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Comparison of Surgical Outcomes Between Microhook Ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade in Combination with Phacoemulsification: A Retrospective, Comparative Case Series

Abstract

Purpose

To study surgical outcomes of patients with a minimum of 6 months of follow-up after undergoing combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy using the Kahook Dual Blade (KDB-Phaco).

Methods

This retrospective comparative case series examined 22 μLOT-Phaco eyes and 81 KDB-Phaco eyes that underwent surgery between December 2016 and October 2018. Data collected from medical records included pre- and postoperative intraocular pressure (IOP), number of IOP-lowering medications and complication occurrence. Potential risk factors for failure were determined by Cox proportional hazards regression analysis. Surgical failure was defined as an IOP of > 20 mmHg, < 20% reduction in preoperative IOP or additional glaucoma surgery. Kaplan-Meier survival analysis was used to assess success rates. Score matching used a genetic algorithm consisting of type of glaucoma.

Results

Of 81 KDB-Phaco eyes, 22 eyes were matched to 22 μLOT-Phaco eyes. Mean IOP in the μLOT-Phaco group decreased from 24.7 ± 6.4 mmHg at baseline to 14.4 ± 3.0 mmHg (P < 0.01) and 13.0 ± 2.5 mmHg (P < 0.01) at 6 and 12 months, respectively. Mean IOP in the KDB-Phaco group decreased from 23.2 ± 5.4 mmHg to 15.8 ± 3.3 mmHg (P < 0.001) and 16.7 ± 2.1 mmHg (P < 0.001), respectively. Mean number of preoperative IOP-lowering medications in the μLOT-Phaco group at baseline was 3.7 ± 1.0, which decreased to 1.4 ± 1.5 (P < 0.01) at 12 months, while in the KDB-Phaco group it decreased from a baseline value of 3.3 ± 1.2 to 1.1 ± 1.4 (P < 0.01). Probability of qualified success at 12 months in the μLOT-Phaco and KDB-Phaco groups was 71.8% and 62.2%, respectively (P = 0.75). Similar postoperative complications were found between the groups.

Conclusions

Use of μLOT-Phaco and KDB-Phaco resulted in comparable IOPs and reductions in the number of medications.

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Fig. 1

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Acknowledgements

We thank the participants of the study.

Funding

This work was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (20K09827). The Rapid Service Fees were funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

Authorship Contributions

Technical assistance for this manuscript was provided by Drs. Yuki Yuasa, Hideaki Okumichi and Yoshiaki Kiuchi. Data collection was provided by Drs. Ryota Aoki, Hiromitsu Onoe and Erina Goda. Analysis and writing of this manuscript were provided by Dr. Ryota Aoki. Editing assistance for this manuscript was provided by Dr. Kazuyuki Hirooka.

Disclosures

Ryota Aoki, Kazuyuki Hirooka, Erina Goda, Yuki Yuasa, Hideaki Okumichi, Hiromitsu Onoe and Yoshiaki Kiuchi declare that they have no conflict of interest and nothing to disclosure.

Compliance with Ethics Guidelines

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional Review Board of the Hiroshima University: E-1363, Kagawa University Faculty of Medicine: 26-110) and with the Helsinki Declaration of 1964, as revised in 2013. All subjects provided written informed consent in addition to the standard consent for surgery prior to their enrollment and participation in the research study.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Kazuyuki Hirooka.

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Aoki, R., Hirooka, K., Goda, E. et al. Comparison of Surgical Outcomes Between Microhook Ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade in Combination with Phacoemulsification: A Retrospective, Comparative Case Series. Adv Ther 38, 329–336 (2021). https://doi.org/10.1007/s12325-020-01543-3

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Keywords

  • Intraocular pressure
  • Kahook dual blade
  • Microhook
  • Ophthalmology