Download PDF
CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2020; 12(02): e181-e187
DOI: 10.1055/s-0040-1717055
Research Article

Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Eli L. Pratte 
1   School of Medicine, University of Missouri, Columbia, Missouri
,
James R. Landreneau 
1   School of Medicine, University of Missouri, Columbia, Missouri
2   Department of Ophthalmology, Mason Eye Institute, University of Missouri, Columbia, Missouri
,
Matthew T. Hirabayashi 
1   School of Medicine, University of Missouri, Columbia, Missouri
2   Department of Ophthalmology, Mason Eye Institute, University of Missouri, Columbia, Missouri
,
Jella A. An 
1   School of Medicine, University of Missouri, Columbia, Missouri
2   Department of Ophthalmology, Mason Eye Institute, University of Missouri, Columbia, Missouri
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Objective Kahook Dual Blade goniotomy (KDB) has proven effective in lowering intraocular pressure (IOP) and reducing the medication burden in patients with glaucoma. This study compares outcomes up to 12 months postoperatively after KDB combined with phacoemulsification (phaco-KDB) between an ophthalmology attending and residents.

Methods A retrospective analysis was performed on 160 eyes of 113 patients who received a phaco-KDB performed by either an ophthalmology attending or a resident under direct guidance of the attending. Data for each patient was collected preoperatively and at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. The primary outcome measure was surgical success, defined as 20% IOP reduction or at least 1 medication reduction at 12 months. The secondary outcome measures included mean IOP and medication reduction at each postoperative time point, adverse events, operating time, and survival time, defined as time to failure to meet the criteria for surgical success or requiring a secondary IOP-lowering procedure.

Results Preoperative mean IOP was comparable between the two groups (p = 0.585), while baseline medications were higher in the attending group (p = 0.040). Rate of successful outcomes was similar in both groups at 12 months (73.3% attending vs. 87.5% residents, p = 0.708). Mean IOP reduction (1.7 vs. 4.3%, p = 0.278) and medication reduction (0.7 vs. 0.6, p = 0.537) also did not differ at 12 months. Presence of adverse events was similar between the groups (21.6 vs. 27.3%, p = 0.938). The survival time was significantly longer in the attending group (356.3 ± 20.2 days vs. 247.1 ± 26.8 days, p = 0.003). Resident cases took ∼10 minutes longer compared with attending cases (p < 0.001).

Conclusion IOP lowering outcomes and rate of adverse events of KDB were similar whether the primary surgeon was an attending or a resident surgeon. The survival time was significantly longer in the attending group, but overall success rate was 77.5% for both groups. This suggests phaco-KDB is an effective procedure that can be safely performed by a trainee under direct supervision of an experienced surgeon.

Keywords

glaucoma - goniotomy - Kahook Dual Blade - KDB - attending - resident - outcomes


Publication History

Received: 27 March 2020

Accepted: 11 August 2020

Article published online:
10 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014; 121 (11) 2081-2090
    CrossrefPubMedSearch in Google Scholar
  • 2 Lichter PR, Musch DC, Gillespie BW. CIGTS Study Group. et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001; 108 (11) 1943-1953
    CrossrefPubMedSearch in Google Scholar
  • 3 Harasymowycz P, Birt C, Gooi P. et al. Medical Management of Glaucoma in the 21st century from a Canadian perspective. J Ophthalmol 2016; 2016: 6509809
    CrossrefPubMedSearch in Google Scholar
  • 4 Newman-Casey PA, Robin AL, Blachley T. et al. The most common barriers to glaucoma medication adherence: a cross-sectional survey. Ophthalmology 2015; 122 (07) 1308-1316
    CrossrefPubMedSearch in Google Scholar
  • 5 Hirabayashi MT, Lee D, King JT, Thomsen S, An JA. Comparison of surgical outcomes of 360° circumferential trabeculotomy versus sectoral excisional goniotomy with the Kahook Dual Blade at 6 months. Clin Ophthalmol 2019; 13: 2017-2024
    CrossrefPubMedSearch in Google Scholar
  • 6 Le C, Kazaryan S, Hubbell M, Zurakowski D, Ayyala RS. Surgical outcomes of phacoemulsification followed by iStent implantation versus goniotomy with the Kahook Dual Blade in patients with mild primary open-angle glaucoma with a minimum of 12-month follow-up. J Glaucoma 2019; 28 (05) 411-414
    CrossrefPubMedSearch in Google Scholar
  • 7 Lee D, King J, Thomsen S, Hirabayashi M, An J. Comparison of surgical outcomes between excisional goniotomy using the Kahook Dual Blade and iStent trabecular micro-bypass stent in combination with phacoemulsification. Clin Ophthalmol 2019; 13: 2097-2102
    CrossrefPubMedSearch in Google Scholar
  • 8 ElMallah MK, Berdahl JP, Williamson BK. et al. Twelve-month outcomes of stand-alone excisional goniotomy in mild to severe glaucoma. Clin Ophthalmol 2020; 14: 1891-1897
    CrossrefPubMedSearch in Google Scholar
  • 9 Berdahl JP, Gallardo MJ, ElMallah MK. et al. Six-month outcomes of goniotomy performed with the Kahook Dual Blade as a stand-alone glaucoma procedure. Adv Ther 2018; 35 (11) 2093-2102
    CrossrefPubMedSearch in Google Scholar
  • 10 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; 13: 715-721
    CrossrefPubMedSearch in Google Scholar
  • 11 Seibold LK, Soohoo JR, Ammar DA, Kahook MY. Preclinical investigation of ab interno trabeculectomy using a novel dual-blade device. Am J Ophthalmol 2013; 155 (03) 524-529.e2
    CrossrefPubMedSearch in Google Scholar
  • 12 Bostan C, Harasymowycz P. Episcleral venous outflow: a potential outcome marker for iStent surgery. J Glaucoma 2017; 26 (12) 1114-1119
    CrossrefPubMedSearch in Google Scholar
  • 13 Toshev AP, Much MM, Klink T, Pfeiffer N, Hoffmann EM, Grehn F. Catheter-assisted 360-degree trabeculotomy for congenital glaucoma. J Glaucoma 2018; 27 (07) 572-577
    CrossrefPubMedSearch in Google Scholar
  • 14 Salinas L, Chaudhary A, Berdahl JP. et al. Goniotomy using the Kahook Dual Blade in severe and refractory glaucoma: 6-month outcomes. J Glaucoma 2018; 27 (10) 849-855
    CrossrefPubMedSearch in Google Scholar
  • 15 Yook E, Vinod K, Panarelli JF. Complications of micro-invasive glaucoma surgery. Curr Opin Ophthalmol 2018; 29 (02) 147-154
    CrossrefPubMedSearch in Google Scholar
  • 16 Khouri AS, Vold SD. Point/Counterpoint: Should Patients Share the Cost of MIGS Procedures? Glaucoma Today [Internet]. BMC. May/June 2015. Available at: https://glaucomatoday.com/articles/2015-may-june/pointcounterpoint-should-migs-be-included-during-residency-training?c4src=issue:feed
  • 17 Bar-David L, Blumenthal EZ. Evolution of glaucoma surgery in the last 25 years. Rambam Maimonides Med J 2018;9(03):
  • 18 Low SAW, Braga-Mele R, Yan DB, El-Defrawy S. Intraoperative complication rates in cataract surgery performed by ophthalmology resident trainees compared to staff surgeons in a Canadian academic center. J Cataract Refract Surg 2018; 44 (11) 1344-1349
    CrossrefPubMedSearch in Google Scholar
  • 19 Thangamathesvaran L, Crane E, Modi K, Khouri AS. Outcomes of resident-versus attending-performed tube shunt surgeries in a United States Residency Program. J Curr Glaucoma Pract 2018; 12 (02) 53-58
    CrossrefPubMedSearch in Google Scholar
  • 20 Kahook Dual Blade - Instructions for Use: New World Medical. 2015 [Available from: https://www.newworldmedical.com/wp-content/uploads/2020/07/KDB-IFU-50-0069-Rev-F.pdf. Accessed Aug 27, 2020
  • 21 Dorairaj SK, Seibold LK, Radcliffe NM. et al. 12-Month outcomes of goniotomy performed using the Kahook Dual Blade combined with cataract surgery in eyes with medically treated glaucoma. Adv Ther 2018; 35 (09) 1460-1469
    CrossrefPubMedSearch in Google Scholar
  • 22 Chang DF, Tan JJ, Tripodis Y. Risk factors for steroid response among cataract patients. J Cataract Refract Surg 2011; 37 (04) 675-681
    CrossrefPubMedSearch in Google Scholar
  • 23 Sieck EG, Capitena Young CE, Epstein RS. et al. Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy. Eye Vis (Lond) 2019; 6: 28
    CrossrefPubMedSearch in Google Scholar
  • 24 Phulke S, Kaushik S, Kaur S, Pandav SS. Steroid-induced glaucoma: an avoidable irreversible blindness. J Curr Glaucoma Pract 2017; 11 (02) 67-72
    CrossrefPubMedSearch in Google Scholar
  • 25 Fong CS, Mitchell P, de Loryn T. et al. Long-term outcomes of phacoemulsification cataract surgery performed by trainees and consultants in an Australian cohort. Clin Exp Ophthalmol 2012; 40 (06) 597-603
    CrossrefPubMedSearch in Google Scholar
  • 26 Bydon M, Abt NB, De la Garza-Ramos R. et al. Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients. J Neurosurg 2015; 122 (04) 955-961
    CrossrefPubMedSearch in Google Scholar