International journal of medical sciences · 2026
Comparative Efficacy of Phacoemulsification Combined with KDB Goniotomy versus Trabeculectomy for Primary Angle-Closure Glaucoma: A Retrospective Cohort Study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Hou Xu, Wu Jing, Yang Xiaxia, Zhou Jian, Hu Dan
Аннотация
OBJECTIVE: This study compared the efficacy and safety between phacotrabeculectomy (phaco-trab) and phacoemulsification combined with Kahook Dual Blade goniotomy (phaco-KDB) in patients with moderate to severe primary angle-closure glaucoma (PACG).
METHODS: This single-center, non-randomized retrospective cohort study included 77 eyes from 74 PACG patients with concurrent cataract, who underwent either phaco-trab (40 eyes, 39 patients) or phaco-KDB (37 eyes, 35 patients). All patients had moderate-to-severe visual field (VF) defects and were using ≥ 2 topical intraocular pressure (IOP)-lowering medications preoperatively. Changes in best-corrected visual acuity (BCVA), IOP, medication use, mean deviation (MD) progression of VF, and complications were compared between the two groups.
RESULTS: The comparable follow-up duration was 13.5 ± 4.1 months (phaco-trab) and 12.9 ± 3.9 months (phaco-KDB) (P = 0.703). Postoperative BCVA improved in both groups, with no significant intergroup difference. The baseline IOP was 30.29 ± 7.69 mmHg in the phaco-trab group and 28.20 ± 4.70 mmHg in the phaco-KDB group, which decreased to 15.64 ± 3.22 mmHg and 17.55 ± 3.34 mmHg respectively (P = 0.041), and the phaco-KDB group required more medications (P =0.027) at the last follow-up. The qualified success rates were 87.5% (phaco-trab) versus 83.8% (phaco-KDB) (P = 0.604). No statistically significant progression of VF defects and no serious intraoperative or postoperative complications were noted.
CONCLUSIONS: Both KDB goniotomy and trabeculectomy, when combined with phacoemulsification, effectively improve visual acuity, reduce IOP, and stabilize VF in patients with moderate-to-severe PACG and concurrent cataract. Phaco-KDB is an effective ab interno procedure that achieves comparable success rate to phaco-trab, it's minimally invasive nature may delay or obviate filtration surgery, simplify procedure, and offer faster visual rehabilitation.
METHODS: This single-center, non-randomized retrospective cohort study included 77 eyes from 74 PACG patients with concurrent cataract, who underwent either phaco-trab (40 eyes, 39 patients) or phaco-KDB (37 eyes, 35 patients). All patients had moderate-to-severe visual field (VF) defects and were using ≥ 2 topical intraocular pressure (IOP)-lowering medications preoperatively. Changes in best-corrected visual acuity (BCVA), IOP, medication use, mean deviation (MD) progression of VF, and complications were compared between the two groups.
RESULTS: The comparable follow-up duration was 13.5 ± 4.1 months (phaco-trab) and 12.9 ± 3.9 months (phaco-KDB) (P = 0.703). Postoperative BCVA improved in both groups, with no significant intergroup difference. The baseline IOP was 30.29 ± 7.69 mmHg in the phaco-trab group and 28.20 ± 4.70 mmHg in the phaco-KDB group, which decreased to 15.64 ± 3.22 mmHg and 17.55 ± 3.34 mmHg respectively (P = 0.041), and the phaco-KDB group required more medications (P =0.027) at the last follow-up. The qualified success rates were 87.5% (phaco-trab) versus 83.8% (phaco-KDB) (P = 0.604). No statistically significant progression of VF defects and no serious intraoperative or postoperative complications were noted.
CONCLUSIONS: Both KDB goniotomy and trabeculectomy, when combined with phacoemulsification, effectively improve visual acuity, reduce IOP, and stabilize VF in patients with moderate-to-severe PACG and concurrent cataract. Phaco-KDB is an effective ab interno procedure that achieves comparable success rate to phaco-trab, it's minimally invasive nature may delay or obviate filtration surgery, simplify procedure, and offer faster visual rehabilitation.