMID: 31114149; PMCID: PMC6488161. Ansari E, Loganathan D. 12-month clinical outcomes of combined phacoemulsification and ab interno goniotomy for open-angle glaucoma in the United Kingdom. PLoS One. 2021 Jun 17;16(6):e0252826. doi: 10.1371/journal.pone.0252826. PMID: 34138879; PMCID: PMC8211240. Salinas L, Chaudhary A, Berdahl JP, Lazcano-Gomez GS, Williamson BK, Dorairaj SK, Seibold LK, Smith S, Aref AA, Darlington JK, Jimenez-Roman J, Mahootchi A, Boucekine M, Mansouri K. Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes. J Glaucoma. 2018 Oct;27(10):849-855. doi: 10.1097/IJG.0000000000001019. PMID: 29979337. Krishnamurthy R, Senthil S, Choudhari N. Initial experience with phacoemulsification and goniotomy using the Kahook dual blade in advanced open-angle glaucoma: Six-month outcomes in Indian eyes. Indian J Ophthalmol. 2021 Sep;69(9):2484-2487. doi: 10.4103/ijo.IJO_2999_20. PMID: 34427249; PMCID: PMC8544104. Murata N, Takahashi E, Saruwatari J, Kojima S, Inoue T. Outcomes and risk factors for ab interno trabeculotomy with a Kahook Dual Blade. Graefes Arch Clin Exp Ophthalmol. 2023 Feb;261(2):503-511. doi: 10.1007/s00417-022-05799-z. Epub 2022 Aug 12. PMID: 35960356. Kuerten D, Walter P, Baumgarten S, Fuest M, Plange N. 12-month outcomes of ab interno excisional goniotomy combined with cataract surgery in primary open-angle glaucoma and normal tension glaucoma. Int Ophthalmol. 2023 Mar 2. doi: 10.1007/s10792-023-02659-5. Epub ahead of print. PMID: 36862355. Miller VJ, Patnaik JL, Young CEC, SooHoo JR, Seibold LK, Kahook MY, Ertel MK, Palestine AG, Pantcheva MB. Outcomes of Kahook Dual Blade Goniotomy for Uveitis Associated Open Angle Glaucoma or Ocular Hypertension. J Glaucoma. 2022 Nov 1;31(11):903-908. doi: 10.1097/IJG.0000000000002099. Epub 2022 Aug 9. PMID: 35980845. Tan Q, Li J, Lin D, Zhao P. Risk factors of surgical failure in combined phacoemulsification and excisional goniotomy for angle-closure glaucoma. Graefes Arch Clin Exp Ophthalmol. 2023 Feb;261(2):535-543. doi: 10.1007/s00417-022-05808-1. Epub 2022 Aug 27. PMID: 36029305. Al Habash A, Albuainain A. Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma. Sci Rep. 2021 May 21;11 (1) : 10660. doi: 10.1038 / s41598-021-90223-5. PMID: 34021228; PMCID: PMC8140085. Omoto, Takashi., Sugiura, Aya., Sugiura, Aya., Fujishiro, Takashi., & Asano-Shimizu, Kimiko. (2021). Twelve-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy in Japanese patients with open-angle glaucoma. PloS one, 16(1), e0245015. Barkander A, Economou MA, Jóhannesson G. Kahook Dual-Blade Goniotomy with and without Phacoemulsification in Medically Uncontrolled Glaucoma. Clin Ophthalmol. 2023 May 12;17:1385-1394. doi: 10.2147/OPTH.S409375. PMID: 37204995; PMCID: PMC10187655. Pratte EL, Ramachandran M, Landreneau JR, An JA. Risk Factors for Hyphema Following Kahook Dual Blade Goniotomy Combined With Phacoemulsification. J Glaucoma. 2023 Mar 1;32(3):165-170. doi: 10.1097/IJG.0000000000002142. Epub 2022 Oct 28. PMID: 36730925. Laroche D, Nkrumah G, Ugoh P, Ng C. 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. 2021 Apr;113(2):230-236. doi: 10.1016/j.jnma.2020.09.147. Epub 2020 Nov 4. PMID: 33158570. Stamer WD, Braakman ST, Zhou EH, et al. Biomechanics of Schlemm's canal endothelium and intraocular pressure reduction[J]. Progress in retinal and eye research,2015,4486-98. DOI:10.1016/j.preteyeres.2014.08.002. Pratte EL, Cho J, Landreneau JR, Hirabayashi MT, An JA. Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification. J Curr Glaucoma Pract. 2022 Jan-Apr;16(1):47-52. doi: 10.5005/jp-journals-10078-1313. PMID: 36060044; PMCID: PMC9385392. Al Habash A, Albuainain A. Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma. Sci Rep. 2021 May 21;11(1):10660. doi: 10.1038/s41598-021-90223-5. PMID: 34021228; PMCID: PMC8140085. Wakil, S.M.; Birnbaum, F.; Vu, D.M.; McBurney-Lin, S.; ElMallah, M.K.; Tseng, H. Efficacy and safety of a single-use dual blade goniotomy: 18-month results. J. Cataract Refract. Surg. 2020, 46, 1408–1415. Sieck, E.G.; Epstein, R.S.; Kennedy, J.B.; SooHoo, J.R.; Pantcheva, M.B.; Patnaik, J.L.; Wagner, B.D.; Lynch, A.M.; Kahook, M.Y.; Seibold, L.K. Outcomes of Kahook Dual Blade goniotomy with and without phacoemulsification cataract extraction. Ophthalmol. Glaucoma 2018, 1, 75–81. Heijl, Anders., Leske, M Cristina., Bengtsson, Bo., Hyman, Leslie., Bengtsson, Boel.. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Archives of ophthalmology (Chicago, Ill. : 1960), 2002, 120(10):1268-79. ElMallah, M.K.; Seibold, L.K.; Kahook, M.Y.; Williamson, B.K.; Singh, I.P.; Dorairaj, S.K.; KDB Goniotomy Study Group. 12-month retrospective comparison of Kahook Dual Blade excisional goniotomy with istent trabecular bypass device implantation in glaucomatous eyes at the time of cataract surgery. Adv. Ther. 2019, 36, 2515–2527. Shi Y, Wang H, Oatts JT, et al. A Prospective Study of Intraocular Pressure Spike and Failure After Gonioscopy-Assisted Transluminal Trabeculotomy in Juvenile Open-Angle Glaucoma: A Prospective Study of GATT in JOAG[J]. American Journal of Ophthalmology: The International Journal of Ophthalmology,2022,23679-88. DOI:10.1016/j.ajo.2021.10.009. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7140673","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":491236260,"identity":"54770f83-19ce-428d-bc27-90d8f7283f2b","order_by":0,"name":"Jian Yu","email":"","orcid":"","institution":"The Third People's Hospital of Dalian University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Yu","suffix":""},{"id":491236261,"identity":"da786560-77c6-470b-bef7-75afbb764be4","order_by":1,"name":"Yachen Wang","email":"","orcid":"","institution":"The Third People's Hospital of Dalian University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Yachen","middleName":"","lastName":"Wang","suffix":""},{"id":491236262,"identity":"b60cd66c-c391-4271-bc8e-e28660b92338","order_by":2,"name":"Huan Guan","email":"","orcid":"","institution":"The Third People's Hospital of Dalian University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Guan","suffix":""},{"id":491236263,"identity":"c86609e4-428a-48ee-bc01-430cb9fdbba2","order_by":3,"name":"Lijun Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYBACPmaGBCB1AMQ2YGCokJCTJ6SFDUXLgTMWxoYNhLRAKKiWg20ViRA2Pi3sDM+kC/7ckednYN4m/XGeRAJjA/PDRzfwOyxNegbPM8OZDWxlEge3SeSxM7AZG+cQ0sIjcZhxwwEeM5CWYsYGHjZpwloMDttDtMyRSGw4QJSWhMOJEC0NxGlJtuY5cDgZ6JdiizPHJIwNmwn4hZ//TOJtnj+HbfsZmDfeqKipk5Nnb374GJ8WBgaeBAgt/wAqwIxXOQiwHyCoZBSMglEwCkY4AAAvAEQVswxsqQAAAABJRU5ErkJggg==","orcid":"","institution":"The Third People's Hospital of Dalian University of Technology","correspondingAuthor":true,"prefix":"","firstName":"Lijun","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-07-16 13:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7140673/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7140673/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87850115,"identity":"7a961845-a7b1-4f97-9349-46dbc641c305","added_by":"auto","created_at":"2025-07-29 15:47:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66167,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of IOP and the number of anti-glaucoma medications before and after surgery among all glaucoma patients.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7140673/v1/3352159e0ee8b96664ba4b35.png"},{"id":87851441,"identity":"1cbd9da3-962d-4bff-a2ad-e8ca06aa2201","added_by":"auto","created_at":"2025-07-29 15:55:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113104,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIntraocular pressure before and after surgery and the number of glaucoma medications before surgery and at the post operative follow-up visits.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7140673/v1/772edd0d7551002ca90c0d85.png"},{"id":87850116,"identity":"95b6a2f4-a1f0-4d2f-8dc5-797834a8f99f","added_by":"auto","created_at":"2025-07-29 15:47:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54687,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCumulative surgical success rates across three criteria (A/B/C)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7140673/v1/859752ce95f541bf17b209b8.png"},{"id":87850118,"identity":"468e734e-99b5-48a8-95a3-d922214c800e","added_by":"auto","created_at":"2025-07-29 15:47:56","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":60009,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCumulative surgical success rates for POAG and PXFG groups across three criteria (A/B/C) using the Kaplan-Meier method. A: Cumulative surgical success rates determined by Criterion A. B: Cumulative surgical success rates determined by Criterion B. C: Cumulative surgical success rates determined by Criterion C.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7140673/v1/f3d85546134fe9332822adb4.png"},{"id":91268961,"identity":"b5e0bf62-2104-4d41-aee4-9645da413265","added_by":"auto","created_at":"2025-09-14 09:31:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1574970,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7140673/v1/2182ddd0-d65d-4059-995f-3aed10f99f2f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the 12-Month Efficacy and Safety of Kahook dual blade goniotomy Combined with Phacoemulsification in Chinese Patients with Open-Angle Glaucoma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, surgical approaches \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003efor glaucoma have evolved significantly\u003c/span\u003e with the introduction of minimally invasive ab-interno surgical techniques. These innovations have emerged as effective alternatives, demonstrating efficacy in reducing intraocular pressure (IOP) while circumventing complications inherent to conventional goniotomy, such as filtering blebs associated with traditional procedures\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The Kahook Dual Blade (KDB), a surgical technique pioneered by Professor Kahook at the University of Colorado School of Medicine, employs a single-use blade specifically engineered for trabecular meshwork excision. This device \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ehas received regulatory approval for glaucoma treatment in China in 2019\u003c/span\u003e. The KDB technique enables ab interno excision of \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe trabecular meshwork tissue along the inner wall of Schlemm's canal across an extended arc, thereby creating direct aqueous humor outflow pathways into Schlemm's canal and collector channels. This mechanism increases the effective drainage area while reducing aqueous outflow resistance. Key procedural advantages include minimal corneal incision dimensions (\u0026lt;\u0026thinsp;1.5 mm), preservation of peri-trabecular anatomical integrity, elimination of conjunctival\u003c/span\u003e and scleral manipulation, and complete independence from filtering bleb formation\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePublished studies have demonstrated the therapeutic efficacy of KDB goniotomy combined with phacoemulsification across diverse clinical subtypes of open-angle glaucoma\u003csup\u003e[\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u0026minus;[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. However, there remains a paucity of data regarding the efficacy and safety profiles of this combined surgical approach (KDB goniotomy with phacoemulsification) in Chinese open-angle glaucoma patients.\u003c/p\u003e\u003cp\u003eevaluate\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ed the effectiveness and safety of KDB\u003c/span\u003e goniotomy combined with cataract surgery in Chinese patients with open-angle glaucoma, with a specific focus on conducting a comparative analysis of surgical outcomes between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXFG) subtypes. This investigation sought to validate the therapeutic performance of KDB in glaucoma surgical management through this targeted subgroup comparison.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003ePatient Selection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis single-center retrospective cohort study enrolled patients from the Third People's Hospital of Dalian University of Technology (Liaoning Province, China). All surgical procedures \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewere performed by a single senior ophthalmologist specializing in glaucoma surgery.\u003c/span\u003e The study protocol received ethical review and approval from the Institutional Review Board of the Hospital and strict\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ely adhere\u003c/span\u003ed to the ethical principles outlined in the Declaration of Helsinki. All patient data underwent rigorous de-identification processes, and the Ethics Committee waived the requirement for informed consent in accordance with national regulations governing retrospective analyses of anonymized clinical records. This study consecutively enrolled 33 patients (43 eyes) who underwent KDB goniotomy combined with phacoemulsification between September 2021 and May 2023.\u003c/p\u003e\u003cp\u003eInclusion Criteria: ①Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; ②Confirmed diagnosis of primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PXFG) with concomitant cataract meeting surgical intervention criteria;③Documented progression of glaucomatous optic neuropathy (elevated intraocular pressure and visual field deterioration) under maximal medical therapy;④Open anterior chamber angle confirmed by gonioscopy.\u003c/p\u003e\u003cp\u003ePatients were excluded if they had: ①Corneal opacity or other anterior segment anomalies that impaired gonioscopic visualization;②Etiologies of secondary glaucoma (e.g., active uveitis, neovascular glaucoma, angle dysgenesis);③Systemic conditions associated with elevated episcleral venous pressure (e.g., Sturge-Weber syndrome); ④Sight-threatening retinal comorbidities (e.g., advanced diabetic retinopathy);⑤Inability to comply with the 12-month standardized follow-up protocol.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePreoperative Examination and Data Collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll patients underwent a standardized preoperative examination: (1) best-corrected visual acuity (BCVA) and logarithm of the minimal angle of resolution (logMAR). Eyes without form vision were classified into one of four low-vision categories, which were assigned decimal equivalents as follows: counting fingers 0.00500, hand motions 0.00250,light perception 0.00125, and no light perception 0.00010; (2) IOP \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003emeasurement via non-contact tonometry (triplicate measurements averaged)\u003c/span\u003e; (3)24-hour IOP monitoring with 2-hour interval measurements, calculating fluctuation as the difference between peak and trough values; and (4) visual field evaluation using the Humphrey Field Analyzer 24\u0026thinsp;\u0026minus;\u0026thinsp;2 strategy (Swedish Interactive Threshold Algorithm standard). We classified the severity of glaucoma into three stages using the mean defect (MD) score on Humphrey visual field tests (MD\u0026ge;-6.0 dB, mild; -6.0\u0026thinsp;\u0026gt;\u0026thinsp;MD \u0026ge;-12.0 dB, moderate; and MD \u0026lt;- 12.0 dB, severe). Preoperative IOP-lowering regimens comprised systemic medications (e.g., acetazolamide) and topical ophthalmic agents including beta-blockers, alpha-adrenergic agonists, topical carbonic anhydrase inhibitors, and prostaglandin analogs. Fixed combination formulations were systematically deconstructed and counted as individual pharmacological agents based on their active components for quantitative analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical Procedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing topical anesthesia, a 2.8 mm corneal limbal incision was created in the superotemporal quadrant to perform standard phacoemulsification with intraocular lens implantation. The surgeon then optimized \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe visualization of the angle structures by adjusting both the patient's head position and microscope tilt angle. The anterior chamber was filled with 1% sodium hyaluronate, a viscoelastic material. The Kahook Dual Blade (KDB) was\u003c/span\u003e introduced into \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe Schlemm's canal, and a continuous trabecular meshwork excision was performed along a 120-degree clockwise arc (4 to 8 o'clock positions). Finally, complete evacuation of viscoelastic material was achieved through irrigation/aspiration, followed by anterior chamber reformation with a balanced salt solution. The primary incision was hydrated to achieve a watertight closure.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003ePostoperative Management and Treatment\u003c/span\u003e\u003c/p\u003e\u003cp\u003eAll patients received standardized postoperative topical pharmacotherapy comprising:\u003c/p\u003e\u003cp\u003e●0.3% gatifloxacin ophthalmic solution (QID for 2\u0026ndash;3 weeks)\u003c/p\u003e\u003cp\u003e●1% prednisolone acetate ophthalmic suspension (initiated at QID with weekly tapering for 28 days)\u003c/p\u003e\u003cp\u003e●0.5% pilocarpine hydrochloride solution (TID for three months)\u003c/p\u003e\u003cp\u003ePreoperative glaucoma medications were discontinued on the day of \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe surgery. Subsequent adjustments to IOP-lowering regimens were made during follow-up evaluations based on serial intraocular pressure measurements and anterior chamber reaction status.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFollow-up Protocol and Data Collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll patients underwent examinations of best-corrected visual acuity, intraocular pressure, visual field, anterior segment of the eye, and fundus on the 1st day, 1st week, 1st month, 3rd month, 6th month, and 12th month postoperatively. We collected the number of glaucoma medications used and any postoperative complications.In terms of postoperative complications. Hyphema \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewas\u003c/span\u003e defined as \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ean anterior chamber blood accumulation exceeding 1\u003c/span\u003e mm in vertical height within the first postoperative week\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e\u003csub\u003e,\u003c/sub\u003eand an IOP spike as an increase in IOP of \u0026gt;\u0026thinsp;10 mmHg above baseline within 1 month after surgery or IOP exceeding 30 mmHg during the first postoperative month\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical Success Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome was surgical success or failure, which was defined according to the IOP criteria. Success was defined according to the postoperative IOP level with or without glaucoma medication at \u0026ge;\u0026thinsp;3 month\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es after surgery as follows\u003c/span\u003e: \u0026ge;20% reduction in the preoperative IOP value and \u0026le;\u0026thinsp;21 mmHg(Criterion A),\u0026ge;20% reduction in the preoperative IOP value and \u0026le;\u0026thinsp;18 mmHg(Criterion B),\u0026ge;20% reduction in the preoperative IOP value, and \u0026le;\u0026thinsp;15 mmHg(Criterion C).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical Methodology\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll statistical analyses were conducted using SPSS \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003esoftware (version 26.0\u003c/span\u003e; IBM Corp.), with continuous variables following a normal distribution expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Visual acuity measurements were converted from decimal notation\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es to logMAR equivalents for analytical consistency. Chi-square tests were performed to compare the number of intraocular pressure (IOP)-lowering medications used preoperatively and postoperatively. Paired-sample t-tests were used to evaluate\u003c/span\u003e longitudinal changes in logMAR visual acuity and IOP values across predefined follow-up intervals. Intergroup comparisons of IOP trajectories were assessed using one-way ANOVA, with Bonferroni-adjusted pairwise post-hoc analyses applied when significant between-group differences emerged. Survival analysis employed Kaplan-Meier curves to estimate cumulative surgical success rates across predefined criteria (A/B/C), while log-rank tests stratified by glaucoma subtype (POAG vs. PXFG) \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewere used to compare\u003c/span\u003e survival distributions. A two-tailed significance threshold was uniformly set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, with Bonferroni correction applied to correct for multiple comparisons in post hoc analyses. Normality assumptions were verified using the Shapiro-Wilk test (α\u0026thinsp;=\u0026thinsp;0.10), and patients requiring secondary surgical interventions were right-censored in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe survival models.\u003c/span\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral Clinical Data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 652px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Descriptive statistics of patients\u0026apos; baseline data.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePOAG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePXFG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eNumber of Eyes \u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e29(67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e14(33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge (years, mean \u0026plusmn; sd)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70.42\u0026plusmn;8.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e67.21\u0026plusmn;8.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77.07\u0026plusmn; 5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp; 20 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12(41.4) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e8(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp; 23 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e17(58.6) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e6(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003ePrevious Surgery (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4（9.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 4（13.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eStages of Glaucoma (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eEarly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e14(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e12 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e2(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eAdvanced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;7(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e6 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e1(7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eLate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;22(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e11(37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;11（78.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 652px;\"\u003e\n \u003cp\u003ePOAG: Primary Open - Angle Glaucoma. PXFG: Pseudoexfoliation Glaucoma.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAs detailed in Table 1, this study enrolled 33 patients (43 eyes) with glaucomatous pathologies, including 20 male eyes and 23 female eyes. The overall cohort had a mean age of 70.42 \u0026plusmn; 8.81 years, with disease staging distributed as follows: 11 mild stage patients (14 eyes), 6 moderate stage patients (7 eyes), and 17 severe stage patients (22 eyes). The POAG subgroup consisted of 22 patients (29 eyes), among whom three individuals (four eyes) had prior goniotomy surgery. Within the POAG cohort, the disease severity was categorized as mild (9 patients, 12 eyes), moderate (5 patients, 6 eyes), and severe (9 patients, 11 eyes). The PXFG subgroup included 11 patients (14 eyes) with distribution across disease stages: mild (2 patients, 2 eyes), moderate (1 patient, 1 eye), and severe (9 patients, 11 eyes).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparative Analysis of Visual Acuity, Intraocular Pressure, and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eQ\u003c/strong\u003e\u003cstrong\u003euantity of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eG\u003c/strong\u003e\u003cstrong\u003elaucoma\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003cstrong\u003eedications\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eU\u003c/strong\u003e\u003cstrong\u003esed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 and Figure 1 present the visual acuity, IOP, and number of glaucom\u003cu\u003ea\u0026nbsp;\u003c/u\u003emedications used by all the patients at each follow-up time point. Preoperatively, the BCVA (logMAR ) of all patients was 0.59 \u0026plusmn;\u0026nbsp;0.53, which significantly improved to 0.31\u0026nbsp;\u0026plusmn;\u0026nbsp;0.35 at 12 months\u0026nbsp;after surgery (p \u0026lt; 0.001). Moreover, there were statistically significant differences (p \u0026lt; 0.001) in the IOP and the number of glaucoma medications in 43 eyes at each follow - up time point compared with the preoperative values.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"border: none;width:540.75pt;margin-left:4.65pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width:541.15pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:34.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eTable 2. Comparison of visual acuity, intraocular pressure and the quantity of anti-glaucoma medications used before and after surgery among all glaucoma patients.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003ePreoperative\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Segoe UI\",sans-serif;color:black;'\u003e1 day\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e3 months\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e6 months\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e12 months\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:114.15pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eBCVA (LogMAR)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.59\u0026plusmn;0.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.31\u0026plusmn;0.35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:114.15pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:114.15pt;padding:0in 5.4pt 0in 5.4pt;height:41.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eIntraocular Pressure\u003cbr\u003e\u0026nbsp; (mmHg, mean \u0026plusmn; sd)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:41.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e24.91\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e6.68\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:41.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e19.74\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;9.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:41.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e15.45\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;4.30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:41.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e14.77\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;2.69\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:41.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e15.16\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;2.98\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:114.15pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:114.15pt;padding:0in 5.4pt 0in 5.4pt;height:47.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eMedications\u003cbr\u003e\u0026nbsp; (mean \u0026plusmn; sd)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:47.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e1.51\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e1.18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:47.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.07\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;0.34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:47.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e1.00\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e0.31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:47.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e0.07\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e0.34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;padding:0in 5.4pt 0in 5.4pt;height:47.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e0.30\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e0.56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:114.15pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:#010205;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.4pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width:541.15pt;padding:0in 5.4pt 0in 5.4pt;height:30.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eBCVA: Best - Corrected Visual Acuity.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAs presented in Table 3 and\u0026nbsp;Figure 2,\u0026nbsp;comparisons were made between the POAG and PXFG groups, as well as between the severe POAG and severe PXFG subgroups, regarding longitudinal changes in the IOP and the number of glaucoma medications used throughout the follow-up period.In the POAG group, the preoperative mean IOP was 23.41 \u0026plusmn; 5.68 mmHg, and the mean number of glaucoma medications used was 1.31 \u0026plusmn; 1.11. These values significantly reduced to\u0026nbsp;\u003cbr\u003e15.72 \u0026plusmn; 2.74 mmHg (p \u0026lt; 0.001) and 0.34 \u0026plusmn; 0.61 (p \u0026lt; 0.001), respectively, 12 months postoperatively.Similarly, in the PXFG group, the preoperative mean IOP was 26.14 \u0026plusmn; 8.51 mmHg, with a mean of 1.93 \u0026plusmn; 1.27 glaucoma medications used. These parameters decreased significantly to 14.00 \u0026plusmn; 3.23 mmHg (p \u0026lt; 0.001) and 0.21 \u0026plusmn; 0.43 (p \u0026lt; 0.001) at 12 months postoperatively.For the severe POAG subgroup, the preoperative mean IOP was 24.45 \u0026plusmn; 6.14 mmHg, and the mean number of glaucoma medications was 1.00 \u0026plusmn; 1.10. These values significantly decreased to 15.45 \u0026plusmn; 2.34 mmHg (p \u0026lt; 0.001) and 0.64 \u0026plusmn; 0.81 (p \u0026lt; 0.001), respectively, 12 months postoperatively. Likewise, in the severe PXFG subgroup, the preoperative mean IOP was 27.82 \u0026plusmn; 8.78 mmHg, with a mean of 2.18 \u0026plusmn; 1.33 medications. Postoperative values significantly reduced to 14.64 \u0026plusmn; 3.53 mmHg (p \u0026lt; 0.001) and 0.27 \u0026plusmn; 0.47 (p \u0026lt; 0.001) at 12 months.\u003c/p\u003e\n\u003ctable style=\"border: none;width:564.0pt;margin-left:4.65pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width:564.0pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:46.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eTable 3. Intraocular pressure before and after surgery and the number of glaucoma medications before surgery and at the post operative follow-up visits.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;border-bottom:solid black 1.0pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eBaseline\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e1 day\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e1 week\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid black; padding: 0in 5.4pt; height: 13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e1 months\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid black; padding: 0in 5.4pt; height: 13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e3 months\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e6 months\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e12 months\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003ePOAG\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eIOP (mmHg, mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e23.41\u0026plusmn;5.68\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e18.55\u0026plusmn;6.74\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e19.98\u0026plusmn;8.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e15.71\u0026plusmn;3.63\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e15.53\u0026plusmn;2.80\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e15.52\u0026plusmn;2.44\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e15.72\u0026plusmn;2.74\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003emedications (mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.31\u0026plusmn;1.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.03\u0026plusmn;0.19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.07\u0026plusmn;0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.07\u0026plusmn;0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.97\u0026plusmn;0.33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.03\u0026plusmn;0.19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.34\u0026plusmn;0.61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.045\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.013\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003ePXFG\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eIOP (mmHg, mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e26.14\u0026plusmn;8.51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e22.21\u0026plusmn;12.68\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e17.09\u0026plusmn;5.69\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e13.32\u0026plusmn;2.18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e15.29\u0026plusmn;6.56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e13.21\u0026plusmn;2.58\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e14.00\u0026plusmn;3.23\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.134\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003emedications (mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.93\u0026plusmn;1.27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.14\u0026plusmn;0.54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.29\u0026plusmn;0.73\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.21\u0026plusmn;0.58\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.07\u0026plusmn;0.27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.14\u0026plusmn;0.54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.21\u0026plusmn;0.43\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.003\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.015\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.007\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eSevere POAG\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eIOP (mmHg, mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e24.45\u0026plusmn;6.14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e20.45\u0026plusmn;7.89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e21.21\u0026plusmn;9.64\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e14.82\u0026plusmn;3.66\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e14.91\u0026plusmn;2.55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e14.73\u0026plusmn;2.33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e15.45\u0026plusmn;2.34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.101\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.182\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003emedications (mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.00\u0026plusmn;1.10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.00\u0026plusmn;0.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.00\u0026plusmn;0.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.00\u0026plusmn;0.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.82\u0026plusmn;0.41\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.00\u0026plusmn;0.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.64\u0026plusmn;0.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.43\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.117\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid black;padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eSevere PXFG\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eIOP (mmHg, mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e27.82\u0026plusmn;8.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e22.36\u0026plusmn;13.17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e16.57\u0026plusmn;5.66\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e13.05\u0026plusmn;2.31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e13.55\u0026plusmn;3.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e13.09\u0026plusmn;2.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e13.64\u0026plusmn;3.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.062\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113.25pt;background: rgb(224, 224, 224);padding: 0in 5.4pt;height: 24pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:top;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003emedications (mean \u0026plusmn; sd)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e2.18\u0026plusmn;1.33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.18\u0026plusmn;0.60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.36\u0026plusmn;0.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.27\u0026plusmn;0.65\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e1.09\u0026plusmn;0.30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.18\u0026plusmn;0.60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e0.27\u0026plusmn;0.47\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:113.25pt;border:none;border-bottom:solid black 1.0pt;background:#E0E0E0;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:right;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.002\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.012\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.0952%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid black; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.005\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.095%; border-top: none; border-right: none; border-left: none; border-image: initial; border-bottom: 1pt solid black; padding: 0in 5.4pt; height: 24pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.75pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width:564.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003ePOAG: Primary Open - Angle Glaucoma. PXFG: Pseudoexfoliation Glaucoma. IOP: Intraocular pressure.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 displays the 24-hour IOP fluctuations measured during preoperative monitoring and at the 12-month postoperative follow-up for both the POAG and PXFG groups. In the POAG group, the preoperative 24-hour IOP fluctuations averaged 9.47 \u0026plusmn; 3.60 mmHg, which significantly decreased to 4.53 \u0026plusmn; 1.86 mmHg 12 months postoperatively (p \u0026lt; 0.001). Similarly, the PXFG group showed a significant reduction, with the preoperative mean IOP fluctuation of 9.59 \u0026plusmn; 3.64 mmHg dropping to 4.03 \u0026plusmn; 1.23 mmHg at the 12-month follow-up (p \u0026lt; 0.001).\u003c/p\u003e\n\u003ctable style=\"border: none;width:388.0pt;margin-left:4.65pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:388.0pt;padding:0in 5.4pt 0in 5.4pt;height:35.15pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;color:black;'\u003eTable 4.Comparison of 24h - hour IOP fluctuation of patients in the two groups before surgery and 12 months after surgery\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border-top:solid black 1.0pt;border-left:none;border-bottom: solid black 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:49.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.9pt;border-top:solid black 1.0pt;border-left: none;border-bottom:solid black 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:49.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003ePreoperative\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.9pt;border-top:solid black 1.0pt;border-left: none;border-bottom:solid black 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:49.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003e12 months\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:75.05pt;border-top:solid black 1.0pt;border-left: none;border-bottom:solid black 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:49.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.15pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003ePOAG (mmHg, mean \u0026plusmn; sd)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.9pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e9.47\u0026plusmn;3.60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.9pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e4.53\u0026plusmn;1.86\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:75.05pt;padding:0in 5.4pt 0in 5.4pt;height:25.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.15pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:black;'\u003ePXFG (mmHg, mean \u0026plusmn; sd)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.9pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e9.59\u0026plusmn;3.64\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.9pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:#231F20;'\u003e4.03\u0026plusmn;1.23\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:75.05pt;border:none;border-bottom:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:24.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:388.0pt;padding:0in 5.4pt 0in 5.4pt;height:42.85pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003ePOAG: Primary Open - Angle Glaucoma. PXFG: Pseudoexfoliation Glaucoma. IOP: Intraocular pressure.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Surgical Success Rates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 3 depicts the cumulative surgical success rates across the three criteria (A/B/C) using the Kaplan-Meier method. Cumulative success rates under Criterion A 83.7%, 81.4%, and 76.7% at 3, 6, and 12 months postoperatively, respectively. The corresponding values for Criterion B were 76.7%, 76.7%, and 69.8%, whereas Criterion C achieved cumulative success rates of 62.8%, 62.8%, and 55.8%, respectively, at the same intervals.\u003c/p\u003e\n\u003cp\u003eFigure 4 illustrates the cumulative surgical success rates for the POAG and PXFG groups across the three criteria (A/B/C) using the Kaplan-Meier method. At 3 months postoperatively, the cumulative success rates in the POAG group were 82.76% (Criterion A), 70.83% (Criterion B), and 58.62% (Criterion C), compared to 85.71%, 85.71%, and 85.71% in the PXFG group, respectively. At 6 months, POAG achieved 79.31% (A), 75.86% (B), and 51.72% (C), whereas PXFG maintained 85.71% (A/B) and 71.43% (C). By 12 months, POAG success rates had decreased to 72.41% (A), 62.07% (B), and 44.82% (C), whereas PXFG retained higher rates of 85.71% (A/B) and 78.57% (C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Complications and Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCommon postoperative complications include hyphema, IOP spike, and secondary glaucoma surgery due to uncontrolled IOP. Hyphema occurred in five eyes (11.63%, three POAG eyes and two PXFG eyes), among which three eyes developed transient IOP elevation. All hyphemas resolved spontaneously within one week, with corresponding normalization of IOP. IOP spikes occurred in 3 eyes (6.98%, 2 POAG eyes, and 1 PXFG eye). \u0026nbsp;IOP elevation occurred in two eyes within 1 week postoperatively, both of which were controlled within the target IOP after 1-2 weeks of glaucoma medication. In the other eye, the IOP remained at 13-18 mmHg within 3 months postoperatively but measured 36 mmHg at the 3rd month postoperatively. Treatment with prostaglandin eye drops was initiated, and the IOP decreased to 18 mmHg after 1 week of use. From 6 to 12 months postoperatively, IOP remained stable at 15-17 mmHg without medication.. Among the patients in both groups, one eye in each group underwent goniotomy again one year after the initial surgery, and the intraocular pressure was well controlled after the surgery. None of the eyes included in the study developed severe complications such as shallow anterior chamber, malignant glaucoma, choroidal detachment, or endophthalmitis after the surgery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the 12-month surgical outcomes of KDB goniotomy combined with phacoemulsification in Chinese patients with open-angle glaucoma and compared the outcomes between the POAG and PXFG cohorts. The postoperative mean IOP and number of glaucoma medications were significantly lower than the preoperative values (P\u0026lt;0.01) in all 43 eyes. Surgical success rates at 12 months were 76.74% (Criterion A), 69.77% (Criterion B), and 55.81% (Criterion C), with no serious surgical complications observed. Published studies on KDB goniotomy for glaucoma of varying severity reported a 20% or greater IOP reduction from baseline in 58.3%\u0026ndash;66.67% of patients\u003csup\u003e[7]\u003c/sup\u003e\u003csup\u003e[8]\u003c/sup\u003e\u003csup\u003e[10]\u003c/sup\u003e\u003csup\u003e[22]\u003c/sup\u003e, alongside a 21.1%\u0026ndash;62.7% reduction in medication usage\u003csup\u003e[7]\u003c/sup\u003e\u003csup\u003e[23]\u003c/sup\u003e\u003csup\u003e[24]\u003c/sup\u003e\u003csup\u003e[25]\u003c/sup\u003e\u003csup\u003e[26]\u003c/sup\u003e, which is consistent with our findings. Barkander et al. reported similar surgical success rates between PXFG and POAG under Criterion A\u003csup\u003e[19]\u003c/sup\u003e, whereas other studies have demonstrated higher success rates in PXFG than in POAG\u003csup\u003e[18]\u003c/sup\u003e\u003csup\u003e[25]\u003c/sup\u003e. These discrepancies in reported success rates may be related to variations in disease severity, preoperative IOP levels, follow-up duration, and success criteria across studies. To further investigate these discrepancies, this study stratified surgical success into three criteria (A/B/C). Notably, PXFG consistently outperformed POAG across all the criteria. While no statistically significant differences were observed between the groups for Criteria A and B at 12 months postoperatively, Criterion C demonstrated success rates of 44.8% (POAG) versus 78.6% (PXFG) (P=0.052). This near-significant finding was limited by the sample size of the study. Future research with expanded enrollment is warranted, as narrowing the 95% confidence interval may yield statistically significant results.\u003c/p\u003e\n\u003cp\u003eThis study revealed no significant differences in\u0026nbsp;the preoperative mean IOP or glaucoma medication count between the POAG and PXFG groups. At 12 months postoperatively, both groups demonstrated statistically significant reductions in mean IOP and glaucoma medication usage compared to the preoperative values (P\u0026lt;0.05 for all within-group comparisons). This study found no statistically significant difference in the mean IOP between the POAG and PXFG groups at 12 months postoperatively. However, the PXFG group demonstrated a greater reduction in IOP than the baseline. Similar results were observed in subgroup analyses of advanced-stage patients from both groups, consistent with previous reports\u003csup\u003e[19][25][26]\u003c/sup\u003e. Patients with PXFG demonstrated a poorer response to preoperative medications, which was characterized by a higher baseline IOP. This contributed to their greater IOP reduction magnitude and higher surgical success rates under Criterion C than those in POAG patients. Additionally, the primary pathophysiological mechanism driving elevated IOP in PXFG involves the accumulation of extracellular exfoliation material within the trabecular meshwork, which disrupts trabecular matrix metabolism and impairs phagocytic function of trabecular cells, ultimately obstructing aqueous outflow\u003csup\u003e[26]\u003c/sup\u003e.\u003csup\u003e\u0026nbsp;\u003c/sup\u003eIn patients\u0026nbsp;with PXFG, KDB goniotomy allows complete resection of the diseased trabecular meshwork tissue, thereby enhancing aqueous outflow and reducing IOP..In contrast, some POAG cases demonstrate relatively lower IOP reduction and surgical success rates than PXFG due to posterior trabecular obstruction.\u003c/p\u003e\n\u003cp\u003eBoth POAG and PXFG patients exhibit significant 24-hour IOP fluctuations, which are major risk factors for glaucomatous progression\u003csup\u003e[27]\u003c/sup\u003e. To date have compared 24-hour IOP fluctuations between these two groups following KDB goniotomy combined with phacoemulsification. However, our study demonstrated that postoperative circadian IOP fluctuations were significantly reduced in both the POAG and PXFG groups compared to preoperative levels, indicating that this surgical approach effectively mitigates both mean IOP and 24-hour IOP fluctuations, which may contribute to better disease progression control.\u003c/p\u003e\n\u003cp\u003eThis study demonstrated similar incidence rates of hyphema and IOP spikes between the two groups. Published studies report hyphema incidence rates ranging from 8.4% to 34.9% and IOP spike rates of 1.0%\u0026ndash;17.0% following KDB\u0026nbsp;goniotomy\u003csup\u003e[11]\u003c/sup\u003e\u003csup\u003e[17]\u003c/sup\u003e\u003csup\u003e[20]\u003c/sup\u003e\u003csup\u003e[25]\u003c/sup\u003e\u003csup\u003e[26]\u003c/sup\u003e\u003csup\u003e[28]\u003c/sup\u003e, which aligns with the findings of the present study. Some authors suggest that IOP spike following micro invasive glaucoma surgery (MIGS) may be associated with postoperative hyphema and transient inflammatory responses\u003csup\u003e[1][5]\u003c/sup\u003e.\u0026nbsp;Other authors have postulated that the abovementioned scenario may be associated with shallow ciliary body detachment or resolution of supraciliary effusion leading to\u0026nbsp;IOP spike\u003csup\u003e[29]\u003c/sup\u003e\u003csub\u003e,\u0026nbsp;\u003c/sub\u003eIn conclusion, we recommend minimizing angle hemorrhage during surgery, intensifying postoperative anti-infective therapy, and performing early anterior segment OCT examinations to evaluate gonioscopic structures and detect ciliary body detachment. Published studies indicate that\u0026nbsp;IOP spikes typically occur within the first postoperative month \u003csup\u003e[1][7][25]\u003c/sup\u003e. In our study, IOP spikes occurred in 2 eyes within 1 week and in 1 eye at 3 months postoperatively. All affected patients achieved the target IOP through the administration of glaucoma medications and close follow-up monitoring. This suggests that an IOP spike may occur within 3 months postoperatively, which does not necessarily represent persistent elevation of IOP, indicating surgical failure. Therefore, early secondary surgeries should be avoided.\u003c/p\u003e\n\u003cp\u003eIn this study, one eye from each subgroup of severe-stage patients in both groups failed to achieve target IOP and showed visual field progression despite maximal medical therapy, necessitating secondary surgery at 1 year postoperatively.These findings suggest that advanced-stage patients require close follow-up, as those with suboptimal postoperative IOP control may face an increased risk of secondary surgery. Additionally, this study included 4 eyes with uncontrolled IOP\u0026nbsp;after trabeculectomy. After undergoing KDB goniotomy combined with phacoemulsification,\u0026nbsp;all of them\u0026nbsp;have successfully achieved the surgical goals of reducing IOP and the number of glaucoma medications\u0026nbsp;by avoiding disruption of the conjunctiva and sclera while preserving the physiological structure of the majority of the trabecular meshwork. KDB goniotomy offers a viable treatment option for patients requiring subsequent filtering glaucoma surgery or those who have failed previous filtering procedures.\u003c/p\u003e\n\u003cp\u003eThe advantages of this study lie in its focus on the population of Chinese open-angle glaucoma patients, relatively long follow-up time, and comparison of the surgical effects of POAG and PXFG, especially through 24-hour IOP monitoring. The limitations of this study are that it was a retrospective study, and it is necessary to extend the follow-up time and increase the sample size to observe long-term effectiveness and safety.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, KDB goniotomy combined with phacoemulsification achieved a significant reduction in IOP and number of glaucoma medications in Chinese patients with open-angle glaucoma, exhibiting favorable safety.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Medical Ethical Committee of the Third People's Hospital of Dalian University of Technology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflict of interest exists in the submission of this manuscript, and the manuscript has been approved by all authors for publication. The work described in this paper is original research that has not been published previously and is not under consideration for publication elsewhere, in whole or in part.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from the Scientific Research Start-up Fund Project of the Third People's Hospital of Dalian University of Technology (2023ky006), and the Medical Science Research Program Project of Dalian Municipal (2111007).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Jian Yu analyzed and interpreted the patient data. Yachen Wang and Huan Guan served as assistants in all the aforementioned surgical procedures, helped collate surgery-related data and materials, and recorded patients' follow-up information. Prof. Lijun Zhao was the supervisor of the project, and she contributed to the writing and revision of the paper. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge our colleagues from the Third People's Hospital of Dalian University of Technology for their generous assistance with our research.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSakamoto T, Nisiwaki H. Factors associated with 1-year outcomes and transient intraocular pressure elevation in minimally invasive glaucoma surgery using Kahook Dual Blades. Sci Rep. 2023 Sep 14;13(1):15206. doi: 10.1038/s41598-023-42575-3. PMID: 37710010; PMCID: PMC10502046.\u003c/li\u003e\n \u003cli\u003eArimura S, Iwasaki K, Gozawa M, Takamura Y, Inatani M.\u0026nbsp;goniotomy followed by phacoemulsification versus goniotomy alone: The Collaborative Bleb-Related Infection Incidence and Treatment Study. PLoS One. 2019 Oct 24;14(10):e0223439. doi: 10.1371/journal.pone.0223439. PMID: 31647848; PMCID: PMC6812865.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Carlo L , Laura D , Milena M ,et al.Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis[J].Plos One, 2017, 12(8):e0183142.DOI:10.1371/journal.pone.0183142.\u003c/li\u003e\n \u003cli\u003eErin GS, Cara EC, Rebecca SE, et al. Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy[J]. Eye and Vision, 2020,6(6):8-13.\u003c/li\u003e\n \u003cli\u003eIwasaki K , Kakimoto H , Orii Y ,et al.Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma [J]. Journal of Clinical Medicine , 2022, 11.DOI : 10.3390 / jcm11051354.\u003c/li\u003e\n \u003cli\u003eBravetti GE, Gillmann K, Salinas L, et al.\u0026nbsp;Surgical outcomes of excisional goniotomy using the kahook dual blade in severe and refractory glaucoma: 12-month results[J]. Eye,2023,37(8):1608-1613. DOI:10.1038/s41433-022-02196-y.\u003c/li\u003e\n \u003cli\u003eGreenwood MD, Seibold LK, Radcliffe NM, Dorairaj SK, Aref AA, Rom\u0026aacute;n JJ, Lazcano-Gomez GS, Darlington JK, Abdullah S, Jasek MC, Bahjri KA, Berdahl JP. Goniotomy with a single-use dual blade: Short-term results. J Cataract Refract Surg. 2017 Sep;43(9):1197-1201. doi: 10.1016/j.jcrs.2017.06.046. PMID: 28991617.\u003c/li\u003e\n \u003cli\u003eMechleb N, Tomey K, Cherfan D, Nemr A, Cherfan G, Dorairaj S, Khoueir Z. Six months\u0026apos; follow-up of combined phacoemulsification-kahook dual blade excisional goniotomy. Saudi J Ophthalmol. 2022 Aug 29;36(2):195-200. doi: 10.4103/sjopt.sjopt_151_21. PMID: 36211310; PMCID: PMC9535917.\u003c/li\u003e\n \u003cli\u003eHirabayashi MT, King JT, Lee D, An JA. Outcome of phacoemulsification combined with excisional goniotomy using the Kahook Dual Blade in severe glaucoma patients at 6 months. Clin Ophthalmol. 2019 Apr 24;13:715-721. doi: 10.2147/OPTH.S196105. PMID: 31114149; PMCID: PMC6488161.\u003c/li\u003e\n \u003cli\u003eAnsari E, Loganathan D. 12-month clinical outcomes of combined phacoemulsification and ab interno goniotomy for open-angle glaucoma in the United Kingdom. PLoS One. 2021 Jun 17;16(6):e0252826. doi: 10.1371/journal.pone.0252826. PMID: 34138879; PMCID: PMC8211240.\u003c/li\u003e\n \u003cli\u003eSalinas L, Chaudhary A, Berdahl JP, Lazcano-Gomez GS, Williamson BK, Dorairaj SK, Seibold LK, Smith S, Aref AA, Darlington JK, Jimenez-Roman J, Mahootchi A, Boucekine M, Mansouri K. Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes. J Glaucoma. 2018 Oct;27(10):849-855. doi: 10.1097/IJG.0000000000001019. PMID: 29979337.\u003c/li\u003e\n \u003cli\u003eKrishnamurthy R, Senthil S, Choudhari N. Initial experience with phacoemulsification and goniotomy using the Kahook dual blade in advanced open-angle glaucoma: Six-month outcomes in Indian eyes. Indian J Ophthalmol. 2021 Sep;69(9):2484-2487. doi: 10.4103/ijo.IJO_2999_20. PMID: 34427249; PMCID: PMC8544104.\u003c/li\u003e\n \u003cli\u003eMurata N, Takahashi E, Saruwatari J, Kojima S, Inoue T. Outcomes and risk factors for ab interno trabeculotomy with a Kahook Dual Blade. Graefes Arch Clin Exp Ophthalmol. 2023 Feb;261(2):503-511. doi: 10.1007/s00417-022-05799-z. Epub 2022 Aug 12. PMID: 35960356.\u003c/li\u003e\n \u003cli\u003eKuerten D, Walter P, Baumgarten S, Fuest M, Plange N. 12-month outcomes of ab interno excisional goniotomy combined with cataract surgery in primary open-angle glaucoma and normal tension glaucoma. Int Ophthalmol. 2023 Mar 2. doi: 10.1007/s10792-023-02659-5. Epub ahead of print. PMID: 36862355.\u003c/li\u003e\n \u003cli\u003eMiller VJ, Patnaik JL, Young CEC, SooHoo JR, Seibold LK, Kahook MY, Ertel MK, Palestine AG, Pantcheva MB. Outcomes of Kahook Dual Blade Goniotomy for Uveitis Associated Open Angle Glaucoma or Ocular Hypertension. J Glaucoma. 2022 Nov 1;31(11):903-908. doi: 10.1097/IJG.0000000000002099. Epub 2022 Aug 9. PMID: 35980845.\u003c/li\u003e\n \u003cli\u003eTan Q, Li J, Lin D, Zhao P. Risk factors of surgical failure in combined phacoemulsification and excisional goniotomy for angle-closure glaucoma. Graefes Arch Clin Exp Ophthalmol. 2023 Feb;261(2):535-543. doi: 10.1007/s00417-022-05808-1. Epub 2022 Aug 27. PMID: 36029305.\u003c/li\u003e\n \u003cli\u003eAl Habash A, Albuainain A. Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma. Sci Rep. 2021 May 21;11 (1) : 10660. doi: 10.1038 / s41598-021-90223-5. PMID: 34021228; PMCID: PMC8140085.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOmoto, Takashi., Sugiura, Aya., Sugiura, Aya., Fujishiro, Takashi., \u0026amp; Asano-Shimizu, Kimiko. (2021). Twelve-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy in Japanese patients with open-angle glaucoma. PloS one, 16(1), e0245015.\u003c/li\u003e\n \u003cli\u003eBarkander A, Economou MA, J\u0026oacute;hannesson G. Kahook Dual-Blade Goniotomy with and without Phacoemulsification in Medically Uncontrolled Glaucoma. Clin Ophthalmol. 2023 May 12;17:1385-1394. doi: 10.2147/OPTH.S409375. PMID: 37204995; PMCID: PMC10187655.\u003c/li\u003e\n \u003cli\u003ePratte EL, Ramachandran M, Landreneau JR, An JA. Risk Factors for Hyphema Following Kahook Dual Blade Goniotomy Combined With Phacoemulsification. J Glaucoma. 2023 Mar 1;32(3):165-170. doi: 10.1097/IJG.0000000000002142. Epub 2022 Oct 28. PMID: 36730925.\u003c/li\u003e\n \u003cli\u003eLaroche D, Nkrumah G, Ugoh P, Ng C. 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. 2021 Apr;113(2):230-236. doi: 10.1016/j.jnma.2020.09.147. Epub 2020 Nov 4. PMID: 33158570.\u003c/li\u003e\n \u003cli\u003eStamer WD, Braakman ST, Zhou EH, et al. Biomechanics of Schlemm\u0026apos;s canal endothelium and intraocular pressure reduction[J]. Progress in retinal and eye research,2015,4486-98. DOI:10.1016/j.preteyeres.2014.08.002.\u003c/li\u003e\n \u003cli\u003ePratte EL, Cho J, Landreneau JR, Hirabayashi MT, An JA. Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification. J Curr Glaucoma Pract. 2022 Jan-Apr;16(1):47-52. doi: 10.5005/jp-journals-10078-1313. PMID: 36060044; PMCID: PMC9385392.\u003c/li\u003e\n \u003cli\u003eAl Habash A, Albuainain A. Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma. Sci Rep. 2021 May 21;11(1):10660. doi: 10.1038/s41598-021-90223-5. PMID: 34021228; PMCID: PMC8140085.\u003c/li\u003e\n \u003cli\u003eWakil, S.M.; Birnbaum, F.; Vu, D.M.; McBurney-Lin, S.; ElMallah, M.K.; Tseng, H. Efficacy and safety of a single-use dual blade goniotomy: 18-month results. J. Cataract Refract. Surg. 2020, 46, 1408\u0026ndash;1415.\u003c/li\u003e\n \u003cli\u003eSieck, E.G.; Epstein, R.S.; Kennedy, J.B.; SooHoo, J.R.; Pantcheva, M.B.; Patnaik, J.L.; Wagner, B.D.; Lynch, A.M.; Kahook, M.Y.; Seibold, L.K. Outcomes of Kahook Dual Blade goniotomy with and without phacoemulsification cataract extraction. Ophthalmol. Glaucoma 2018, 1, 75\u0026ndash;81.\u003c/li\u003e\n \u003cli\u003eHeijl, Anders., Leske, M Cristina., Bengtsson, Bo., Hyman, Leslie., Bengtsson, Boel.. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Archives of ophthalmology (Chicago, Ill. : 1960), 2002, 120(10):1268-79.\u003c/li\u003e\n \u003cli\u003eElMallah, M.K.; Seibold, L.K.; Kahook, M.Y.; Williamson, B.K.; Singh, I.P.; Dorairaj, S.K.; KDB Goniotomy Study Group. 12-month retrospective comparison of Kahook Dual Blade excisional goniotomy with istent trabecular bypass device implantation in glaucomatous eyes at the time of cataract surgery. Adv. Ther. 2019, 36, 2515\u0026ndash;2527.\u003c/li\u003e\n \u003cli\u003eShi Y, Wang H, Oatts JT, et al. A Prospective Study of Intraocular Pressure Spike and Failure After Gonioscopy-Assisted Transluminal Trabeculotomy in Juvenile Open-Angle Glaucoma: A Prospective Study of GATT in JOAG[J]. American Journal of Ophthalmology: The International Journal of Ophthalmology,2022,23679-88. DOI:10.1016/j.ajo.2021.10.009.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"glaucoma, goniotomy, Kahook dual blade, surgical outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7140673/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7140673/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo evaluate the efficacy and safety of Kahook dual-blade (KDB) goniotomy combined with phacoemulsification for open-angle glaucoma in Chinese patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe 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. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe\u003c/span\u003e 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\u0026thinsp;\u0026ge;\u0026thinsp;20% with IOP\u0026thinsp;\u0026le;\u0026thinsp;21 mmHg), Criterion B (IOP reduction\u0026thinsp;\u0026ge;\u0026thinsp;20% with IOP\u0026thinsp;\u0026le;\u0026thinsp;18 mmHg), and Criterion C (IOP reduction\u0026thinsp;\u0026ge;\u0026thinsp;20% with IOP\u0026thinsp;\u0026le;\u0026thinsp;15 mmHg).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe 43 eyes included had a mean preoperative IOP of 24.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.68 mmHg, which decreased to 15.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98 mmHg at 12 months postoperatively (\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The mean number of preoperative glaucoma medications\u003c/span\u003e decreased from 1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 to 0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56 at 12 months postoperatively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe\u003c/span\u003e 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 no\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003et significantly differen\u003c/span\u003et between \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe POAG and\u003c/span\u003e PXFG groups. At 12 months, mean IOP in the POAG group was 15.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74 mmHg, compared at 23.41\u0026thinsp;\u0026plusmn;\u0026thinsp;5.68 mmHg preoperatively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewhereas in the\u003c/span\u003e PXFG group, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe mean IOP decreased from 26.14\u0026thinsp;\u0026plusmn;\u0026thinsp;8.51 mmHg preoperatively to 14.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23 mmHg postoperatively\u003c/span\u003e at 12 months(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Twenty-four-hour IOP fluctuations at 12 months were 4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86 mmHg in POAG and 4.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23 mmHg in PXFG, both significantly lower than preoperative values (9.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60 mmHg and 9.59\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64 mmHg, respectively; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for both groups). The mean number of glaucoma medications used at 12 months postoperatively was 0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61 in the POAG group and 0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47 in the PXFG group, both significantly lower than preoperative values (1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10 and 1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27, respectively; P\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;=\u0026thinsp;0.456); according to Criterion B, 62.07% vs. 85.71% (P\u0026thinsp;=\u0026thinsp;0.164); and according to Criterion C, 44.82% vs. 78.57% (P\u0026thinsp;=\u0026thinsp;0.052). Common surgical complications include hyphema and IOP spikes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eKDB 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.\u003c/p\u003e","manuscriptTitle":"Analysis of the 12-Month Efficacy and Safety of Kahook dual blade goniotomy Combined with Phacoemulsification in Chinese Patients with Open-Angle Glaucoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-29 15:47:52","doi":"10.21203/rs.3.rs-7140673/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"753a8591-8e54-43bc-8ad4-8f54a674831d","owner":[],"postedDate":"July 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-14T09:23:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-29 15:47:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7140673","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7140673","identity":"rs-7140673","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}