TherapeuTic advances in Ophthalmology - Retrospective comparison of Kahook Dual Blade Excisional Goniotomy with trabecular aspiration in pseudoexfoliation glaucoma at the time of cataract surgery

Sep 30, 2026

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Minimally invasive glaucoma surgeries (MIGS) have shown safety and efficacy in trials, but real-world evidence for pseudoexfoliation glaucoma (PEX) remains limited. This retrospective propensity-matched study compared cataract extraction combined with Kahook Dual Blade Excisional Goniotomy (KDB) versus trabecular aspiration (TA) in 99 patients (113 eyes). Outcomes included intraocular pressure, medication burden, complications, and reoperations. Both approaches lowered IOP, while KDB required more additional surgical interventions for adequate control.

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TherapeuTic advances in Ophthalmology Original Research | Retrospective comparison of Kahook Dual Blade Excisional Goniotomy with trabecular aspiration in pseudoexfoliation glaucoma at the time of cataract surgery using propensity score matching
Alicja Strzalkowska, Piotr Strzalkowski, Alexandra V. Schilcher, Jennifer Prues-Hoelscher, Kristina Spaniol and Gerd Geerling
Abstract
Background: Minimally invasive glaucoma surgeries (MIGS) have gained attention for their safety and efficacy, especially in clinical trials involving primary open-angle glaucoma. However, real-world data on pseudoexfoliation glaucoma (PEX glaucoma) remain limited. To our knowledge, this is the first real-world study comparing postoperative outcomes of Kahook Dual Blade Excisional Goniotomy (KDB) or trabecular aspiration (TA) in PEX glaucoma. Objective: To compare the efficacy and safety of combined clear cornea cataract extraction with either KDB or TA in patients with PEX glaucoma.
Design: A retrospective analysis.
Methods: We reviewed 113 eyes from 99 patients who underwent cataract surgery combined with either KDB (n = 71) or TA (n = 42) between May 2017 and May 2023 at the University Eye Hospital. Propensity score matching was used to create comparable groups of 30 KDB and 30 TA cases based on age, sex, baseline intraocular pressure (IOP), and number of glaucoma medications. Key outcomes included IOP, number of glaucoma medications, complications, and reoperations.
Results: The mean patient age was 80.5 ± 7.3 years for KDB and 80.4 ± 7.7 years for TA, p = 0.94. 73.3% were women, p = 1.0. The mean baseline IOP was 20.4 ± 7.1 for KDB and
20.0 ± 8.4 for TA, p= 0 .35, and the baseline number of glaucoma medications (Meds) was
2.0 ± 1.2 for KDB and 2.0 ± 1.2 for TA, p= 0.78. The mean postoperative IOP at 12 months was
13.5 ± 3.6 mmHg for KDB and 14.2 ± 2.6 mmHg for TA, p= 0.12, and Meds at 12 months were
1.0 ± 1.2 for KDB and 1.4 ± 1.1 for TA p= 0.12. The median follow-up was 13.1 (IQR: 11.6–17. 1) months for the whole group. A total of four eyes following KDB and two after TA required additional surgery to lower the IOP.
Conclusion: Both KDB and TA with cataract extraction lowered IOP in PEX glaucoma.
However, KDB was associated with a higher rate of additional surgical interventions to achieve adequate IOP control.
Keywords: goniotomy, Kahook Dual Blade, PEX glaucoma, trabecular aspiration
Received: 24 April 2025; revised manuscript accepted: 21 November 2025. | | TherAdv Ophthalmol 2026, Vol. 18: 1–10
DOI: 10. 1177/ 25158414251405351 © The Author(s), 2026.
Article reuse guidelines: [sagepub.com/journals](sagepub.com/journals)permissions
Correspondence to:
Alicja Strzalkowska
Department of Ophthalmology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstreet 5, Düsseldorf 40225, Germany
Alicja.Strzalkowska@ [med.uni-duesseldorf.de](med.uni-duesseldorf.de)
Piotr Strzalkowski Alexandra V. Schilcher Jennifer Prues-Hoelscher Kristina Spaniol
Gerd Geerling
Department of Ophthalmology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany | | --- | --- | --- | | Introduction
At present, a growing number of minimally invasive glaucoma surgical (MIGS) are reported to be effective and safe in the setting of randomized | clinical trials. 1,2 Many of these procedures have recently been validated for both efficacy and safety through numerous real-world studies,3,4 primarily focusing on primary open-angle | | [journals.sagepub.com/home/oed](journals.sagepub.com/home/oed) 1 Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) which permits any use, reproduction and distribution of the work without further permission provided the

FAQs

What was the study designed to compare in pseudoexfoliation glaucoma?

It compared postoperative outcomes of cataract extraction combined with either Kahook Dual Blade Excisional Goniotomy (KDB) or trabecular aspiration (TA) in pseudoexfoliation glaucoma (PEX).

How were patients selected and how were treatment groups made comparable?

The study retrospectively reviewed 113 eyes from 99 patients who underwent combined cataract surgery with KDB or TA between May 2017 and May 2023. Propensity score matching created comparable groups based on age, sex, baseline IOP, and number of glaucoma medications.

What were the main findings on intraocular pressure and need for further surgery?

At 12 months, both KDB and TA lowered intraocular pressure. KDB was associated with a higher rate of additional surgical interventions to achieve adequate IOP control.

Sep 30, 2026

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