Kahook Dual Blade Goniotomy versus iStent Implantation Combined with Phacoemulsification: A Systematic Review and Meta-analysis.

Autor:	Guedes J; Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA., Amaral DC; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., de Oliveira Caneca K; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Cassins Aguiar EH; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., de Oliveira LN; Faculty of Medicine, State University of Feira de Santana, Feira de Santana, Brazil., Mora-Paez DJ; Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA., Cyrino LG; University of São Paulo, São Paulo, SP, Brazil., Louzada RN; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Moster MR; Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA., Myers JS; Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA., Schuman JS; Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.; Drexel University School of Biomedical Engineering, Science and Health Studies, Philadelphia, PA, USA., Shukla AG; Columbia University Irving Medical Center, New York, NY, USA., Shalaby WS; Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.; Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt.
Jazyk:	angličtina
Zdroj:	Journal of glaucoma [J Glaucoma] 2024 Dec 09. Date of Electronic Publication: 2024 Dec 09.
DOI:	10.1097/IJG.0000000000002522
Abstrakt:	Prcis: In this meta-analysis, Kahook dual blade goniotomy achieved higher rates of surgical success compared to iStent/iStent inject implantation combined with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 6 compared to the Stent group. Purpose: To compare the outcomes of phacoemulsification combined with either Kahook Dual Blade (KDB) goniotomy (phaco-KDB) or trabecular microbypass stent (iStent and iStent inject) implantation (phaco-Stent). Methods: A literature search was performed on PubMed, Embase, Web of Science, and Cochrane Library from inception to April 2024. Randomized clinical trials and observational studies that compared KDB goniotomy to the first or second generation iStent combined with phacoemulsification were included. The main outcomes measures were surgical success, mean change in intraocular pressure (IOP) and medication number, and complication rates. Mean differences (MD) and pooled odds ratios (OR) were used to analyze continuous and binary outcomes, respectively. Results: Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject). The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (OR: 0.68; 95% CI:0.50 to 0.92; P=0.01; I2=40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13 mmHg; 95% CI: 0.43 to 1.83; P=0.002; I2=51%). By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69 mmHg; 95% CI:0.44 to 2.95; P=0.008; I2=74%). However, compared to the phaco-iStent inject group, there was no significant difference in IOP reduction (MD: -0.72 mmHg; 95% CI: -3.69 to 2.24; P=0.63; I2=64%). Medication reduction and the incidence of adverse events were comparable between groups. Conclusion: KDB goniotomy may offer better surgical success compared to Stent implantation, when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared to iStent. However, iStent inject showed similar IOP reduction to KDB. Competing Interests: Conflict of Interest: The authors have no conflicts of interest pertinent to the material presented. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu