Preliminary Outcomes of iStent Inject vs Kahook Dual Blade Goniotomy Combined With Phacoemulsification: A Randomized Controlled Trial.

BACKGROUND Canal-based minimally invasive glaucoma surgery (CB-MIGS) is increasingly used to reduce intraocular pressure (IOP) with a favorable safety profile in patients with mild-to-moderate glaucoma. This study assessed the safety and efficacy of phacoemulsification combined with iStent inject implantation (phaco-iStent) vs goniotomy using the Kahook Dual Blade (phaco-KDB) in patients with open-angle glaucoma or ocular hypertension. MATERIAL AND METHODS This prospective randomized trial included 68 eyes (35 phaco-iStent, 33 phaco-KDB) operated on by a single surgeon between 2024 and 2025. Surgical success was defined as IOP reduction ≥20% from baseline or IOP ≤15 mm Hg, with subcategories of complete and satisfactory success. Postoperative assessments were performed up to 12 months, with mean follow-up duration of 8±2.4 months. RESULTS Both procedures led to a similar reduction in IOP (P=0.355 at 6 months). Mean IOP decreased from 19.37 ± 4.03 mm Hg to 16.58±3.64 mm Hg in the phaco-iStent group and from 18.15±3.76 mm Hg to 15.46±3.15 mm Hg in the phaco-KDB group (approximately 14% reduction in both groups). The mean number of glaucoma medications decreased from 1.29±0.71 to 0.00 ± 0.00 in the phaco-iStent group and from 1.00±0.61 to 0.00±0.00 in the phaco-KDB group. Complete surgical success at 6 months was achieved in 68.8% of phaco-iStent eyes and 62.5% of phaco-KDB eyes. The most common adverse events were corneal edema and hyphema, which occurred more frequently in the phaco-KDB group; all resolved without additional surgical intervention. CONCLUSIONS Both the phaco-iStent and the phaco-KDB techniques significantly reduced IOP and medication burden with few postoperative complications. However, long-term outcomes should be interpreted with caution because of decreasing follow-up over time.