New World Medical
Surgeons who want to remove the TM have a new device, the Kahook Dual Blade. Because it is an ab interno micro-incisional instrument, not an implant, it is covered under existing reimbursement codes.
“We might call this a trabeculectomy ab interno, or we might call it an ab interno goniotomy,” said Nathan M. Radcliffe, MD, assistant professor of ophthalmology, director of Glaucoma Service, New York Eye Surgery Center, New York University Langone Medical Center. “In the surgical world, we sometimes struggle with reimbursement, but the goniotomy code has been around for years.”
The blade has a pointed tip that penetrates the TM and a ramp that elevates the tissue under pressure. Two blades free the tissue strip from the rest of the meshwork.
Blood reflux is common the first day, Radcliffe added, but clears in almost all patients within a week. Surgeons can expect about a 5 mm Hg reduction in pressure when used in conjunction with cataract surgery and 80% of patients are able to eliminate at least one medication.