Surgery: Manual Phacoemulsification and MIGS using a Kahook Dual Blade

This video demonstrates a manual phacoemulsification and a Minimally Invasive Glaucoma Surgery (MIGS) using a Kahook Dual Blade. The soft cataract was removed using a phacoemulsification and then a Kahook Dual Blade was used to dissect and remove a portion of the trabecular meshwork.

Surgeon: Dr. Kevin M. Barber, President, Advanced Center for Eyecare Global, USA


Dr. Barber: This is Dr. Kevin Barber, presenting a case of phacoemulsification with MIGS using a Kahook Dual Blade by New World Medical. So you can see here, this is a relatively soft cataract. 2.4 millimeter, clear corneal incision was just made. Followed by the capsulorhexis, starting centrally and moving out peripherally. Grabbing the flap and walking it around, striving for approximate 5.5 to 6 millimeter in diameter capsulorhexis.

Hydrodissection now being performed with a Chang cannula. You’ll see a fluid wave and then the golden ring. This lens is prolapsed, you can see the nasal hole of the lens did prolapse into the anterior chamber. Therefore, I will remove this nucleus with a flip technique, simply back chopping the vertically placed nucleus.

This is a nice technique for a soft lens, as it allows for the phacoemulsification to be done at the iris plane, lessening the likelihood of doing any damage to the posterior capsule due to the soft nature of the nuclear material. This is one of my prefered techniques for a soft cataract.

As we get down to the final parts of the nucleus you can see the second instrument, a Connor wand, now assisting with the removal of the epinucleus. We’ll slide the Connor wand posterior to the epinucleus and we’ll lift and rotate it forward.

Now transition to irrigation/aspiration. Stripping the cortical remnants centrally, saving the subincisional cortex for last. I prefer a 45 degree angled I/A tip, which allows me good exposure to the subincisional cortex, as seen here.

We will now get a good fill of a cohesive viscoelastic. This is a preloaded Alcon AU0T00 lens. Center it within the capsular bag. We now tilt the patient’s head away from the surgeon, approximately 30 degrees, and then tilting the microscope, having the patient look down, and using a gonio lens to give visualization of the angle.

Before focusing down too much, I will place the Kahook Dual Blade through the corneal incision, to be done in an atraumatic fashion. We will then engage the Kahook Blade into the trabecular meshwork, and begin working counter-clockwise. The Kahook Blade is dissecting and removing the trabecular meshwork as it is advanced, and you can see a small tag of it there.

To maximize the effect of this procedure, I’ll go back and try to accomplish another one to two clock hours of treatment inferiorly. We’ll then come to the point where the initial pass was terminated and go just beyond that, engage the trabecular meshwork, and then come back to meet the initial pass. This will amputate any trabecular meshwork that might still be connected. As it is ideal to remove the dissected parts of the trabecular meshwork. That’s being done now during your irrigation/aspiration where the viscoelastic is being removed, as well as any dissected and amputated remnants of the trabecular meshwork. Wounds were then hydrated and closed. And this concludes the case of manual phacoemulsification with a MIGS procedure using the Kahook Dual Blade. Thank you for watching.

3D Version

August 26, 2020

Last Updated: September 12, 2022

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