A quantitative assessment of the corneal endothelium and transparency after Kahook dual blade goniotomy combined with phacoemulsification

Purpose: To evaluate the effects of Kahook dual-blade (KDB) goniotomy combined with phacoemulsification on corneal endothelial health and transparency. Design: Prospective comparative study. Methods: Sixty-four patients were enrolled: 32 underwent combined KDB goniotomy and phacoemulsification (phaco+KDB), and 32 underwent phacoemulsification alone. Corneal densitometry (CD), endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variation (CV), hexagonality (HEX), and intraocular pressure (IOP) were measured preoperatively and at 1 and 3 months postoperatively. Results: The phaco+KDB group demonstrated a significant reduction in IOP postoperatively ( P < 0.001). There were no significant differences between the two groups in the changes in ECD, HEX, CCT, or CV at either postoperative time point ( P > 0.05). However, in the phaco+KDB group, CD values demonstrated a statistically significant decrease in the anterior 0–2 mm, 2–6 mm, and central 0–2 mm zones at both 1 and 3 months postoperatively ( P < 0.001). Conclusion: KDB goniotomy combined with phacoemulsification resulted in a similar impact on corneal endothelial parameters as phacoemulsification alone, suggesting no additional endothelial risk. The observed improvement in CD suggests enhanced transparency in the early postoperative period, possibly because of IOP reduction. These findings support the safety of KDB as a microinvasive glaucoma surgery that does not require permanent implants and may offer additional benefits in corneal clarity postoperatively.