Abstract:AIM: To investigate the intraocular pressure (IOP)-lowering efficacy of bleb-free ab interno trabeculectomy by means of the Kahook Dual Blade (KDB). METHODS: This retrospective cohort study enrolled patients with uncontrolled open angle glaucoma (OAG) who underwent standalone KDB ab interno trabeculectomy. Changes in IOP, the number of preoperative and postoperative IOP-lowering medications, as well as intraoperative and postoperative surgical profiles were analyzed. All participants completed a 6-month follow-up. Arithmetic mean, standard deviation (SD) and frequency were calculated, and the Wilcoxon test was used for statistical analysis. RESULTS: A total of 23 participants (15 males) were included, with a mean age of 69.3±9.6y. The baseline mean IOP was 21.7±5.6 mm Hg, with patients taking an average of 3.1±1.0 topical IOP-lowering medications, and 10 patients received adjuvant systemic acetazolamide preoperatively. At the 3-month follow-up, the mean IOP decreased to 12.7±4.3 mm Hg, with a mean medication score of 2.9±1.8. At the 6-month follow-up, mean IOP was reduced by 40.6% from the baseline level (P<0.01), with a mean medication requirement of 2.8±1.0; one-fifth of all participants discontinued glaucoma medications completely. Only mild postoperative hyphemata occurred in 10 cases, and no other surgery-related adverse complications were observed. CONCLUSION: Standalone ab interno trabeculectomy with KDB yields significant IOP reduction and favorable surgical safety in patients with uncontrolled OAG, meanwhile decreasing the requirement of topical IOP-lowering medications. Long-term therapeutic efficacy remains to be further validated. Distinct from previous published studies, this study focuses on a Caucasian population and confirms surgical efficacy of KDB as a single glaucoma procedure.
