October 1

Kahook Dual Blade for Goniotonomy

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Introduction
Glaucoma is among the leading causes of blindness worldwide and has been for a long time. All existing
treatments for glaucoma target intraocular pressure (IOP) reduction either through the use of oral or
topical medications, laser or surgical treatment. The trabecular meshwork (TM), specifically the
juxtacanalicular meshwork, has actually for a long time been believed to be the site of greatest
resistance to aqueous outflow. Incision and/or removal of the trabecular meshwork, i.e Trabeculectomy
or Goniotomy, has actually been efficiently used to reduce IOP in congenital glaucoma or glaucoma from
birth for many years and much more recently has been shown to be beneficial in adult patients too. The
Kahook Dual Blade (KDB) is a novel goniotomy blade produced to generate a more total elimination of
TM through a minimally invasive approach, i.e. with least surgery.

How Cataracts Are Formed Khanna Vision Institute


The dual blade has a number of design features to attain a much more complete goniotomy. First is the
sharp tip designed with a taper to allow for smooth entry of the blade through TM as well as into
Schlemm’s Canal (SC). The heel of the device fits conveniently within SC and enables smooth
improvement of the blade within the canal while protecting against collateral damage throughout
therapy.

Kahook Dual Blade (KDB)
Kahook Dual Blade (KDB)

Kahook Dual Blade (KDB):- SILVER LINING IN THE DARK CLOUDS OF GLAUCOMA

Indications and Pre-operative Considerations
Goniotomy with the Kahook Dual Blade is suggested for the treatment of open angle glaucoma as well
as eye hypertension, patients with unrestrained IOP or those who have managed IOP. However various
other factors such as multiple medication allergies medicine intolerance, or non-compliance might be
considered for this procedure. It is approved as a standalone procedure or in combination with
phacoemulsification (phaco) cataract surgery. When it is used as a standalone procedure, it can be
performed in pseudophakic or phakic patients. In phakic patients, unique treatment ought to be taken
to avoid damage to the lens capsule. While it is indicated with any type of disease it might be
inappropriate for patients with an extremely low target IOP given that successful goniotomy still depends upon license aqueous outflow pathways downstream. Consequently, it ought to not be
expected to lower IOP beyond episcleral venous pressure i.e 8-10mmHg. Patients with more distal
scarring and also outflow malfunction may likewise have actually limited success with these procedures.


Specific success has actually been seen in patient’s additional open angle glaucoma such as
pseudoexfoliation glaucoma as well as pigmentary glaucoma. Since the mechanism of elevated IOP in
these patients is associated with accumulation of extracellular material and also pigment within the TM
respectively, it is instinctive that elimination of the TM need to improve IOP. The KDB goniotomy has
actually likewise shown success in congenital glaucoma and also has been utilized in patients with
uveitic and/or steroid induced glaucoma with reported success.


Clinical Outcomes
Goniotomy with KDB remains to gain acceptance and extensive use among medical professionals due to
its beneficial risk profile compared to both filtering system surgical procedures and various other MIGS
procedures in addition to the documented success rates. Researches released since it came onto the
marketplace in 2015 have shown these advantages. Given the relative novelty of this blade
nevertheless, most published researches are limited to 1 year of follow up.


Conclusions
KDB goniotomy is a risk-free as well as effective option for handling glaucoma in suitable patients.
Compared to various other goniotomy/trabeculectomy treatments, it leads to much less surrounding
tissue damages as well as a much more complete elimination of TM. Medical research has actually
demonstrated the efficiency of KDB goniotomy both with and without phacoemulsification for reduction
of both IOP as well as medication dependancy. Nevertheless, given the relative novelty of this blade,
most researches are restricted to twelve month compliance with follow up. When compared against
various other MIGS devices such as the iStent, KDB produced equal, otherwise enhanced IOP reduction.
Longer term follow-up as well as future prospective research studies are required to much better
elucidate the clinical end results of this device along with determining the very best candidates for the
procedure.

KDB had marked its remarkable presence in the following procedures:-

 Goniotomy Using the Kahook Dual Blade in Severe and Refractory
Glaucoma

 Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis
Combined with Phacoemulsification for Angle Closure Glaucoma

 Reversible Cystoid Macular Edema Following Uneventful
Microinvasive Kahook Dual Blade Goniotomy in a Pseudophakic Patient: A
Case Report

 Ab Interno Trabeculectomy with a Dual Blade: Surgical
Technique for Childhood Glaucoma


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