iStent inject and Kahook Dual Blade with phaco lowered pressure similarly, and patients came off drops

Design

Prospective randomised single-surgeon trial

Population

68 eyes with open-angle glaucoma or ocular hypertension having phacoemulsification

Primary outcome

Surgical success (IOP reduction ≥20% or IOP ≤15 mm Hg) and IOP change

Effect

IOP ≈ −14% in both; medications to 0 in both; complete success 68.8% vs 62.5% at 6 months

This single-surgeon randomised trial in Poland compared two canal-based minimally invasive glaucoma procedures combined with phacoemulsification in 68 eyes with open-angle glaucoma or ocular hypertension: iStent inject (35) and goniotomy with the Kahook Dual Blade (33).

Pressure fell similarly — from 19.4 to 16.6 mm Hg with iStent and 18.2 to 15.5 mm Hg with goniotomy, about 14% in each (P 0.355 at six months). Mean medications fell from 1.3 and 1.0 to none in both. Complete success at six months was 68.8% and 62.5%. Corneal oedema and hyphema were more frequent after goniotomy but resolved without further surgery.

In patients with mild glaucoma on one or two drops who needed cataract surgery, both arms came off drops with modest pressure reduction; without a phaco-alone arm, how much is due to the MIGS itself is unknown. Goniotomy uses a single-use blade rather than an implant, which can matter for cost. The trial is small and follow-up thinned out after six months.

• Consider combining canal-based MIGS with cataract surgery in mild-to-moderate open-angle glaucoma on one or two drops.
• In this trial, pressure fell modestly (about 14%) and patients came off drops; without a phaco-alone arm, how much is due to the MIGS itself is unknown.
• Warn patients having goniotomy about transient hyphema.
• Do not use canal-based MIGS where a low target pressure is required; filtering surgery is usually needed.

Why it matters

It gives surgeons a head-to-head comparison between an implant and a cheaper blade-based alternative.

Don't overread it

Sixty-eight eyes, one surgeon and a mean follow-up of eight months; it is not powered to show equivalence.

The statistics, in plain English

P = 0.355 means no detectable difference, but with 68 eyes the trial could miss a real difference of a few mm Hg. 'Similar' here means not shown to differ.

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