Comparing iStent and KDB Implants: Similar IOP reduction but varied medication effects

Both iStent Inject implantation (iStent) and Kahook Dual Blade goniotomy (KDB), when combined with phacoemulsification, are effective in lowering intraocular pressure (IOP) in patients with mild to advanced open-angle glaucoma, according to a study. However, KDB appeared to offer a potential advantage in reducing medication dependency postoperatively compared to iStent.

This retrospective chart review of 153 patients at a single center, aimed to assess the 2-year outcomes of these procedures.

Both iStent and KDB procedures, when combined with phacoemulsification, resulted in a significant reduction in IOP across all stages of glaucoma. Specifically, the mean IOP decreased from baseline to 14.2±4.1 mm Hg in the iStent group and to 14.7±3.6 mm Hg in the KDB group after 2 years.

The study found that the number of medications required postoperatively was significantly reduced in both groups. However, patients who underwent KDB experienced a greater reduction in medications compared to those who received iStent implants.

The success criteria of the study, defined as IOP reduction of at least 20% with a postoperative IOP of no more than 18 mm Hg, were met by a similar proportion of patients in both groups. However, a higher percentage of patients in the KDB group achieved a reduction of at least 1 medication compared to the iStent group.

The study found that the efficacy of both procedures remained consistent across different stages of glaucoma severity, indicating their suitability for a broad range of patients.

Reference
Barkander A, Economou MA, Jóhannesson G. Outcomes of iStent Inject Versus Kahook Dual Blade Surgery in Glaucoma Patients Undergoing Cataract Surgery. J Glaucoma. 2023;32(10):e121-e128. doi: 10.1097/IJG.0000000000002243. Epub 2023 Jun 14. PMID: 37327470; PMCID: PMC10538610.