Pilocarpine response may predict short-term success of Kahook dual-blade goniotomy, study finds

A greater reduction in intraocular pressure (IOP) following pilocarpine administration may predict short-term success with Kahook dual-blade (KDB) goniotomy at 1-month post-surgery, but this predictive value diminishes by 3 months, according to a poster presented at AAO 2024.

This prospective case series included 21 patients and measured IOP 1 hour after administering 2% pilocarpine. Surgical success was defined as either a ≥20% IOP reduction or a decrease in medication burden.

KDB was successful in 62.5% of patients at postoperative Week 1, 55.0% at 1 month, and 47.4% at 3 months. By the 3-month mark, the average IOP decreased by 3.3 mmHg from a baseline of 16.1 mmHg, with patients requiring 0.3 fewer medications. A significant correlation was found between IOP reduction from pilocarpine and KDB success at 1 month (odds ratio: 1.96), though this association diminished by 3 months.

The study concluded that while pilocarpine response may predict short-term KDB success, further research with longer follow-up is needed to clarify its long-term predictive value.

Reference
Joo JH, et al. In-Office Pilocarpine Challenge as Predictor of Goniotomy Outcome. Poster presented at: American Academy of Ophthalmology Annual Meeting; October 2024; Chicago.