Endoscopic cyclophotocoagulation and Kahook Dual Blade trabeculotomy in combination with phacoemulsification

Convenient to perform alongside cataract surgery and relatively safe, minimally invasive glaucoma surgeries (MIGS) are growing in popularity. Few studies have examined the effect safety of performing combined MIGS. We outcomes combining two distinct MIGS: endoscopic cyclophotocoagulation (ECP) ab interno trabeculotomy with Kahook Dual Blade (KDB; New World Medical, Rancho Cucamonga, Calif), along phacoemulsification extraction intraocular lens placement (PEIOL). ECP is a cyclodestructive procedure goal treating ciliary processes disable aqueous-producing epithelium. tends be more durable older patients. Younger patients tend require re-treatment as either epithelium returns or residual increases function. KDB treatment aims remove trabecular meshwork complete fashion than alternative forms trabeculotomy. The suspected location greatest resistance outflow, juxtacanalicular meshwork, included this treatment. By decreasing aqueous production increasing outflow KDB, we hypothesize pressure (IOP) may decrease, an additive fashion, alone while maintaining low side profile. All eyes case series were diagnosed mild moderate open-angle (OAG) visually significant cataract. underwent ECP, PEIOL. PEIOL was performed first, then over approximately 270 degrees processes, sparing temporal quadrants, for 90 nasal quadrant. Data collected de-identified analysis. visual acuity (VA), IOP, number medications, complications. recorded at preoperative visit 1 day, week, 1, 3, 6, 12 months postoperatively. Averaged data each follow-up time point compared using paired t test. limit statistical significance set p < 0.05. Ten from 7 series. average patient age 68 ± years, distribution males females equal (see Table 1). Patients Caucasian (70%), Asian (20%), African American (10%). Only eye had received prior laser selective trabeculoplasty. Mean historical maximum IOP 25.3 3.7 mm Hg. At visit, mean found 18.6 3.9 Hg, on 2.1 1.4 which varying combinations latanoprost, timolol, dorzolamide, brimonidine. Preoperative Humphrey field deviation –4.38 4.85 dB. No lost vision result surgery, all best corrected VA 20/20 better months.Table 2Intraocular medications (mean standard deviation)Mean (mm Hg)Absolute reduction Hg)Percent (%)Medications (n)Absolute medication (n)Preoperative18.6 3.9——2.1 1.4—3 months16.0 3.1–2.6 2.6 (p = 0.012)–12.6 13.0 0.013)1.0 1.2–1.1 0.040)6 months13.9 3.2–4.7 0.003)–23.8 16.5 0.001)0.8. 0.9–1.3 1.2 0.017)12 months14.7 2.4–3.9 4.2 0.017)–18.0 18.5 0.013)0.8 1.1 0.004)IOP, Open table new tab postoperative month 3 ranged 13.9 16.0 Hg 2). Absolute by 0.017), 18% 18.5% 0.013) decrease. decreased 1.0 0.8 0.9 12. 1.3 0.004), 68.5% 34.9% decrease 0.001).Table 1DataPreopPOM3POM6POM12IOPMedAgeSexRaceTmIOPMedsIOPMedsIOPMedsIOPMeds? %*? % Percent reduction? #†? # Change mmHg? %‡? #§? used78FA22203151151161–20%–4–67%–278FA22203161151161–20%–4–67%–265FC221441611411410%0–75%–370MC22122110901308%1–100%–257MAA29244234123113–54%–13–25%–171MC26161151161150–6%–1–100%–163MC31232160200151–35%–8–50%–163MC27200182111141–30%–6N/A165FC30211160160200–5%–1–100%–165FC22161140110130–19%–3–100%–1Preop, preoperative; POM, Postoperative Month; pressure; Med, Medications; Tm, Maximum IOP; A, Asian; C, Caucasian; AA, ? reduction† mmHg‡ reduction§ used Preop, 12, success. A ?20% considered successful outcome, 40% achieving deemed ?1 reduction, achieved 90% one that did not achieve no previously, reduced greater 20%. completed follow-up, required additional intervention. Transient complications arose 2 eyes. microhyphema week spontaneously resolved. second experienced spike day 48 normalized medication. same cystoid macular edema resolved anti-inflammatory 3. Aliendres et al. working similar study PEIOL, 49 eyes.1Aliendres JL Villavicencio JCI Menzel CG Sánchez MR Maldonado C Chauca J. Comparison surgery: canaloplasty Ab micropulse v/s trabeculectomy endocyclophotocoagulation.Invest Ophthalmol Vis Sci. 2020; 61: 3156Google Scholar Their unpublished, but their abstract reports 6-month baseline 16.96 3.66 11.44 2.15 6. This represents 32.5% 1.2, representing 60% change. These results favourable ours terms use. Two PEIOL—one Francis al.2Francis BA Berke SJ Dustin L Noecker R. Endoscopic versus medically controlled glaucoma.J Cataract Refract Surg. 2014; 40: 1313-1321Abstract Full Text PDF PubMed Scopus (56) Google Siegel —are comparable. 12% 73% months.2Francis 15% 85% months.3Siegel MJ Boling WS Faridi OS al.Combined glaucoma.Clin Exp Ophthalmol. 2015; 43: 531-539Crossref (49) measurements both comparable 18.1 3.0 17.2 4.8 respectively. can reasonably conclude least efficacious out months. Studies vary, making comparison difficult. Dorairaj 26.2% 50% months.4Dorairaj SK Seibold LK Radcliffe NM al.12-month goniotomy treated glaucoma.Adv Ther. 2018; 35: 1460-1469Crossref (39) Berdahl noted impressive 36.2% 6 months.5Berdahl JP Gallardo ElMallah MK al.Six-month stand-alone procedure.Adv 2093-2102Crossref (20) resulted 57.7% 63.5% respectively.4Dorairaj 69.8% 67.9% respectively.5Berdahl Our combination less led medications. outcome measures those al., slightly higher One might assume adding offers little benefit. However, there many confounding factors. First, it possible our small sample size hiding procedure. Second, vary greatly extent aggressiveness application even when applied single surgeon day. Third, increase durability IOP-lowering effect. would longer 12-month interval study. also difficult due missing variables, potential bias, methodologic differences. demographic Demographic sparse. Both subgroup analysis showing between lower groups.4Dorairaj Scholar,5Berdahl Also, these industry funding. decision add prescribed valued burden. It likely investigator drop Overall, demonstrates comparatively safe use great limitation detecting subtleties efficacy allow analyses. Furthermore, although different anatomic structure quadrant ECP. untreated change given changes caused procedures. Future directions include expansion size, further ultimately randomized control studies. authors proprietary commercial interest any materials discussed article.