What is KDB (Kahook Dual Blade) Goniotomy?

KDB Goniotomy works on the inside of the eye to widen the existing drainage pathway. This allows more efficient drainage of the internal eye fluid (aqueous humour) in this way reduces the eye pressure.

How is KDB Goniotomy performed?

KDB Goniotomy is done by making small incisions into the eye which usually self-seal and do not require stitches. There is no extra implanted device required for this procedure. Using a Kahook Dual Blade, the surgeon will slice open a portion of the internal drainage canal. The KDB is specially made to excise and remove the trabecular meshwork in this area with a clean cut. This allows for more efficient fluid drainage out of the eye.

What is the purpose of KDB Goniotomy?

KDB Goniotomy is done to reduce the eye pressure by improving the drainage through the existing drainage pathway. It can be done with cataract surgery or as a stand-alone procedure.

KDB Goniotomy can be used to lower eye pressures in patients who are not achieving target pressures, or to lower pressure in patients who rely on multiple eye drops to lower their eye pressures and are not tolerating them well. In this case, a successful KDB Goniotomy can potentially reduce the number of glaucoma drops needed to lower the eye pressures.

How does KDB Goniotomy reduce the pressure of the eye?

The aqueous humour, the fluid that the eye produces to nutrify the cells of the eye, is continually produced and then drained via the internal drainage pathway of the eye. The first part of this pathway has a filtration layer called the trabecular meshwork. This structure provides a partial barrier to the outflow of aqueous fluid. It can be abnormally restrictive in glaucoma patients leading to build up of pressure. KDB Goniotomy essentially involves cutting the trabecular meshwork wide open in one area so that aqueous drainage can occur more easily, and in this way leads to lower eye pressure.

Can KDB Goniotomy be used in all patients with glaucoma?

Glaucoma is a group of diseases that causes loss of vision by slow deterioration of the optic nerves. There are many different types of glaucoma with different causes. For this reason, not all procedures are suitable for all types of glaucoma. Your ophthalmologist will discuss what type of glaucoma surgery is best for your type of glaucoma. In general, KDB Goniotomy has been found to be particularly effective in cases of pseudoexfoliation glaucoma, uveitic glaucoma and chronic angle closure glaucoma.

Why choose KDB Goniotomy over other options?

Different surgeries also have different rates of success and also different kinds of complications. KDB Goniotomy is a minimally invasive surgery, with a shorter time for the procedure, and faster recovery. Compared with the standard procedures, KDB Goniotomy requires less postoperative visits and has a faster healing time. However, the degree of pressure reduction is not always that much (barring some exceptions), therefore this must be kept in mind in the decision-making process.

After surgery will I still need glaucoma medications?

You may or may not need to continue the glaucoma medications after surgery. Your ophthalmologist will set a target range for the pressure lowering based on your degree of glaucoma. If you are achieving this target range after surgery without glaucoma drops, you will not need to resume them. If your pressure is still not low enough, you may be asked to resume some or all of the glaucoma drops. This is because in some cases, glaucoma surgeries need to be augmented by glaucoma drops to achieve target pressures.

How painful is the surgery?

The surgery is usually done as an outpatient procedure under conscious sedation with a local anesthetic. Most of the operation is comfortable and painless.

Are there any risks involved with this treatment?

There can be a small amount of bleeding during the surgery which usually stops. Occasionally, there can be a lot of bleeding, especially in older patients who have been on blood thinners and have more fragile blood vessels. Bleeding can also be excessive in patients with very high preoperative pressures, which come down abruptly with the surgery. If this happens, there may be a need for reoperation to drain the blood.

As with any intraocular surgery, there is a small risk of infection and inflammation. Antibiotics and anti-inflammatory medications are used during and right after surgery to prevent infection and to improve healing.

When can I resume my normal activities after surgery?

For glaucoma surgery, there is a period of time right after surgery when the eye pressure is very unstable and there is high risk for complications like bleeding and excessive pressure lowering (hypotony). Generally, we advise 2-4 weeks of restricted physical activities especially heavy lifting, bending from a standing position, swimming, running and jumping. Depending on your vision, and if you were able to drive before the operation, patients can usually resume driving within 36 hours after surgery or as your ophthalmologist advises.

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