Use of ab interno Kahook Dual Blade trabeculectomy for treatment of primary congenital glaucoma

Abstract

Introduction: Primary congenital glaucoma is a rare ocular disorder that is responsible for 0.01%–0.04% of total blindness worldwide.1 The goal of congenital glaucoma management is to allow for proper development of the immature visual system by controlling intraocular pressure. Medical therapy usually provides a supportive role to temporarily reduce intraocular pressure, but patients typically require iridocorneal angle surgery to facilitate aqueous humor outflow. In this report, we describe the use of minimally invasive ab interno Kahook Dual Blade trabeculectomy for treatment of primary congenital glaucoma. Case description: A 13-month-old male with bilateral primary congenital glaucoma due to a loss of function TEK mutation. He had bilateral findings of elevated intraocular pressures, buphthalmos, Haab’s striae, photophobia, and myopia. Over the course of 6 weeks, three ab interno trabeculectomies with a Kahook Dual Blade were performed in the patient’s left eye and one in the patient’s right eye. After 3 months, intraocular pressures while receiving pressure reducing ophthalmic drops bilaterally reduced from 43 to 21 mmHg in the right eye after a single surgery and from 44 to 34 mmHg in the left eye after three surgeries, eventually requiring glaucoma drainage implant placement. There were no complications. Conclusion: Ab interno Kahook Dual Blade Trabeculectomy is a minimally invasive and potentially successful procedure for the treatment of congenital glaucoma. The safety profile of minimally invasive glaucoma surgery warrants consideration for congenital glaucoma patients, as they usually require iridocorneal angle surgery because pharmacologic therapy is typically inadequate.

Update in Genetics and Surgical Management of Primary Congenital Glaucoma

“…One such instrument is the recently introduced Kahook dual blade, which enables controlled excision of the trabecular meshwork with an ab interno approach and is specifically designed to allow for a more controlled depth of trabecular incision and decrease the rate of underlying ciliary body image that may be observed with the use of sharper MVR blades. 54,55 Trabeculotomy ab externo Trabeculotomy ab externo is an intervention for the treatment of PCG wherein the SC is cannulated and trabecular meshwork torn towards the anterior chamber in a controlled manner using an external approach with a scleral cut-down. 9,56,57 This procedure was developed in the 1960s thorough the works of Smith 56 and Burian 57 , who independently cannulated the SC using a nylon suture and a metal probe, respectively.…”

Resultados de curto prazo da trabeculotomia ab-interno usando o Kahook Dual Blade em pacientes com glaucoma congênito primário

“…After three months, while receiving hypotensive eye drops bilaterally, the patient's IOP was reduced from 43 to 21 mmHg in the OD after a single procedure and from 44 to 34 mmHg in the OS after three surgeries, requiring glaucoma drainage implant placement. The author claimed that the asymmetry in the level of maldevelopment possibly resulted in the poor response to surgery in the left eye (6) . Although our first case showed buphthalmos and an increased axial length, the surgical response was satisfactory.…”

Ab interno trabeculectomy with the dual blade in juvenile open-angle glaucoma

“…Ab interno trabeculectomy with the Trabectome was introduced to eliminate the creation of a filtering bleb and its use has been described in a patient with JOAG with 5-year follow-up. 5 Histopathology analysis of residual TM tissues after Trabectome use have demonstrated significant charring from thermal injury, with the suggestion that there may be tissue debris occluding distal collector channels. 3,7 Tissue incised with the dual blade revealed more complete removal of TM without damage to surrounding tissues.…”

“…3 It allows for excision of TM tissue with minimal reported collateral damage and has been successful in the treatment of childhood glaucoma and primary congenital glaucoma. 3–5 In addition, goniotomy with the KDB has been shown to significantly reduce IOP and the use of IOP-lowering medications in glaucomatous eyes in patients ranging from ages 18 to 90 years. 6 Here we describe a patient with JOAG successfully treated with ab interno trabeculectomy using the dual blade.…”