Guedes Jaime, Amaral Dillan Cunha, de Oliveira Caneca Karina, Cassins Aguiar Eduardo Henrique, de Oliveira Lucas Neves, Mora-Paez Denisse J, Cyrino Laura Goldfarb, Louzada Ricardo Noguera, Moster Marlene R, Myers Jonathan S, Schuman Joel S, Shukla Aakriti Garg, Shalaby Wesam Shamseldin
Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University.
Drexel University School of Biomedical Engineering, Science and Health Studies, Philadelphia, PA.
J Glaucoma. 2025 Mar 1;34(3):232-247. doi: 10.1097/IJG.0000000000002522. Epub 2024 Dec 9.
In this meta-analysis, Kahook dual blade (KDB) goniotomy achieved higher rates of surgical success compared with iStent/iStent inject implantation combined with phacoemulsification. KDB goniotomy demonstrated better intraocular pressure (IOP) reduction at month 6 compared with the stent group.
To compare the outcomes of phacoemulsification combined with either KDB goniotomy (phaco-KDB) or trabecular microbypass stent (iStent and iStent inject) implantation (phaco-Stent).
A literature search was performed on PubMed, Embase, Web of Science, and Cochrane Library from inception to April 2024. Randomized clinical trials and observational studies that compared KDB goniotomy to the first or second-generation iStent combined with phacoemulsification were included. The main outcome measures were surgical success, mean change in IOP and medication number, and complication rates. Mean differences (MDs) and pooled odds ratios were used to analyze continuous and binary outcomes, respectively.
Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject). The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (odds ratio: 0.68; 95% CI: 0.50 to 0.92; P = 0.01; I2 = 40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13 mm Hg; 95% CI: 0.43 to 1.83; P = 0.002; I2 = 51%). By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69 mm Hg; 95% CI: 0.44 to 2.95; P = 0.008; I2 = 74%). However, compared with the phaco-iStent inject group, there was no significant difference in IOP reduction (MD: -0.72 mm Hg; 95% CI: -3.69 to 2.24; P = 0.63; I2 = 64%). Medication reduction and the incidence of adverse events were comparable between groups.
KDB goniotomy may offer better surgical success compared with Stent implantation when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared with iStent. However, iStent inject showed a similar IOP reduction to KDB.
在这项荟萃分析中，与iStent/iStent inject植入联合超声乳化术相比，卡胡克双刃（KDB）前房角切开术取得了更高的手术成功率。与支架组相比，KDB前房角切开术在术后6个月时眼压（IOP）降低效果更好。
比较超声乳化联合KDB前房角切开术（超声乳化-KDB）或小梁微旁路支架（iStent和iStent inject）植入术（超声乳化-支架）的效果。
在PubMed、Embase、Web of Science和Cochrane图书馆进行了从创刊到2024年4月的文献检索。纳入了比较KDB前房角切开术与第一代或第二代iStent联合超声乳化术的随机临床试验和观察性研究。主要结局指标为手术成功率、IOP平均变化和用药数量以及并发症发生率。分别使用平均差（MDs）和合并比值比来分析连续性和二分类结局。
纳入了14项研究，共1959只眼（958只超声乳化-KDB眼，1000只超声乳化-支架眼，包括753只超声乳化-iStent眼和207只超声乳化-iStent inject眼）。综合结果显示，超声乳化-KDB组的手术成功率显著高于超声乳化-支架组（比值比：0.68；95%可信区间：0.50至0.92；P = 0.01；I² = 40%），且在术后6个月时，超声乳化-KDB组的IOP降低幅度大于超声乳化-支架组（MD：1.13 mmHg；95%可信区间：0.43至1.83；P = 0.002；I² = 51%）。到术后12个月时，两组的IOP降低幅度相似。术后12个月的亚组分析显示，超声乳化-KDB组的IOP降低幅度大于超声乳化-iStent组（MD：1.69 mmHg；95%可信区间：0.44至2.95；P = 0.008；I² = 74%）。然而，与超声乳化-iStent inject组相比，IOP降低幅度无显著差异（MD：-0.72 mmHg；95%可信区间：-3.69至2.24；P = 0.63；I² = 64%）。两组之间的用药减少情况和不良事件发生率相当。
与支架植入术联合超声乳化术相比，KDB前房角切开术可能具有更好的手术成功率。与iStent相比，KDB前房角切开术在术后12个月时IOP降低效果更好。然而，iStent inject的IOP降低效果与KDB相似。
