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Research Article: 24-month outcomes of a combined 180-degree phacogoniotomy with KDB procedure

Date Published: 2026-08-19

Abstract:
We aimed to evaluate the 24-month efficacy and safety of combined 180-degree phacogoniotomy with Kahook Dual Blade (KDB) in patients with various forms of glaucoma. This retrospective, single-centre study included 66 eyes from 66 patients who underwent combined phacogoniotomy with KDB surgery at Rochdale Infirmary, UK, between November 2021 and January 2023. Patients with moderate-to-advanced open-angle, secondary, or narrow-angle glaucoma were included. Primary outcomes were changes in mean intraocular pressure (IOP) and number of IOP-lowering medications from baseline to 24 months. Secondary outcomes included surgical success, defined according to the criteria of Dorairaj et al. and the American Academy of Ophthalmology (AAO) criteria. Mean IOP significantly decreased from 19.4 ± 6.6 mmHg at baseline to 14.1 ± 4.3 mmHg at 24 months, representing a mean reduction of 5.3 mmHg (27%) (p < 0.0001). The mean number of IOP-lowering medications was reduced from 3.0 ± 0.7 to 1.7 ± 1.2 at 24 months, a mean reduction of 1.3 medications (43%) (p < 0.0001). At 24 months, 92% of eyes achieved success by Dorairaj’s criteria, and 76% achieved qualified success and 19% absolute success according to AAO standards. Visual acuity improved slightly but not significantly. Combined 180-degree phacogoniotomy with KDB provides a significant and sustained 24-month reduction in intraocular pressure and medication burden, with a favourable safety profile. These findings support phacogoniotomy with KDB as an effective minimally invasive option for patients with coexisting cataract and glaucoma.

Introduction:
Glaucoma is a heterogeneous chronic progressive optic neuropathy, one of the leading causes of blindness around the world. It is thought to be a multifactorial disease, in which the intraocular pressure (IOP) is identified as a modifiable risk factor. Research has shown that lowering IOP can slow down or stop disease progression ( 1 – 3 ). The conventional approach to lowering IOP involves commencing with the safer and least invasive approaches such a topical medication (drops) or selective laser trabeculoplasty (…

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