Laroche Daniel, Nkrumah Gideon, Ugoh Peter, Ng Chester
Department of Ophthalmology, New York Eye and Ear of Mount Sinai, USA; Advanced Eyecare of New York.
University of Pittsburgh, Pittsburgh, PA, USA.
J Natl Med Assoc. 2021 Apr;113(2):230-236. doi: 10.1016/j.jnma.2020.09.147. Epub 2020 Nov 4.
To determine the efficacy and safety of Kahook Dual Blade (KDB) goniotomy alone or combined with phacoemulsification cataract surgery to lower intraocular pressure and medication burden in Black and Afro-Latinx patients with open angle glaucoma (OAG).
A retrospective, single center case series of patients with OAG who were managed with medications and underwent phacoemulsification combined with goniotomy (PE + KDB) using Kahook Dual Blade or goniotomy alone (KDB alone) in pseudophakic patients. Indications for glaucoma surgery included reduction of intraocular pressure (IOP) and reduction of medication burden. Our study parameters included pre- and postoperative information on IOP, the use of IOP-lowering medications, visual field, and adverse events through 6 months of follow-up.
Among all 63 eyes of 63 patients undergoing surgery, Kahook goniotomy with or without phacoemulsification, mean IOP was significantly reduced from 17.4 mmHg at baseline to 14.0 mmHg at month 6 (P = 0.0012), a 19.5% reduction (KDB alone -26.4%, PE + KDB -16.6%). The mean number of topical IOP-lowering medications was reduced from 2.6 at baseline to 1.6 ± 0.3 at month 6 (P = 0.0012), a 38.5% reduction (Kahook alone -10.7%, PE + Kahook -48.0%). Mean visual fields were stable in the PE + KDB group and progressed in the KDB alone group. Postoperative adverse events were mild and included transient hyphema, IOP spikes, posterior capsule opacification, tearing, glare and mild pain.
Phacoemulsification combined with Kahook dual blade goniotomy significantly lowers both IOP and medication burden in Black and Afro-Latinx patients with open angle glaucoma. In pseudophakic patients with advanced glaucoma medication burden is not significantly reduced and visual field progression occurred. Adverse events were not sight-threatening and self limited.
确定单独使用卡胡克双刃刀（KDB）前房角切开术或联合超声乳化白内障手术降低黑人和非洲裔拉丁裔开角型青光眼（OAG）患者眼压及药物负担的疗效和安全性。
一项回顾性单中心病例系列研究，纳入使用药物治疗且接受了超声乳化联合前房角切开术（PE + KDB，使用卡胡克双刃刀）或单独前房角切开术（仅KDB）的假晶状体OAG患者。青光眼手术的指征包括降低眼压（IOP）和减轻药物负担。我们的研究参数包括术前和术后6个月随访期间的眼压、降眼压药物使用情况、视野及不良事件信息。
在接受手术的63例患者的63只眼中，无论是否联合超声乳化，卡胡克前房角切开术后平均眼压从基线时的17.4 mmHg显著降至第6个月时的14.0 mmHg（P = 0.0012），降低了19.5%（仅KDB组降低26.4%，PE + KDB组降低16.6%）。局部降眼压药物的平均使用数量从基线时的2.6种降至第6个月时的1.6 ± 0.3种（P = 0.0012），降低了38.5%（仅卡胡克组降低10.7%，PE + 卡胡克组降低48.0%）。PE + KDB组的平均视野稳定，仅KDB组视野进展。术后不良事件轻微，包括短暂性前房积血、眼压峰值、后囊膜混浊、流泪、眩光和轻度疼痛。
超声乳化联合卡胡克双刃刀前房角切开术可显著降低黑人和非洲裔拉丁裔开角型青光眼患者的眼压及药物负担。在晚期青光眼的假晶状体患者中，药物负担未显著降低且出现了视野进展。不良事件不威胁视力且为自限性。
