Kahook Dual Blade® Procedure For Excisional Goniotomy

What is a goniotomy?

A goniotomy is a procedure where the surgeon makes excises (cuts out) a portion of the diseased trabecular meshwork in order to increased outflow of aqueous humor from the eye in turn to achieve reduced Intraocular pressure. In a healthy eye, the trabecular meshwork allows for the aqueous humor to flow continuously from the anterior chamber (front of the eye) into the distal drainage pathway which assists in maintaining optimal intraocular pressure.  In individuals with glaucoma, the diseased trabecular meshwork impedes this constant flow which contributes to elevated intraocular pressure and can lead to damage of the optic nerve and progression of the disease. When other interventions such as medicated drops and laser treatments fail, an excisional goniotomy may be indicated to remove a portion of the trabecular meshwork and improve drainage of aqueous humor from the eye.

What is a Kahook Dual Blade®?

A Kahook Dual Blade® is the surgical tool which the surgeon uses to perform this procedure. Its unique two blade design allows for it to pierce the trabecular meshwork effectively and create two parallel incisions to create a “drain” that allows continuous outflow of aqueous humor from the anterior chamber. This tool was specifically designed to execute this task with the utmost precision and has the utility to pierce, slice, and then cut away the diseased trabecular meshwork without damaging nearby ocular tissue. First the surgeon will make a small incision in the cornea with a blade to access the anterior chamber. Secondly, the anterior chamber will be filled with a special fluid to stabilize it for the procedure. Finally, the surgeon will use the Kahook Dual Blade® to create a excise a portion of the trabecular meshwork and restore outflow of the aqueous humor.

When is this Procedure performed?

A gomiotomy with a Kahook Dual Blade® is typically performed at the same time as cataract surgery, but in some cases it is performed as a stand alone procedure if the physician feels it is warranted in a patient who does not require cataract extraction.

Contraindications and risks

Not everyone with poorly controlled glaucoma is a good candidate for a Kahook Dual Blade® Goniotomy. It is not recommended that patients experiencing active neovascularization, angle dysgenesis, and certain patients with narrow angle glaucoma undergo this procedure.

The possible complications of a Kahook Dual Blade® Goniotomy include a spike in intraocular pressure following the procedure and hyphema (pooling of blood in the anterior chamber of the eye), both of which are usually temporary and resolve on their own or with conservative treatment. Rare but more serious complication include corneal edema, rebound iritis, cyclodialysis cleft, posterior vitreous detachment, Descemet’s tears and posterior capsular opacification. Every surgical procedure vary some degree of risk, but those associated with Kahook Dual Blade® Goniotomy occur at a lower frequency when compared to other glaucoma related procedures such as a trabulectomy or other goniotomy procedures.

Always have a discussion with your physician to determine if this procedure is right for you ad to gain a better understanding of the risks involved.

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