Comparative Efficacy of Phacoemulsification Combined with KDB Goniotomy versus Trabeculectomy for Primary Angle-Closure Glaucoma: A Retrospective Cohort Study

TL;DR

This study compares two surgical treatments for glaucoma and cataract, finding both effective but with slight differences in outcomes.

Contribution

The study provides a direct comparison of phaco-KDB and phaco-trab for PACG, highlighting the minimally invasive benefits of phaco-KDB.

Findings

Both procedures improved visual acuity and reduced intraocular pressure in patients with PACG and cataract.

Phaco-KDB achieved a success rate comparable to phaco-trab but required more medications post-surgery.

Phaco-KDB offers faster recovery and may reduce the need for more invasive filtration surgery.

Abstract

This study compared the efficacy and safety between phacotrabeculectomy (phaco-trab) and phacoemulsification combined with Kahook Dual Blade goniotomy (phaco-KDB) in patients with moderate to severe primary angle-closure glaucoma (PACG).

This single-center, non-randomized retrospective cohort study included 77 eyes from 74 PACG patients with concurrent cataract, who underwent either phaco-trab (40 eyes, 39 patients) or phaco-KDB (37 eyes, 35 patients). All patients had moderate-to-severe visual field (VF) defects and were using ≥ 2 topical intraocular pressure (IOP)-lowering medications preoperatively. Changes in best-corrected visual acuity (BCVA), IOP, medication use, mean deviation (MD) progression of VF, and complications were compared between the two groups.

The comparable follow-up duration was 13.5 ± 4.1 months (phaco-trab) and 12.9 ± 3.9 months (phaco-KDB) (P = 0.703). Postoperative BCVA improved in both groups, with no significant intergroup difference. The baseline IOP was 30.29 ± 7.69 mmHg in the phaco-trab group and 28.20 ± 4.70 mmHg in the phaco-KDB group, which decreased to 15.64 ± 3.22 mmHg and 17.55 ± 3.34 mmHg respectively (P = 0.041), and the phaco-KDB group required more medications (P =0.027) at the last follow-up. The qualified success rates were 87.5% (phaco-trab) versus 83.8% (phaco-KDB) (P = 0.604). No statistically significant progression of VF defects and no serious intraoperative or postoperative complications were noted.

Both KDB goniotomy and trabeculectomy, when combined with phacoemulsification, effectively improve visual acuity, reduce IOP, and stabilize VF in patients with moderate-to-severe PACG and concurrent cataract. Phaco-KDB is an effective ab interno procedure that achieves comparable success rate to phaco-trab, it's minimally invasive nature may delay or obviate filtration surgery, simplify procedure, and offer faster visual rehabilitation.

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