When to use the dual blade Nathan Radcliffe: “If you have experience with trabecular bypass, or other types of incisional trabecular meshwork (TM) surgeries, you want to approach the Kahook Dual Blade (KDB) with an open mind. In my experience, the dual blade has delivered unsurpassed efficacy in terms of lowering IOP, which I couldn’t have predicted based on my experiences with other types of trabecular bypass.” Leonard Seibold: “The KDB has allowed me to perform a more complete goniotomy than other methods available, and a more complete TM removal, in a simple yet elegant manner. But you should have a good foundation in intraoperative gonioscopy in order to perform this surgery to the best of its capabilities.”

In my experience, the dual blade has delivered unsurpassed efficacy in terms of lowering IOP.

Selecting the right patient NR: “The KDB procedure is versatile – it can be performed in patients combined with cataract surgery, and also in phakic patients with 20/20 vision. It can also be used in patients who are already pseudophakic, and alongside other procedures, such as other types of trabecular bypass (if one wants to expand the number of accessed collector channels), glaucoma drainage devices, endocyclophotocoagulation, and more.” LS: “Any patient with open angle glaucoma, whether primary or in some cases secondary, can be a candidate. The most profound pressure reductions I’ve found are in patients who have pigmentary or pseudoexfoliative glaucoma – where we know the site of obstruction is at the level of the TM, so by removing that tissue you can dramatically increase aqueous outflow and lower IOP. Additionally, any patient with uncontrolled IOP despite medications, or who is intolerant, allergic, or not adhering to their medications, could potentially benefit.” Getting the preparation right NR: “Using gonioscopic visualization, you want to make sure that you have adequately inflated the anterior chamber, as this is going to be important during the TM treatment. You want the eye to be slightly pressurized, certainly higher than episcleral venous pressure, but not so high that you’ll collapse the TM. A pressure of around 20 mmHg is ideal.” LS: “Like in any angle surgery, a good view of your target tissue is key – in this case that’s the TM. Examine these patients closely in your preop evaluation, because when you’re deciding who’s a candidate you want to be able to visualize good angle anatomy and landmarks, so you know you’ll be able to see the target tissue well in surgery.”

Any patient with open angle glaucoma, whether primary or even in some cases secondary (particularly pigmentary and pseudoexfoliative glaucoma), can be a candidate.