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Kahook Dual Blade and the management of glaucoma in children

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Reports on the use of minimally invasive glaucoma surgery (MIGS) in children with glaucoma are limited. Two recent articles examine the use of Kahook dual blade (KDB; New World Medical) and other MIGS devices on the management of glaucoma in children.

In the first article, Go and Freedman review relevant articles on the role of MIGS in childhood glaucoma management and found that KDB, along with Trabectome and Xen gel stent, have demonstrated mixed results but have been used successfully in selected cases with short-term follow-up. According to the review, gonioscopy-assisted transluminal trabeculotomy and Trab360 appear safe and effective for achieving circumferential trabeculotomy in childhood glaucoma.

Go and Freedman said that the risks and benefits of using MIGS over other “more established methods” should be considered on a case-by-case basis. More research is needed to validate these initial findings.

The second article presents a case report of a successful ab-interno trabeculotomy with KDB in secondary traumatic angle recession glaucoma in a child. A KDB ab-interno trabeculotomy was performed in a 7 years-old boy with blunt trauma in the left eye with angular recess surroundings 110° and concomitant intra-ocular pressure (IOP) elevation of approximately 35 mmHg after previously receiving the maximum topical and systemic ocular hypotensive therapy. No glaucomatous neuropathy was noted at the time of KDB ab-interno trabeculotomy.

Post-surgery, oral and topical hypotensive medications were gradually withdrawn. During the follow-up period, IOP levels remained at approximately 11 mmHg. Functional and structural assessment of glaucoma also remained stable throughout the follow-up.

The authors concluded that KDB demonstrated a favorable safety profile and should be considered for trabecular glaucoma and those secondary to trauma, although studies are needed to better define which patients and glaucoma types will benefit most.

“According to the experiences of these authors, KDB is a low cost procedure when compared to the others MIGS, for that reason it was chosen. The case described can contribute not only to help spreading this anti-glaucoma technique, but also to increase the range of options in which KDB can be safely indicated,” the authors concluded.

Go MS, Freedman SF. Minimally invasive glaucoma surgery in childhood glaucoma. Curr Opin Ophthalmol. 2022;33(2):91-96. doi: 10.1097/ICU.0000000000000827. PMID: 34772851.

Reis LS, Arancibia AEL, Prata TS, et al. Ab-interno trabeculotomy with Kahook dual blade in secondary traumatic glaucoma in a child. Am J Ophthalmol Case Rep. 2022;25:101354. doi: 10.1016/j.ajoc.2022.101354. PMID: 35146206; PMCID: PMC8818491.