Efficacy and Safety of Kahook Dual Blade Goniotomy and Trabecular Micro-Bypass Stent in Combination with Cataract Extraction

In recent years, rapid advancements in glaucoma research have led to the development of more effective treatments of this chronic and irreversible condition. Of these, Kahook Blade Dual (KDB) goniotomy and second-generation trabecular micro-bypass stent (iStent) are two novel biomimetic procedures which have designs inspired by the eye's natural drainage mechanisms. In this retrospective study, we evaluated the safety and effectiveness of both surgeries by including 176 eyes from 110 patients: 142 eyes in the iStent group and 34 in the KDB group. The primary outcomes of this study were the proportions of patients in each group attaining a 20% reduction in IOP and a post-operative IOP < 19 mmHg. At the last follow-up, a 20% reduction in IOP was achieved by 67% of iStent inject patients and 50% of KDB patients (<i>p</i> = 0.07). The iStent group also showed a higher proportion of patients reaching an IOP of less than 19 mmHg (81% vs. 71% in the KDB group, <i>p</i> = 0.13). The number of medications did not decrease in either group from pre-op to the last follow-up. The KDB group had more failures (29.4% vs. 4.2%) and a significantly higher adverse event rate than the iStent inject group (47.1% vs 12.0%).