Kahook Dual Blade Goniotomy Matches Micro-Bypass Implant in IOP-Lowering Ability

Kahook Dual Blade Goniotomy (KDB, New World Medical) can lower intraocular pressure (IOP) when combined with phacoemulsification approximately as effectively as an iStent Inject® (Glaukos) implant paired with cataract removal, according to research presented at the American Society of Cataract and Refractive Surgery 2023 annual meeting, held in San Diego, CA, from May 5 to 8, 2023.1

Kevin Yang Wu, MD, and Michael Marchand, MD, with the University of Sherbrooke Health Center in Québec, Canada, conducted a retrospective, single-center, observational, longitudinal case series to compare the efficacy and safety of Kahook Dual Blade goniotomy and second-generation iStent Inject with cataract extraction.

The researchers included patients undergoing either of the minimally invasive glaucoma surgeries (MIGS) as well as elective cataract extraction in the study. They assessed IOP, IOP-lowering medication use, and best-corrected visual acuity (BCVA) before the operation and at 1 day, 2 weeks, 1 month, 6 months, and 12 months after the operation. The researchers also reviewed all participants for adverse events. Efficacy was monitored by evaluating  the proportion of each group’s patients whose IOP dropped at least 20%. Various types of glaucoma were assessed in subgroups.

The investigation reviewed 49 eyes of 29 patients in the iStent group and another 22 eyes or 16 patients in the KDB goniotomy group. Patients in each group had mean follow-up of 6 months.

Intraocular pressures dropped significantly in both patients who received Kahook Dual Blade goniotomy and iStent Inject implants (Phaco-KDB preoperative 23.68±6.06 mm Hg, postoperative 12.8±2.4 mm Hg; Phaco-iStent preoperative 21.51±4.99 mm Hg, postoperative 15±1.91 mm Hg; P <.0001 for both).

IOP and medications changes were not significantly different between the groups, and there were no major adverse events, the researchers reported.

The patients who underwent Kahook Dual Blade goniotomy and those who received the iStent Inject implant had clinically significant IOP-lowering when combined with phacoemulsification, the investigators said.


Wu KY, Marchand M. Kahook dual blade goniotomy versus trabecular micro-bypass stent (iStent inject): surgical outcomes in combination with phacoemulsification. Poster presented at: American Society of Cataract and Refractive Surgery (ASCRS) 2023 annual meeting; May 5-8, 2023; San Diego, CA. Poster 94444.