Document Type

Article

Publication Date

12-15-2025

Comments

This article is the author’s final published version in Journal of Current Glaucoma Practice, Volume 19, Issue 4, 2025, Pages 186-198.

The published version is available at https://doi.org10.5005/jp-journals-10078-1498. Copyright ©  The Author(s) 2025.

 

Abstract

AIM AND BACKGROUND:To compare postoperative intraocular pressure (IOP) spikes and 1-year surgical success among goniotomy procedures: Kahook Dual Blade (KDB), OMNI, bent ab interno needle goniotomy (BANG), and gonioscopy-assisted transluminal trabeculotomy (GATT).

MATERIALS AND METHODS: This single-center, retrospective chart review included glaucoma patients ≥18 years, who underwent goniotomy from January 2021 to December 2022 with ≥3 months of follow-up. Primary outcomes were IOP spikes (≥10 mm Hg increase within 3 months) and 12-month surgical success (≥20% IOP and/or ≥1 medication reduction without further surgery). Secondary outcomes included IOP and medication changes.

RESULTS: Among 247 eyes (107 KDB, 63 OMNI, 77 BANG; all with phacoemulsification), IOP spikes occurred in 13.0% with no difference between groups (p = 0.900). Spikes were more common in severe glaucoma and associated with failure (p = 0.041), postoperative interventions (p < 0.001), and reoperation (p = 0.026). At 12 months (n = 164), 68.9% achieved success with no difference between procedures (p = 0.972). Lower baseline IOP, open-angle glaucoma (OAG), and IOP spikes predicted failure. GATT eyes (n = 39, mostly standalone) had different baseline characteristics, were excluded from main analysis, but showed similar success (79.3%) with greater IOP and medication reduction.

CONCLUSION: Kahook Dual Blade, OMNI, and BANG with phacoemulsification had comparable 1-year safety and efficacy. IOP spikes increase the risk of failure and reoperation, especially in severe glaucoma. GATT showed favorable outcomes when performed standalone.

CLINICAL SIGNIFICANCE: Choice among KDB, OMNI, and BANG can be individualized without compromising outcomes. Monitoring for IOP spikes is crucial in high-risk eyes. Standalone GATT offers strong results when cataract surgery is not needed.

HOW TO CITE THIS ARTICLE: Shalaby WS, Chang SL, Yu J, et al. Impact of Postoperative Intraocular Pressure Spikes on Outcomes Following Goniotomy: A Comparative Study of Surgical Techniques. J Curr Glaucoma Pract 2025;19(4):186–198.

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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

PubMed ID

41523173

Language

English

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