Kahook Dual Blade Ab-interno Trabeculectomy Compared With Conventional Goniotomy in the Treatment of Primary Congenital Glaucoma: 1-Year Results

Introduction: Kahook dual blade (KDB) removes a strip of the trabecular meshwork from the angle, which may make it superior to simple goniotomy in treating the angle anomaly in primary congenital glaucoma (PCG). This prospective study compares KDB ab-interno trabeculectomy to conventional goniotomy in PCG. Methods: Forty-two eyes of 29 patients with PCG underwent ab-interno trabeculectomy using a KDB or conventional goniotomy using a 25-G irrigating needle, targeting 100 to 120 degrees of the nasal iridocorneal angle. Patients were seen at 1, 3, 6, and 12 months postoperatively. Success was defined as intraocular pressure (IOP) <= 21 mm Hg at 1-year follow-up visit, with no evidence of glaucoma progression. Results: The KDB group included 21 eyes of patients with a median age of 6 months (interquartile range: 4 to 8.5 mo) and the goniotomy group included 21 eyes of patients with a median age of 5 months (interquartile range: 3 to 9.5 mo). There was a significant reduction in IOP in both groups at all follow-up visits. The reduction in the number of glaucoma medications was significant at 1, 3, and 6 months postoperatively in the KDB group, and at 1 month in the goniotomy group. There was no significant difference in IOP or glaucoma medications between both groups at any follow-up visit. Success was achieved in 12 eyes (57.1%) in each group, with no eyes developing any serious complications. Conclusion: One-year results show that KDB ab-interno trabeculectomy is at least as effective as goniotomy in the treatment of PCG. Eyes with bilateral glaucoma had a tendency to fail both procedures.