Dual blade goniotomy and direct viscodilation of the collector channels combined with cataract surgery

Session Details

Session Title: Cataract Surgery & Glaucoma

Session Date/Time: Sunday 23/09/2018 | 14:00-16:00

Paper Time: 14:00

Venue: Room A3, Podium 1

First Author: : L.Burk USA

Co Author(s): :    J. Gilmore                    

Abstract Details

Purpose:

The effects of combining goniotomy using the Kahook Dual Blade, direct viscodilation of the collector channels, and cataract surgery were evaluated for reduction of intraocular pressure (IOP) and dependence on glaucoma drops in the treatment of all levels of glaucoma severity. This unique technique called “clean the gutter and power wash the downspouts”, not only removes trabecular meshwork but forcibly viscodilates the collector channels.

Setting:

Dallas Eye and Ear, Dallas, Texas

Methods:

The Goniotomy-Viscodilation-Cataract group contained 105 eyes with mild, moderate, and advanced glaucoma. Following standard cataract surgery, the Kahook Dual Blade was used to remove trabecular meshwork in the nasal and inferior quadrants. The viscoelastic was injected as the perpendicular cannula was held against the outer wall and dragged through the goniotomy gutted canal. Elimination of all drops and an IOP of 20mmHG or less were considered full success. IOP was monitored for steroid response and at least every three months. Glaucoma drops were adjusted as needed.

Results:

Mild disease accounted for 50% with 50% evenly distributed between moderate and advanced glaucoma. 30% had previous glaucoma surgery. 50% were on anticoagulants. 60% were diabetic. 80% were African Americans. Initial IOP was 19.9mmHg (SD+/-5.5) on 1.8 medications. At one month the IOP was 16.0mmHg (SD+/-3.8). No glaucoma medications in 90% of eyes. Throughout the first year, the mean IOP remained 16.0mmHg (+/- 4.2). Hypotony, choroidal detachments, cyclodialysis clefts were not observed. Less than 10% had a hyphema. Two eyes required washout, one combined with an Ahmed glaucoma implant. Upon further investigation, this patient was mistakenly taking three anticoagulants.

Conclusions:

The synergy of this Goniotomy-Viscodilation technique dubbed “clean the gutter and power wash the downspouts” is responsible for the marked reduction of glaucoma drops. Unlike the GATT procedure and viscoelastic canaloplasty, the Kahook Dual Blade actually removes the trabecular meshwork that may otherwise subsequently collapse into the collector channels if not removed. This unique combined Goniotomy-Viscodilation-Cataract procedure is a safe and effective approach for compliance issues and the financial burden associated with glaucoma treatment.

Financial Disclosure:

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