MIGS - KAHOOK DUAL BLADE (KDB) SURGERY - TIAGO PRATA, MD, PHD скачать в хорошем качестве

MIGS - KAHOOK DUAL BLADE (KDB) SURGERY - TIAGO PRATA, MD, PHD

Surgical Technique • The Kahook Dual Blade goniotomy is most commonly performed under topical anesthesia. A corneal paracentesis is first created and the anterior chamber and angle are deepened with viscoelastic. Non-preserved lidocaine is instilled intracamerally before viscoelastic for further anesthesia. • A temporal clear corneal incision of at least 1.5mm is then created. More viscoelastic is added if necessary to deepen the nasal angle. Care should be taken not to over-inflate the eye as this can cause collapse of and difficulty entering the canal. Likewise, under inflation of the anterior chamber may result in corneal striae with gonioscopy. • Next, the patient’s head is tilted approximately 30-45 degrees away from the surgeon and the microscope is tilted 45 degrees towards the surgeon. Viscoelastic is placed on the underside of a direct gonioprism and the device is inserted through the corneal incision sideways with the surgeon’s dominant hand while the gonioprism is placed on the ocular surface with the non-dominant hand so that the nasal TM is in direct view. • The sharp tip of the blade is inserted through the TM and into SC. After the TM is pierced, the heel of the device is seated against the wall of SC and advanced in a clockwise or counterclockwise manner for approximately 3-5 clock hours depending on surgeon preference. As the device is advanced, the ramp gently stretches the TM while the dual blades create parallel incisions to generate a strip of TM. If a large trabecular strip is present this can be removed with intraocular forceps (as in this video). Small and/or peripheral strips however can be left in place. • Viscoelastic is then irrigated from the anterior chamber. All wounds are hydrated and checked to ensure water-tight closure. It is recommended that IOP be kept slightly high, around 20-25mmHg, at the end of the case to prevent further blood reflux. Clinical information • KDB goniotomy is a safe and effective option for managing glaucoma in appropriate patients. Compared to other goniotomy/trabeculectomy procedures, it results in a more complete removal of TM. • Clinical studies have demonstrated the efficacy of KDB goniotomy both with and without phacoemulsification for reduction of both IOP and medication dependence. However, most studies are limited to 12 month follow up. • When compared against other MIGS devices such as the iStent, KDB produced equal, if not improved IOP lowering. Longer term follow-up and future prospective studies are needed to better elucidate the clinical outcomes of this device as well as determining the best candidates for the procedure.