Journal article
Kahook Dual Blade Goniotomy Versus iStent Implantation Combined With Phacoemulsification: A Systematic Review and Meta-Analysis
Journal of glaucoma, v 34(3), pp 232-247
01 Mar 2025
PMID: 39641580
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Pr & eacute;cis:In this meta-analysis, Kahook dual blade (KDB) goniotomy achieved higher rates of surgical success compared with iStent/iStent inject implantation combined with phacoemulsification. KDB goniotomy demonstrated better intraocular pressure (IOP) reduction at month 6 compared with the stent group.Objective:To compare the outcomes of phacoemulsification combined with either KDB goniotomy (phaco-KDB) or trabecular microbypass stent (iStent and iStent inject) implantation (phaco-Stent).Methods:A literature search was performed on PubMed, Embase, Web of Science, and Cochrane Library from inception to April 2024. Randomized clinical trials and observational studies that compared KDB goniotomy to the first or second-generation iStent combined with phacoemulsification were included. The main outcome measures were surgical success, mean change in IOP and medication number, and complication rates. Mean differences (MDs) and pooled odds ratios were used to analyze continuous and binary outcomes, respectively.Results:Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject). The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (odds ratio: 0.68; 95% CI: 0.50 to 0.92; P = 0.01; I 2= 40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13 mm Hg; 95% CI: 0.43 to 1.83; P = 0.002; I 2= 51%). By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69 mm Hg; 95% CI: 0.44 to 2.95; P = 0.008; I 2= 74%). However, compared with the phaco-iStent inject group, there was no significant difference in IOP reduction (MD: -0.72 mm Hg; 95% CI: -3.69 to 2.24; P = 0.63; I 2= 64%). Medication reduction and the incidence of adverse events were comparable between groups.Conclusion:KDB goniotomy may offer better surgical success compared with Stent implantation when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared with iStent. However, iStent inject showed a similar IOP reduction to KDB.
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Details
- Title
- Kahook Dual Blade Goniotomy Versus iStent Implantation Combined With Phacoemulsification: A Systematic Review and Meta-Analysis
- Creators
- Jaime Guedes - Thomas Jefferson UniversityDillan Cunha Amaral - Universidade Federal do Rio de JaneiroKarina de Oliveira Caneca - Univ Fed Rio de Janeiro, Fac Med, Rio de Janeiro, RJ, BrazilEduardo Henrique Cassins Aguiar - Universidade Federal do Rio de JaneiroLucas Neves de Oliveira - Universidade Federal do Rio de JaneiroDenisse J. Mora-Paez - Thomas Jefferson UniversityLaura Goldfarb Cyrino - Universidade de São PauloRicardo Noguera Louzada - Universidade Federal do Rio de JaneiroMarlene R. Moster - Wills Eye HospitalJonathan S. Myers - Wills Eye HospitalJoel S. Schuman - Drexel UniversityAakriti Garg Shukla - Columbia University Irving Medical CenterWesam Shamseldin Shalaby - Thomas Jefferson University
- Publication Details
- Journal of glaucoma, v 34(3), pp 232-247
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 16
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- School of Biomedical Engineering and Science
- Web of Science ID
- WOS:001432397400006
- Scopus ID
- 2-s2.0-85211744020
- Other Identifier
- 991022197317804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Ophthalmology