Does use of pilocarpine after goniotomy procedures improve outcomes?

The use of pilocarpine after goniotomy procedures in patients with mild to end-stage glaucoma may improve short-term surgical success and reduce the number of glaucoma medications needed after surgery, according to a poster presented at the American Glaucoma Society Annual Meeting.

In this retrospective comparative case series, 532 Kahook Dual Blade goniotomy procedures were performed with (n = 432) or without the use of pilocarpine (n = 100) post-operatively. Most surgeries were performed with phacoemulsification. The primary outcome measure was surgical success defined as intraocular pressure (IOP) reduction of >20% and/or the reduction of >1 topical glaucoma medications.

At 1 month after the procedure, the success rate was 76.8% in patients using pilocarpine compared with 64.4% in patients not using pilocarpine (P = 0.02). At 3 months, the success rates were 78.3% and 61.8% (P = 0.01), respectively. After 12 months there was no statistically significant difference between groups.

Patients using pilocarpine post-operatively had mean IOP reduced from 17.4 mmHg on 2 medications to 14.2 mmHg on 1.5 medications whereas patients not using pilocarpine post-operatively had mean IOP reduced from 17.7 mmHg on 2 medications to 14.3 mmHg on 1.7 medications. At 12 months there was no statistically significant difference between groups in IOP and use of medications. At months 1, 3, 6, 20, and 24 there was however a significant difference in the number of medications in favor of patients using pilocarpine post-operatively.

The most common complication was hyphema. Post-operative week 1 IOP spikes rates were similar between groups.

Reference
Zaver D, et al. Postoperative Use of Pilocarpine After Kahook Dual Blade Goniotomy in Mild to End-Stage Glaucoma. Presented at: American Glaucoma Society Annual Meeting 2022.