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. 2022 Jul 30;22(1):327.
doi: 10.1186/s12886-022-02545-1.

Risk factors for intraocular pressure elevation in a six-month period after ab interno trabeculotomy using a Kahook Dual Blade

Setsu Murakami-Kojima  1 , Eri Takahashi  2 , Momoka Eguchi-Matsumoto  1 , Junji Saruwatari  3 , Kei-Ichi Nakashima  1 , Toshihiro Inoue  1
Affiliations

Risk factors for intraocular pressure elevation in a six-month period after ab interno trabeculotomy using a Kahook Dual Blade

Setsu Murakami-Kojima et al. BMC Ophthalmol. .

Abstract

Background: To examine the risk factors for an early postoperative intraocular pressure (IOP) increase after ab interno trabeculotomy using a Kahook Dual Blade (KDB trabeculotomy).

Methods: A retrospective study was performed in 76 exfoliation glaucoma (EXG) eyes and 56 primary open angle glaucoma (POAG) eyes that underwent KDB trabeculotomy, with or without cataract surgery at Kumamoto University Hospital. Postoperative high IOP was classified as IOP≥20 mmHg (within three months after surgery, whether persistent or temporary), transient IOP≥20 mmHg (IOP≥20 mmHg after surgery, then dropped below 20 mmHg), and the presence of IOP spikes (≥ 10 mmHg from baseline). Risk factors were examined using logistic regression analysis.

Results: The preoperative mean IOP (SD) was 24.98 (7.23) mmHg in patients with EXG and 21.28 (6.58) mmHg in patients with POAG. IOP was reduced by 32.1% in patients with EXG and by 17.7% in patients with POAG at 6 months after surgery. Postoperative IOP≥20 mmHg was observed in 56.6% of EXG patients and in 51.8% of POAG patients. IOP spikes occurred in 15.8% of EXG patients and in 14.3% of POAG patients. Logistic regression analysis showed that factors with significant odds ratios (ORs) were age (OR = 0.866, 95% CI = 0.793-0.945), preoperative medication use (OR = 2.02, 95% CI = 1.17-3.49), trabeculotomy in combination with cataract surgery (OR = 0.0674, 95% CI = 0.015-0.303), and IOP at day 1 (OR = 1.41, 95% CI = 1.18-1.68) for postoperative IOP≥20 mmHg, the IOP at day 1 (OR = 1.1, 95% CI = 1.03-1.17) for transient IOP≥20 mmHg, and age (OR = 0.948, 95% CI = 0.901-0.997) and preoperative IOP (OR = 0.83, 95% CI = 0.736-0.936) for IOP spikes.

Conclusion: Although KDB trabeculotomy is an effective treatment for patients with EXG and POAG, patients who take multiple preoperative medications and have a high IOP on day 1 require careful follow-up to prevent postoperative IOP elevation.

Keywords: Exfoliation glaucoma; Intraocular pressure; Kahook dual blade; Primary open angle glaucoma; Trabeculotomy ab interno.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
IOP distributions at different times after trabeculotomy ab interno using a Kahook dual blade. Trabeculotomy ab interno using a Kahook dual blade (KDB-LOT) alone or combined with phacoemulsification (phaco) was performed in patients with exfoliation glaucoma (EXG) or primary open angle glaucoma (POAG). The boxes represent the 25th, 50th, and 75th percentiles of IOP and cross marks show the average
Fig. 2
Fig. 2
Changes in IOP after trabeculotomy ab interno using a Kahook dual blade. Mean change in intraocular pressure (IOP) with standard error bars for patients with exfoliation glaucoma (EXG) or primary open-angle glaucoma (POAG) undergoing KDB trabeculotomy with (combined) or without (alone) phacoemulsification. Statistical analysis was performed using one-way analysis of variance with Bonferroni correction
Fig. 3
Fig. 3
Kaplan–Meier curve for all eyes for the onset of IOP≥20 mmHg after surgery. Dotted lines indicate the 95% confidence intervals
See this image and copyright information in PMC

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