New dual blade can help surgeons lower IOP

Take-home: A new trabecular meshwork excision blade takes a new approach in IOP reduction.

AURORA, COLORADO-A new trabecular meshwork excision blade is yet another option for glaucoma surgeons in their quest to lower patients’ IOP.

The dual blade (Kahook Dual Blade, New World Medical) is engineered for angle anatomy and incises the trabecular meshwork through paired incisions to allow for tissue removal, said Leonard K. Seibold, MD, assistant professor and codirector, Glaucoma Fellowship, University of Colorado School of Medicine.

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Use of the blade can be paired with cataract surgery or as a standalone procedure. The blade is one of several new minimally invasive surgery options within glaucoma.

“The dual blade performs a goniotomy through the trabecular meshwork to allow increased aqueous outflow, thereby lowering IOP,” Dr. Seibold said.

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Four unique design features of the blade, according to Dr. Seibold, include its sharp tip, which can pierce through the trabecular meshwork; a ramp that elevates and stretches the trabecular meshwork; a dual blade that helps to incise and results in a free strip of meshwork; and a footplate that fits atraumatically in Schlemm’s canal.

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The single-use, disposable blade is used via an ab interno approach through a clear corneal incision. It is placed in the anterior chamber and the tip of the blade is pierced across the trabecular meshwork, then the dual blades create two incisions as the blade is advanced, Dr. Seibold said. A free strip of trabecular meshwork is created and removed. Surgeons can treat approximately 90 to 150 degrees of the angle.

If use of the dual blade is combined with cataract surgery, the post-op regimen is similar to that of standard cataract surgery. Patients use a nonsteroidal inflammatory drug and a topical steroid tapered over three to four weeks. Pilocarpine is added to keep the cleft open for four weeks; patients restart their glaucoma drops as needed.

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