Instituto de Olhos Ciências Médicas, Belo Horizonte, MG, Brazil.
Glaucoma Department, Instituto de Olhos Ciências Médicas, Belo Horizonte, MG, Brazil.
Arq Bras Oftalmol. 2021 Sep 10;85(4):359-363. doi: 10.5935/0004-2749.20220046. eCollection 2021.
The purpose of this study was to investigate the postoperative outcomes and evaluate the success predictors of phacoemulsification with Kahook Dual Blade goniotomy for cataract and glaucoma management in eyes with primary open-angle glaucoma.
This was a retrospective, non-comparative; inter ventional case series in which all patients with primary open-angle glaucoma who underwent phacoemulsification with Kahook Dual Blade goniotomy between June 2018 and April 2019 were enrolled. All the participants had a minimum follow-up period of 6 months. Preoperative and postoperative intraocular pressure values (at 1, 3, and 6 months), number of antiglaucoma medications, best-corrected visual acuity, surgical complications, and any subsequent related events or procedures were recorded. A logistic regression analysis was performed to investigate the association between the different variables and surgical outcomes.
A total of 47 patients (57 eyes) were included (mean age, 70.5 ± 7 years). The mean intraocular pressure was reduced from 15.5 ± 4.2 mmHg to 12.2 ± 2.4 mmHg at the last follow-up visit (p<0.001). The mean number of antiglaucoma medications decreased significantly from 1.9 ± 1.0 to 0.6 ± 1.0 during the same period (p<0.001). On the basis of the predefined criterion (intraocular pressure reduction ≥20% and/or reduction ≥1 medication), the 6-month success rate was 86%. A higher preoperative intraocular pressure value (odds ratio [OR]= 2.01; p=0.016) and greater percentage of initial (30 days) intraocular pressure reduction (OR= 1.02; p=0.033) were sig nificantly associated with surgical success.
Our findings suggest that phacoemulsification with Kahook Dual Blade goniotomy is an effective and safe alternative for cataract management in eyes with primary open-angle glaucoma that positively impacts intraocular pressure control and medication burden. Eyes with higher baseline intraocular pressure and a more pronounced initial response to the procedure appeared to present better outcomes at 6 months. Further studies are needed to evaluate the long-term efficacy and safety profile of the procedure.
本研究旨在探讨超声乳化白内障吸除术联合 Kahook 双切刀房角切开术治疗原发性开角型青光眼合并白内障患者的术后效果，并评估其手术成功的预测因素。
本研究为回顾性、非对照、干预性病例系列研究，纳入 2018 年 6 月至 2019 年 4 月期间接受超声乳化白内障吸除术联合 Kahook 双切刀房角切开术治疗的所有原发性开角型青光眼患者。所有患者的随访时间均至少为 6 个月。记录术前和术后的眼压值（术后 1、3 和 6 个月）、降眼压药物的使用数量、最佳矫正视力、手术并发症以及任何后续相关事件或手术。采用逻辑回归分析评估不同变量与手术结果之间的关系。
共纳入 47 例（57 只眼）患者（平均年龄 70.5 ± 7 岁）。末次随访时，眼压从术前的 15.5 ± 4.2mmHg 降至 12.2 ± 2.4mmHg（p<0.001）。同时，降眼压药物的使用数量从术前的 1.9 ± 1.0 降至术后的 0.6 ± 1.0（p<0.001）。根据预设标准（眼压降低≥20%和/或减少≥1 种药物），6 个月时的手术成功率为 86%。术前眼压较高（优势比 [OR]=2.01；p=0.016）和初始（30 天）眼压降低幅度较大（OR=1.02；p=0.033）与手术成功显著相关。
本研究结果表明，超声乳化白内障吸除术联合 Kahook 双切刀房角切开术是治疗原发性开角型青光眼合并白内障的一种有效且安全的方法，可有效控制眼压和减少药物使用。基线眼压较高和术后早期眼压反应更明显的患者在 6 个月时的手术效果更好。需要进一步的研究来评估该手术的长期疗效和安全性。
