Outcome of Combined Kahook Dual Blade Surgery and Deep Sclerectomy: Adverse Effects of Postsurgical Low Intraocular Pressure
Year: 2025
Type: article
Study design: Case Report
Abstract: which the addition of trabeculectomy did not result in a further reduction of IOP.Postoperative bleeding into the bleb, which is common after trabeculotomy, may hinder bleb formation.8 In this study, we present two patients where internal excisional trabeculotomy was combined with modified deep sclerectomy in an attempt to decrease postoperative IOP.In these cases, low IOP immediately after surgery resulted in extensive bleeding in the anterior chamber, leading to suboptimal outcomes. Case DesCriptionThe two patients were diagnosed with high-tension open-angle glaucoma and indicated for surgical treatment.Both patients signed introDuCtionInternal excisional trabeculotomy, such as Kahook Dual Blade (KDB) surgery, is recognized as a safe and effective procedure, 1 recommended for the treatment of mild to moderately severe glaucoma.However, despite its increasingly frequent use in clinical practice, concerns remain regarding its limited efficacy in reducing intraocular pressure (IOP).One of the efforts to address the shortcomings of internal excisional trabeculotomy includes combining it with other glaucoma procedures to extend its applicability to moderate to severe glaucoma.One such approach involves a combination of internal trabeculotomy with endoscopic cyclophotocoagulation. 2 However, the reduction in IOP achieved through this procedure was found to be 32.9%, 3 a reduction inferior to that of filtering surgery.When comparing the surgical outcomes of a concomitant KDB and endoscopic cyclocoagulation cohort with a phaco-endoscopic cyclophotocoagulation cohort, the IOP at 1 year was similar (13.8 ± 4.1 and 13.7 ± 2.4 mm Hg, respectively).These findings indicate that combined cyclophotocoagulation and internal excisional trabeculotomy may not achieve a sufficient reduction in IOP. 4 To enhance the effectiveness of IOP reduction through internal excisional trabeculotomy, one potential option may be its combination with deep sclerectomy performed from outside the eye.However, a significant reduction in IOP shortly after deep sclerectomy may induce a massive reflux of blood, clot formation, and the development of peripheral anterior synechiae (PAS), and may lead to a need for reoperation.5 Several prior reports exist on the use of combined external trabeculotomy and external trabeculectomy for the treatment of congenital glaucoma, 6,7 in 1,
Authors: Etsuo Chihara, Tomoyuki Chihara
Institution: Sensho-kai Eye Institute
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4406774170