The sector of glaucoma surgical intervention is rapidly evolving, and there are several novel techniques that are less invasive than traditional glaucoma surgery. Although these techniques are less definitive in terms of their efficacy, they offer a viable stepping stone to attempt to safely delay, or in some cases even prevent traditional incisional surgeries like trabeculectomies and glaucoma drainage device implants.

Kahook Dual Blade (KDB): Goniotomy

This procedure is performed through a small two millimeter incision and can be done at the time of cataract surgery through the same incision your surgeon performs cataract surgery, or as a standalone procedure. A blade is utilized to unroof the trabecular meshwork which is the drainage pathway that sits at the edge of the iris (colored part of the eye). Typically about three to four clock hours, or 25-33% of the drainage pathway is excised. This effectively reduces an area of resistance for fluid to flow out of the eye. It is expected for some blood to reflux into the eye through this area of excision, which may result in some inflammation and blurry vision which resolves within a short period of time (days to weeks).

OMNI Surgical System: Visco-cannulation and Trabeculotomy

This procedure is performed through a small two millimeter incision and can be done at the time of cataract surgery through the same incision your surgeon performs cataract surgery, or as a standalone procedure. The visco-cannulation portion of the procedure involves the injection of visco-elastic, a gel-like fluid, into the Schlemm’s canal, which is a part of the internal outflow pathway of the eye. This serves to dilate this canal, as well as the tiny collector channels which are further downstream in the outflow pathway of fluid from the eye. This effectively helps to reduce the resistance to the outflow of fluid in these portions of the conventional outflow pathway. 

The second part of this dual-mechanism procedure is a trabeculotomy, which involves a breaking open of the trabecular meshwork, which is the initial area of resistance in the internal outflow pathway of the eye. This trabeculotomy is achieved by injecting a microcatheter (or stiff thread) into Schlemm’s canal and then pulling this thread through the roof of the canal or the trabecular meshwork to break it open and eliminate this area of resistance. This may be performed for 6-12 clock hours or 180 to 360 degrees. It is expected for some blood to reflux into the eye through this area of excision, which may result in some inflammation and blurry vision which resolves with a short period of time (days to weeks).