Retrospective comparison of Kahook Dual Blade Excisional Goniotomy with trabecular aspiration in pseudoexfoliation glaucoma at the time of cataract surgery using propensity score matching

TL;DR

This study compares two minimally invasive glaucoma surgeries combined with cataract surgery in patients with pseudoexfoliation glaucoma, finding similar IOP reduction but more additional surgeries needed with one method.

Contribution

This is the first real-world study comparing KDB and TA in pseudoexfoliation glaucoma using propensity score matching.

Findings

Both KDB and TA combined with cataract surgery reduced intraocular pressure in pseudoexfoliation glaucoma patients.

KDB was associated with a higher rate of additional surgical interventions compared to TA.

Abstract

Minimally invasive glaucoma surgeries (MIGS) have gained attention for their safety and efficacy, especially in clinical trials involving primary open-angle glaucoma. However, real-world data on pseudoexfoliation glaucoma (PEX glaucoma) remain limited. To our knowledge, this is the first real-world study comparing postoperative outcomes of Kahook Dual Blade Excisional Goniotomy (KDB) or trabecular aspiration (TA) in PEX glaucoma.

To compare the efficacy and safety of combined clear cornea cataract extraction with either KDB or TA in patients with PEX glaucoma.

A retrospective analysis.

We reviewed 113 eyes from 99 patients who underwent cataract surgery combined with either KDB (n = 71) or TA (n = 42) between May 2017 and May 2023 at the University Eye Hospital. Propensity score matching was used to create comparable groups of 30 KDB and 30 TA cases based on age, sex, baseline intraocular pressure (IOP), and number of glaucoma medications. Key outcomes included IOP, number of glaucoma medications, complications, and reoperations.

The mean patient age was 80.5 ± 7.3 years for KDB and 80.4 ± 7.7 years for TA, p = 0.94. 73.3% were women, p = 1.0. The mean baseline IOP was 20.4 ± 7.1 for KDB and 20.0 ± 8.4 for TA, p = 0.35, and the baseline number of glaucoma medications (Meds) was 2.0 ± 1.2 for KDB and 2.0 ± 1.2 for TA, p = 0.78. The mean postoperative IOP at 12 months was 13.5 ± 3.6 mmHg for KDB and 14.2 ± 2.6 mmHg for TA, p = 0.12, and Meds at 12 months were 1.0 ± 1.2 for KDB and 1.4 ± 1.1 for TA p = 0.12. The median follow-up was 13.1 (IQR: 11.6–17.1) months for the whole group. A total of four eyes following KDB and two after TA required additional surgery to lower the IOP.

Both KDB and TA with cataract extraction lowered IOP in PEX glaucoma. However, KDB was associated with a higher rate of additional surgical interventions to achieve adequate IOP control.

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