Author’s Disclosure Block: Kevin Yang Wu, none; Lysa Houadj, none; Michael Marchand-Gareau, none

Abstract Body
Purpose:Controversy exists regarding the efficacy and safety of Kahook Blade Dual (KDB) goniotomy to that of a second-generation trabecular micro-bypass stent (iStent inject) in combination with cataract extraction. This study aims to bridge existing research limitations, which have either focused solely on first-generation iStent or limited their scope to mild-to-moderate primary open-angle glaucoma patients, with small samples and outside North America. Study Design: We performed a retrospective, single-center, observational, longitudinal case series to compare the efficacy and safety of these two types of microinvasive glaucoma surgery (MIGS). Methods: All MIGS were combined with elective cataract extraction.Data collection included intraocular pressure (IOP), IOP-lowering medications and best-correct visual acuity (BCVA) preoperatively and at 1 day, 2 weeks, 1, 3, 6, 9, 12, 15, 18, 21, and 24 month postoperatively. In addition, intraoperative and postoperative adverse events were also be examined. Major complications and surgical failure criteria, defined by the necessity of subsequent filtrative surgery, were also evaluated. The primary outcomes of this study were patients achieving >20% IOP reduction and those with a postoperative IOP <19 mmHg at final follow-up. Subgroup analysis were conducted for different types and severity of glaucoma. Results: A total of 38 patients (66 eyes) were included in the iStent inject group and 19 patients (25 eyes) in the KDB group. Mean follow-ups were 13 months for both groups. For the primary outcome, both the iStent inject and KDB showed similar success rates in achieving a 20% IOP reduction and <19 mmHg at final follow-up (67% and 60%, respectively) with no significant difference (p=0.55). Average pre- and post-operative IOPs were 23,68 ± 6,06 mmHg and 12,8 ± 2,4 mmHg in the Phaco-KDB group as well as 21,51 ± 4,99 mmHg and 15 ± 1,91 mmHg in the Phaco-iStent inject group. Changes in IOP-lowering medications (mean change: 0.05 vs. 0) and BCVA were not significantly different between iStent inject and KDB groups, respectively (P>0.05). Rates of intraoperative and postoperative adverse events (5% vs. 6%), major complications (1.7% vs. 2.6%), and failure criteria (1% vs. 2%) were all reasonably low and comparable between the two groups. Conclusion: This study highlights both KDB and iStent inject, combined with phacoemulsification, as effective in IOP reduction with comparable efficacy and safety. As North America's premier evaluation with the largest sample, using a standardized protocol for diverse glaucoma severities, it emphasizes procedure choice based on patient profiles and surgeon skill.These results position the study as a reference for subsequent multicentered, prospective research, focusing on cost-effectiveness and subgroup evaluation, thereby equipping clinicians to optimize MIGS decisions tailored to individual patient profiles.