Efficacy and safety of Kahook dual blade glide in Indian patients with glaucoma

Dear Editor, I read with interest the article by Bhumbla S et al.[1] titled “A Prospective Study of Efficacy and Safety of Kahook Dual Blade (KDB) Glide in Indian Patients with Glaucoma.” I would like to highlight several methodological and reporting inconsistencies that merit clarification to facilitate accurate interpretation of the study’s findings. In the Introduction, the authors state that the purpose of the study was to evaluate the safety and efficacy of KDB goniotomy either as a standalone procedure or in combination with cataract surgery in Indian patients with open-angle glaucoma. In contrast, the Methods section of the abstract and the demographic data presented in Table 1 clearly indicate that all 68 enrolled patients underwent KDB goniotomy combined with phacoemulsification. Thus, the study appears to have assessed only the combined procedure, and not standalone KDB goniotomy as implied in the Introduction.[1] The description of the surgical technique outlines a standalone KDB procedure with only a brief reference to the possibility of combining it with cataract surgery. However, Table 1 indicates that 100% of cases underwent combined KDB and phacoemulsification. Furthermore, although the authors included patients with various sub-types and severity of open-angle glaucoma and collected data regarding disease severity, the severity of glaucoma within the study cohort was neither defined nor reported. This information is essential, as the outcomes of KDB goniotomy, which does not circumvent episcleral venous pressure, may differ in eyes with advanced glaucoma.[2] The authors report enrolling 68 patients and excluding those with less than 12 months of follow-up. However, Tables 2 and 3 indicate that only 29 patients had data available at the 12-month follow-up visit. This represents fewer than half of the enrolled subjects and may substantially affect the reliability of the final outcome measures and the reported success rates, especially in light of the stated inclusion criteria.[1] A further inconsistency arises in the Discussion, which states that 74 patients were included in the study, whereas the abstract, results, and tables consistently report a sample size of 68. The statement on page 2 – “in our study, 74 patients were studied” – is inconsistent with the rest of the manuscript and requires correction. The Discussion describes a case involving a patient with a central corneal opacity following pterygium surgery who underwent phacoemulsification combined with KDB. However, the exclusion criteria explicitly state that cases with poor angle visualization due to media haze were excluded. An explanation for this discrepancy would be appreciated. Clarification of these issues would assist readers in appropriately interpreting the study outcomes.