Comparing the Surgical Outcomes of Combined Kahook Dual Blade (KDB) Phacoemulsification Versus Non-Penetrating Deep Sclerectomy (NPDS) Phacoemulsification for Advanced Glaucoma with Co-Existing Cataract

Purpose: To compare the 2-year efficacy and safety of Kahook dual blade (KDB) phacoemulsification and non-penetrating deep sclerectomy (NPDS) combined with phacoemulsification for advanced open angle glaucoma (OAG) and co-existing cataract. Methodology: This was a single-centre, longitudinal, retrospective comparative study. We included 112 patients diagnosed with advanced OAG and co-existing cataract, of which 49 underwent 120 degrees of KDB-excisional goniotomy with phacoemulsification (Group A) and 63 underwent MMC-augmented NPDS with phacoemulsification (Group B). The main outcome measures at 2 years were success rates (complete success: proportion of eyes with intraocular pressure (IOP) reduction >20% from baseline without any glaucoma medications; qualified success: IOP reduction >20% with glaucoma medications), decrease in medications, number of postoperative interventions and number of complications. Results: Mean (SD) baseline IOP in Group A and Group B was 15.47 (4.78) and 17.43 (5.99) mmHg, respectively. There was no significant difference in the mean IOP between the groups at any follow-up visit ( P > 0.05). However, there was a significant decrease in the number of antiglaucoma medications (AGMs) in Group A compared to Group B at all follow-up visits ( P < 0.001). The success rates at the end of 2 years were 73.5% and 79.4% in Groups A and B, respectively. Further, we did not encounter major vision-threatening complications such as choroidal effusion, suprachoroidal haemorrhage or ocular hypotony in either group. About 6.1% in group A and 4.8% in group B required additional glaucoma surgical intervention within the follow-up period. Conclusion: KDB-phaco and NPDS-phaco had similar IOP-lowering effects in advanced glaucoma without any vision-threatening complications. However, the KDB group required significant fewer AGMs postoperatively than NPDS group in eyes with advanced glaucoma.