Phacoviscocanalostomy with Ologen implant and Kahook dual blade goniotomy in the management of primary open-angle glaucoma associated with cataract: a retrospective cohort study

Abstract

Aim To evaluate efficacy and safety of combining Kahook Dual Blade goniotomy, phacoviscocanalostomy and an Ologen for advanced POAG. Background Primary open-angle glaucoma (POAG) is a chronic, progressive condition that requires lifelong monitoring. Phacoviscocanalostomy is associated with fewer complications than trabeculectomy. The use of the Ologen® implant has demonstrated safety and efficacy in further reducing IOP. The Kahook Dual Blade (KDB) offers a minimally invasive approach for complete excision of TM which maintains patency and reduces the risk of reclosure. Patients and methods This retrospective case series reviewed the medical records of 28 eyes from 28 patients with. uncontrolled advanced POAG and cataract, who underwent phacoviscocanalostomy, Ologen implant and KDB goniotomy. Following phacoemulsification. A Swan Jacob surgical gonioprism and The KDB was then used to perform ab-interno goniotomy, Subsequently, viscocanalostomy with Ologen implant was performed. The primary outcome measure was the reduction of IOP from baseline. Secondary outcomes included postoperative complications, final visual acuity, and the number of medications required at 12 months. Results The mean age was 65 ± 10 years. The cohort consisted of 15 males (53.6%) and 13 females (46.4%). The baseline IOP was 24 ± 4 mmHg. At 12 months, the IOP remained lower at 12 ± 2 mmHg, with a median reduction of -51%. Preoperatively, 67.9% of patients required three medications, 28.6% required two, and 3.6% required one. Postoperatively, 53.6% of patients required no medications, 25% required one, and 17.8% required two (P < 0.001). Visual acuity also showed significant improvement, with the median increasing from 0.15 preoperatively to 0.9 postoperatively (P < 0.001). Corneal edema reported in (3.6%) and hyphema in (7.1%). 53.6% of cases achieved complete success, 39.3% experienced qualified success. 7.1% resulted in failure. Conclusion The KDB goniotomy, phacoviscocanalostomy, and Ologen proved to be a safe and effective for achieving IOP reduction and decreasing the need for medications in advanced POAG cases.