What question did this study set out to answer?

To evaluate how the order of surgical procedures affects outcomes in combined phacoemulsification and KDB goniotomy.

May 28, 2026Clinical ophthalmology0 citationsOpen Access

Impact of Surgical Sequence on Outcomes of Combined Phacoemulsification and Kahook Dual Blade KDB Goniotomy: A 1-Year Prospective Comparative Study

NMNicole Mechleb ANAntony Nemr KTKarim Tomey

Key Points

To evaluate how the order of surgical procedures affects outcomes in combined phacoemulsification and KDB goniotomy.
Prospective comparative randomized cohort study
Included 47 patients with randomized assignment to phacoemulsification followed by KDB or vice versa
Follow-up assessments included efficacy outcomes related to intraocular pressure (IOP) and medication use.
82% surgical success at 6 months and 73% at 12 months for both groups
Postoperative hyphema occurred more frequently in phacoemulsification-first group (52% vs. 19%, p=0.008)
No significant difference in IOP reduction or medication use between groups.

Abstract

Nicole Mechleb,1â 3 Antony Nemr,3 Karim Tomey,3,4 Daniel George Cherfan,3 Georges Cherfan,2,3 Syril Dorairaj,5 Youssef Abdelmassih,1,2 Ziad Khoueir2,3,5 1Rothschild Foundation Hospital, Paris, France; 2Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; 3Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; 4Faculty of Medicine, Lebanese American University, Gilbert and Rose-Mary Chagoury School of Medicine, Byblos, Lebanon; 5Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USACorrespondence: Ziad Khoueir, Faculty of Medicine, Saint-Joseph University, Al-Mathaf Square, P.O. Box 116-5311, Beirut, Lebanon, Tel +00961 1 397 009, Email ziadkhoueir@hotmail.comPurpose: To compare the effect of surgical sequence during combined excisional KDB goniotomy using the Kahook Dual Blade (KDB) and phacoemulsification.Methods: In this prospective comparative randomized cohort we included patients that underwent combined phacoemulsification and excisional KDB goniotomy with KDB. Eye were randomized into 2 groups: group PG underwent phacoemulsification followed by KDB goniotomy and GP KDB followed by phacoemulsification.Results: A total of 47 patients (59 eyes) were included: 27 eyes (46%) in group PG and 32 eyes (54%) in GP. Post-operative efficacy outcomes were comparable for IOP, number of medications, decrease in IOP at all the follow-up periods regardless of surgical sequence. Post-operative IOP and number of medications significantly decreased in both groups. Surgical success was achieved in 82% and 73% of eyes at 6- and 12-month follow-up respectively. Postoperative hyphema at day 1 was more frequent in group PG (52% vs. 19%, p=0.008). This difference did not reach statistical significance at day 7 (26% vs. 13%, p=0.16).Conclusion: Combined Phacoemulsification-KDB KDB goniotomy has a good safety and efficacy profile. If KDB goniotomy is performed before phacoemulsification, the occurrence of early postoperative hyphema is significantly lower without affecting surgical success in terms of IOP decrease and reduction in glaucoma medication.Keywords: glaucoma, Kahook Dual Blade, excisional KDB goniotomy, phacoemulsification

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