Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma

Mohammed K ElMallah,1 John P Berdahl,2 Blake K Williamson,3 Syril K Dorairaj,4 Malik Y Kahook,5 Mark J Gallardo,6 Ahad Mahootchi,7 Sanjay N Smith,8 Leonard A Rappaport,9 Daniela Diaz-Robles,10 Gabriel S Lazcano-Gomez11 1Ocala Eye, Ocala, FL, USA; 2Vance Thompson Vision, Sioux Falls, SD, USA; 3Willia...

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Autores principales:	ElMallah MK, Berdahl JP, Williamson BK, Dorairaj SK, Kahook MY, Gallardo MJ, Mahootchi A, Smith SN, Rappaport LA, Diaz-Robles D, Lazcano-Gomez GS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	glaucoma standalone kahook dual blade goniotomy Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/7170eb927cff461b9640f1f6a81fc286
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spelling	oai:doaj.org-article:7170eb927cff461b9640f1f6a81fc2862021-12-02T08:30:44ZTwelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma1177-5483https://doaj.org/article/7170eb927cff461b9640f1f6a81fc2862020-07-01T00:00:00Zhttps://www.dovepress.com/twelve-month-outcomes-of-stand-alone-excisional-goniotomy-in-mild-to-s-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Mohammed K ElMallah,1 John P Berdahl,2 Blake K Williamson,3 Syril K Dorairaj,4 Malik Y Kahook,5 Mark J Gallardo,6 Ahad Mahootchi,7 Sanjay N Smith,8 Leonard A Rappaport,9 Daniela Diaz-Robles,10 Gabriel S Lazcano-Gomez11 1Ocala Eye, Ocala, FL, USA; 2Vance Thompson Vision, Sioux Falls, SD, USA; 3Williamson Eye Center, Baton Rouge, LA, USA; 4Mayo Clinic, Jacksonville, FL, USA; 5University of Colorado, Aurora, CO, USA; 6El Paso Eye Surgeons, El Paso, TX, USA; 7The Eye Clinic of Florida, Zephyrhills, FL, USA; 8Medical Eye Associates, South Miami, FL, USA; 9Tidewater Eye Centers, Portsmouth, VA, USA; 10Clinica Santa Lucia, Guadalajara, Mexico; 11Asociacion Para Evitar Le Ceguera (APEC), Mexico City, MexicoCorrespondence: Mohammed K ElMallah Email elmallah@ocalaeye.comPurpose: To describe 12-month intraocular pressure (IOP) and medication use outcomes following excisional goniotomy (EG) as a stand-alone procedure in eyes with medically uncontrolled glaucoma.Methods: This was a retrospective analysis of data from surgeons at 8 centers (6 US, 2 Mexico). Eyes with glaucoma undergoing standalone EG with a specialized instrument (Kahook Dual Blade, New World Medical, Rancho Cucamonga, CA) for IOP reduction and followed for 12 months postoperatively were included. Data were collected preoperatively, intraoperatively, and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. The primary outcome was reduction from baseline in IOP, and key secondary outcomes included IOP-lowering medication reduction as well as adverse events.Results: A total of 42 eyes were analyzed, of which 36 (85.7%) had mild to severe primary open-angle glaucoma (POAG). Mean (standard error) IOP at baseline was 21.6 (0.8) mmHg, and mean number of medications used at baseline was 2.6 (0.2). At 3, 6, and 12 months postoperatively, mean IOP reductions from baseline were 4.6 mmHg (22.3%), 5.6 mmHg (27.7%), and 3.9 mmHg (19.3%) (p≤ 0.001 at each time point). At the same time points, mean medications reductions of 0.7 (25.8%), 0.9 (32.6%), and 0.3 (12.5%) medications were seen (p< 0.05 at months 3 and 6, not significant at month 12). Six eyes (14.3%) underwent additional glaucoma surgery during the 12-month follow-up period.Discussion: Standalone EG with KDB can reduce IOP, and in many cases reduce medication use, through up to 12 months in eyes with mild to severe glaucoma. Statistically significant and clinically relevant reductions in IOP were seen at every time point. While the goal of surgery was not to reduce medication burden, mean medication use was significantly reduced at all but the last time point. In the majority of eyes, the need for a bleb-based glaucoma procedure was delayed or prevented for at least 12 months.Keywords: glaucoma, standalone, Kahook dual blade, goniotomyElMallah MKBerdahl JPWilliamson BKDorairaj SKKahook MYGallardo MJMahootchi ASmith SNRappaport LADiaz-Robles DLazcano-Gomez GSDove Medical Pressarticleglaucomastandalonekahook dual bladegoniotomyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 1891-1897 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	glaucoma standalone kahook dual blade goniotomy Ophthalmology RE1-994
spellingShingle	glaucoma standalone kahook dual blade goniotomy Ophthalmology RE1-994 ElMallah MK Berdahl JP Williamson BK Dorairaj SK Kahook MY Gallardo MJ Mahootchi A Smith SN Rappaport LA Diaz-Robles D Lazcano-Gomez GS Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma
description	Mohammed K ElMallah,1 John P Berdahl,2 Blake K Williamson,3 Syril K Dorairaj,4 Malik Y Kahook,5 Mark J Gallardo,6 Ahad Mahootchi,7 Sanjay N Smith,8 Leonard A Rappaport,9 Daniela Diaz-Robles,10 Gabriel S Lazcano-Gomez11 1Ocala Eye, Ocala, FL, USA; 2Vance Thompson Vision, Sioux Falls, SD, USA; 3Williamson Eye Center, Baton Rouge, LA, USA; 4Mayo Clinic, Jacksonville, FL, USA; 5University of Colorado, Aurora, CO, USA; 6El Paso Eye Surgeons, El Paso, TX, USA; 7The Eye Clinic of Florida, Zephyrhills, FL, USA; 8Medical Eye Associates, South Miami, FL, USA; 9Tidewater Eye Centers, Portsmouth, VA, USA; 10Clinica Santa Lucia, Guadalajara, Mexico; 11Asociacion Para Evitar Le Ceguera (APEC), Mexico City, MexicoCorrespondence: Mohammed K ElMallah Email elmallah@ocalaeye.comPurpose: To describe 12-month intraocular pressure (IOP) and medication use outcomes following excisional goniotomy (EG) as a stand-alone procedure in eyes with medically uncontrolled glaucoma.Methods: This was a retrospective analysis of data from surgeons at 8 centers (6 US, 2 Mexico). Eyes with glaucoma undergoing standalone EG with a specialized instrument (Kahook Dual Blade, New World Medical, Rancho Cucamonga, CA) for IOP reduction and followed for 12 months postoperatively were included. Data were collected preoperatively, intraoperatively, and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. The primary outcome was reduction from baseline in IOP, and key secondary outcomes included IOP-lowering medication reduction as well as adverse events.Results: A total of 42 eyes were analyzed, of which 36 (85.7%) had mild to severe primary open-angle glaucoma (POAG). Mean (standard error) IOP at baseline was 21.6 (0.8) mmHg, and mean number of medications used at baseline was 2.6 (0.2). At 3, 6, and 12 months postoperatively, mean IOP reductions from baseline were 4.6 mmHg (22.3%), 5.6 mmHg (27.7%), and 3.9 mmHg (19.3%) (p≤ 0.001 at each time point). At the same time points, mean medications reductions of 0.7 (25.8%), 0.9 (32.6%), and 0.3 (12.5%) medications were seen (p< 0.05 at months 3 and 6, not significant at month 12). Six eyes (14.3%) underwent additional glaucoma surgery during the 12-month follow-up period.Discussion: Standalone EG with KDB can reduce IOP, and in many cases reduce medication use, through up to 12 months in eyes with mild to severe glaucoma. Statistically significant and clinically relevant reductions in IOP were seen at every time point. While the goal of surgery was not to reduce medication burden, mean medication use was significantly reduced at all but the last time point. In the majority of eyes, the need for a bleb-based glaucoma procedure was delayed or prevented for at least 12 months.Keywords: glaucoma, standalone, Kahook dual blade, goniotomy
format	article
author	ElMallah MK Berdahl JP Williamson BK Dorairaj SK Kahook MY Gallardo MJ Mahootchi A Smith SN Rappaport LA Diaz-Robles D Lazcano-Gomez GS
author_facet	ElMallah MK Berdahl JP Williamson BK Dorairaj SK Kahook MY Gallardo MJ Mahootchi A Smith SN Rappaport LA Diaz-Robles D Lazcano-Gomez GS
author_sort	ElMallah MK
title	Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma
title_short	Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma
title_full	Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma
title_fullStr	Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma
title_full_unstemmed	Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma
title_sort	twelve-month outcomes of stand-alone excisional goniotomy in mild to severe glaucoma
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/7170eb927cff461b9640f1f6a81fc286
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Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma

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