Micropulse Cyclophotocoagulation Research Articles

Morphometric analysis of the anterior chamber in patients with refractory glaucoma after micropulse cyclophotocoagulation

PURPOSE. To evaluate the anatomical-topographic parameters of the anterior chamber of the eye before and after micropulse cyclophotocoagulation (mCPC) in patients with refractory glaucoma in pseudophakic and phakic eyes.METHODS. The study included 60 patients (62 eyes) with moderate (7 eyes) and advanced (55 eyes) refractory glaucoma. Study groups were formed as follows: the 1st group consisted of 31 pseudophakic eyes (32 patients), the 2nd group included 31 phakic eyes (30 patients). All patients underwent mCPC according to a modified technique. To assess anatomical parameters patients underwent optical coherence tomography of the anterior segment (AS-OCT). Anterior chamber angle (ACA) and anterior chamber depth (ACD) were measured at specific follow-up time points after mCPC.RESULTS. Hypotensive effect by the end of 12-month follow-up was achieved in the patients of the first group in 83.1% of cases, in the second group — in 80.6% of cases (p<0.05). According to OCT findings, anterior chamber depth in patients with phakic eyes during the 12-month follow-up remained the same as before surgery — 2.43±0.21 (mm). In the other group with pseudophakic eyes, anterior chamber depth also did not change during the observation period, with an average value of 3.27±0.12 (mm). No significant changes (p>0.05) were found in the irido-corneal angle measurements in the 4 meridians over the entire follow-up period in both groups.CONCLUSION. Micropulse cyclophotocoagulation performed at fluence rate F=121 J/cm2 does not result in changes of structures of the anterior segment of the eye. The stability of anterior chamber anatomy as well as the absence of postoperative complications in early and longterm follow-up proved the minimal traumatic effect of this surgery in patients with refractory glaucoma. 

Modern trends in the treatment of glaucoma

In nearly all Russian regions, glaucoma ranks first among the causes of disability due to ophthalmic pathology, which is in line with global trends of glaucoma incidence growth and its leading position among the causes of irreversible blindness. Treatment of glaucoma is aimed at lowering intraocular pressure (IOP). This review presents the main current trends in the treatment of glaucoma: drug therapy, laser surgery, fistulizing, drainage and non-penetrating surgery, as well as the latest micro-invasive glaucoma surgery (MIGS).Currently, the pharmaceutical market offers many antihypertensive drops. Fixed-dose combinations of drugs have been proposed to increase treatment adherence, and effective drug delivery methods are being developed, which lower IOP with minimal side effects. Further development of laser surgery makes it both a method of choice for the initial treatment (selective laser trabeculoplasty) and expands its capabilities for various stages of glaucoma (micropulse cyclophotocoagulation). All this significantly reduces the frequency of classical macroinvasive antiglaucoma operations. The previously existing gap between conservative medical therapy and antiglaucoma surgery is filled by the newest MIHG procedures. In recent years, at all stages of primary open-angle glaucoma therapy, the emergence of new pharmaceuticals, methods and implants has been noted. These constitute the purpose of this publication.

Hyphema and vitreous hemorrhage after micropulse cyclophotocoagulation a case report.

We present two cases of vitreous hemorrhage after micropulse cyclophotocoagulation one of which had concurrent hyphema. To the best of our knowledge, these are the first cases of vitreous hemorrhage due to micropulse CPC in the United States. The first case is an 82-year-old woman with bilateral severe primary open angle glaucoma. BCVA in the right eye was 20/25, and 10-2 Humphrey visual field showed severe peripheral defects. The patient underwent MPCPC of the right eye and at one week, a settled 2 mm hyphema and vitreous hemorrhage confirmed by B-scan were noted. At three months, the patient had a BCVA of 20/80 with an IOP of 12 and retina consultation deferred a PPV. The second case is of a patient with bilateral moderate stage POAG who underwent MPCPC in both eyes. His original VA was 20/200 bilaterally. At 2 weeks, RE VA was count fingers at one foot and LE was 20/150-1. At two months, a RE B scan revealed dense vitreous opacities. Retina consultation revealed vitreous hemorrhage but a PPV was deferred. Clinicians should be aware of the risks of bleeding and the potential need for additional surgical interventions after MPCPC.

Dynamics of intraocular pressure in patients with refractory glaucoma after transscleral cyclophotocoagulation in micropulse mode

A retrospective analysis of IOP values was carried out in 38 patients (38 eyes) with refractory glaucoma stage III–IV after transscleral micropulse cyclophotocoagulation (mCPC) using the Cyclo G6 IRIDEX device on the next day after the procedure, after 1 month, 6, 12 and 24 months after surgery. The dynamics of IOP in the postoperative period largely depends on the initial values of the clinical parameter and does not depend on the patient’s age (p = 0.32), glaucoma stage (p = 0.46), history of antiglaucoma surgery (p = 0.34), the number of used drugs (p = 0.72). After mCPC, patients with lower baseline IOP values have a higher decrease in the indicator (-36 %) and a gradual increase by the follow-up period of 12–24 months compared with patients with high baseline IOP values.

Comparison of the efficacy of micropulse diode laser transscleral cyclophotocoagulation using different energy protocols

Abstract: PURPOSE: This study aimed to explore the safety and efficacy of laser treatment settings of micropulse transscleral cyclophotocoagulation treatment in glaucoma patients and to evaluate the relationship between intraocular pressure (IOP) reduction and different treatment parameters. MATERIALS AND METHODS: A total of 74 eyes in 64 glaucoma patients with IOP over 21 mmHg or under 20 mmHg with visual field progression who underwent micropulse transscleral cyclophotocoagulation treatment were included. Patients were divided into success and failure groups based on criteria of 20% IOP reduction rate. The predictive factors of IOP reduction between success and failure groups and the IOP reduction rates in the different treatment duration groups were evaluated. Predictive factors for IOP reduction were analyzed using univariate and multivariate regression models. RESULTS: Patients in the success group had significantly higher baseline IOP (median: 28.0 vs. 23.0 mmHg; P = 0.016) and longer treatment times (median: 240 vs. 160 s; P = 0.001). Treatment duration range between 200 and 240 s achieved significantly higher intraocular pressure reduction rates (47.8 ± 17.4%) than durations under 140 s (23.1 ± 14.2%). Univariate analysis showed that baseline IOP and treatment duration were significant contributing factors in IOP reduction. Multivariable analysis further demonstrated that treatment duration over 200 s was the significant predictive factor for IOP reduction. CONCLUSION: Treatment duration settings were the most significant factor of IOP reduction rates in micropulse cyclophotocoagulation. Customized therapy according to the target IOP reduction rate can be applied with different treatment duration settings to achieve optimal outcomes.

Micropulse cyclophotocoagulation compared to continuous wave cyclophotocoagulation for the management of refractory pediatric glaucoma.

Micropulse cyclophotocoagulation (MPCPC) has been shown in adults to offer a favorable post-operative safety profile compared to continuous wave transscleral cyclophotocoagulation (CWCPC) in the management of glaucoma. The purpose of this study is to evaluate the long term efficacy, safety, and effectiveness of MPCPC in the management of pediatric glaucoma when compared to CWCPC. IRB approved retrospective chart review of patients with pediatric glaucoma that underwent MPCPC and CWCPC at 2 separate institutions. Success was defined as intraocular pressure (IOP) between 5 and 21mmHg on any number of topical glaucoma medication without requiring additional surgical intervention or oral IOP lowering medication. Of the 48 patients in the study, 22 (26 eyes) underwent MPCPC and 26 (30 eyes) underwent CWCPC. At 1 year, 7 out of 26 eyes (26.9%) achieved success in the MPCPC group compared to 13 out of 30 eyes (43.3%) in the CWCPC group. Survival analysis unveiled a statistically significant difference in success between the two groups (p = 0.03). In pediatric glaucoma patients undergoing cyclophotocoagulation procedures, CWCPC outperformed MPCPC using default settings in terms of achieving long-term IOP control. Additional studies are required to evaluated augmented MPCPC settings in pediatric glaucoma patients.

A Systematic Review of Cyclophotocoagulation Techniques: Continuous Wave Versus Micropulse for Glaucoma Treatment.

Micro-pulse cyclophotocoagulation (MP-CPC) represents the latest iteration of minimally invasive laser procedures aimed at reducing intraocular pressure (IOP) through the disruption of pigmented ciliary body epithelium. This systematic review aims to assess the efficacy and safety profile of the MP-CPC procedure in comparison to CW-CPC for the treatment of glaucoma. We initiated a search on PubMed, ScienceDirect, and the Cochrane Library databases for studies that compared micro-pulse and traditional CW-CPC in terms of their efficacy and safety profiles. We employed medical subject headings terms and keywords such as "cyclophotocoagulation," "cyclodestructive," "photocoagulation," "CPC," "micropulse," "micro-pulse," and "glaucoma" within the timeframe from 2015 to 2023. We assessed the success rate, IOP reduction, antiglaucoma medications, and complications of MP-CPC and CW-CPC. We included six articles in this study, comprising two randomized controlled trials, three retrospective, and one prospective cohort, published between 2015 and 2023. Five out of six reported a significant reduction in IOP for both procedures with comparable success rates observed in MP-CPC compared to CW-CPC. One article reported an increase in IOP in MP-CPC. Both groups reported a decrease in the number of antiglaucoma medications, while one study reported an increase in medications in both MP-CPC and CW-CPC groups. Complication rates were lower in the MP-CPC group with two articles reporting a significant decrease compared to the CW-CPC group. MP-CPC has shown promising results in the treatment of glaucoma in the adult population. With comparable results in IOP reduction and fewer instances of serious ocular complications, MP-CPC may open new possibilities for the use of cyclophotocoagulation procedures in the earlier stages of glaucoma. However, its efficacy in the pediatric population and for neovascular glaucoma remains less defined, thus warranting further studies to establish optimal laser parameters for different types of glaucoma and specific populations of glaucoma patients.

Criteria for choosing the energy of micropulse transscleral cyclophotocoagulation

For a long time, the main parameter of micropulse cyclophotocoagulation (mTS-CPC) operation planning has been the calculated total energy. However, this indicator alone is not enough to determine more accurate correlations between exposure parameters and treatment outcomes.Purpose: to determine the criteria for choosing energy parameters to be used in mTS-CPC in refractory glaucoma patients.Material and methods. We propose a more reliable indicator of mTS-CPC clinical results, the energy flow, which is calculated from the speed of the probe movement. We developed and used a new strategy for conducting mTS-CPC: dividing the hemispheres of the ocular surface into 4 quadrants for a better control of the light guide movement while maintaining the selected speed. The standardized protocol for conducting the procedure has been modified so that the calculated energy flow is 121.8 J/cm2.Results. The evaluation of the treatment results of 140 patients according to the Kaplan Meier criteria showed the success of the treatment. IOP fell by 30 %, as compared with the baseline in the advanced stage, and by 20 % in the terminal stage, causing no complications. 12 months after the follow-up start, IOP compensation was noted in 81.3 % of cases.Conclusion. The presented modification of mTS-CPC using the energy flow parameters makes it possible to unify the technology of laser treatment, and the results obtained demonstrate a good and uncomplicated hypotensive effect. The availability of standardized energy indicators allows for a selective treatment tactics, depending on the individual characteristics of glaucomatous patients.

Микроимпульсная циклофотокоагуляция в комбинированном лечении неоваскулярной глаукомы

Purpose. To evulate the efficiency of micropulse cyclophotocoagulation (MP-CPC) in the combined treatment of patients with secondary refractory neovascular glaucoma with object vision. Material and methods. The study involved 30 patients (30 eyes) with neovascular glaucoma (NVG) in the stage of partial or complete blockade of the iridocorneal angle with decompensated intraocular pressure (IOP) resistant to drug therapy, who had object vision. Two study groups were formed, 15 eyes each. The first main group is represented by patients whom performed MP-CPC (Cyclo G6 Glaucoma Laser System by IRIDEX), as a stage of combined treatment before implantation of Ahmed glaucoma valve (IAGV). The second control group included patients who initially were treated by this type of drainage surgery without preliminary micropulse laser exposure. The follow-up period was 18 months. Results. The implementation of MP-CPC in the main group led to a significant decrease in IOP on the 1st day after treatment from 27.5±6.1 to 23.6±4.6 mm Hg, with the maximum attainment of normal values on the 3rd day of observation, which averaged 20.3±4.4 mm Hg. (p<0.05). By the end of the 1st month, an increase in mean IOP values to subcompensated values was recorded – 24.4±6.3 mm Hg. After valve drainage implantation, by the end of the 1st month of observation, IOP in the main group was 19 (16.5; 22.0) mm Hg, and in the control group it was 24.5 (20.5; 25.8) mm Hg. (p<0.05). After 18 months of the postoperative period, the level of ophthalmotonus in the main group is 15.5 (15.0; 18.2), and in the control group – 16.5 (15.0; 19.5) mm Hg. (p>0.05). A significant decrease in the amounts of hypotensive drugs in the main group was revealed: 1 (0; 2) versus 2 (1; 3) in the control group (p=0.03). In both groups, there was no significant deterioration in visual functions during the entire observation period. Conclusions. MP-CPC can be considered as a preliminary stage in the combined treatment of neovascular refractory glaucoma, as it reduces the risk of preoperative ophthalmohypertension before valve surgery, leads to a significant decrease in the amounts of hypotensive drugs in the late postoperative period, thereby improving the effectiveness treatment of patients with neovascular refractory glaucoma who have object vision. Key words: micropulse cyclophotocoagulation, neovascular glaucoma, valve's Ahmed

Micropulse cyclophoto-coagulation in patients with primary open-angle glaucoma: early results

Aim – to evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) procedure in patients with primary open-angle glaucoma (POAG).
 Material and methods. The study was conducted in 21 patients with POAG and uncompensated intraocular pressure (IOP) using pharmacotherapy. All patients underwent MP-TSCPC procedure with IRIDEX Cyclo G6 device. The follow-up period lasted for 1 month. During this time, the visual acuity, IOP dynamics, complications, as well as the number of hypotensive drugs used were evaluated. Statistical analysis was performed using STATISTICA 12.0 software.
 Results. Among patients with moderate and advanced glaucoma, the IOP reduced by 46.7 (3.3; 64.3) % from baseline values by the end of the follow-up period. The target IOP was achieved in 30.7% of patients. In 75% of patients who achieved target IOP, the number of hypotensive drops used was reduced by 1 component. In all patients with terminal stage glaucoma, pain was relieved, and IOP was reduced by 35.5 (8.4; 41.1) %. No intra- or postoperative complications were reported in any case.
 Conclusion. MP-TSCPC can be considered as a relatively safe adjunctive method to achieve target IOP in addition to medical treatment in patients with moderate and advanced glaucoma, as well as appropriate method to control pain in patients with the terminal stage of the disease.

Сравнительные результаты микроимпульсной циклофотокоагуляции с учетом различных уровней энергии у пациентов с первичной открытоугольной глаукомой

Purpose. To evaluate the safety and efficacy of different laser energy parameters when performing micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with different stages of primary open-angle glaucoma (POAG). Material and methods. 177 patients with moderate (47) and advanced (130) stages of primary open-angle glaucoma were under observation. All patients underwent repeated laser (mean 1,3±0,6) and surgical (mean 1,78±0,7) penetrating and nonpenetrating antiglaucoma surgeries. According to the amount of total energy during MP-TSCPC, patients were divided into 2 groups. The protocol of the first group (117 patients) included a total energy of 125J, fluence of 121,8 J/cm² . The protocol of the second group included increased energy (60 patients) where the total energy was 150 J, fluence 152 J/cm² . Results. Surgery and postoperative period in all patients were areactive. According to the data obtained when comparing the two groups on Kaplan – Meier chart, after 12 months of observation the group of patients with the fluence of 152J/cm² showed better results. A positive result was achieved in 95% of cases, compared to 87,1% in patients in the first group with an fluence of 121,8 J/cm². Conclusion. MP-TSCPC in patients with POAG with a fluence of 121,8 J/сm² and a total energy of 125 J and a fluence of 152 J/сm² and a total energy of 150 J is an effective and safe treatment method. The success parameters evaluated according to the Kaplan – Meier criterion showed that performing MP-TSCPC with 150 J energy was more effective than with 125 J. In the first group, 87,1% (102 out of 117 patients) success was achieved in up to 12 months of follow-up. In 60 patients with a higher energy (150 J), MP-TSCPC resulted in a long-term hypotensive effect in 95% (57 out of 60 patients) in the same period of observation. Key words: open angle glaucoma, intraocular pressure, micropulse cyclophotocoagulation, fluence

Micropulse cyclophotocoagulation based on a modified protocol of energy parameters in the treatment of patients with end-stage glaucoma

Purpose: to evaluate the effectiveness of transscleral micropulse cyclophotocoagulation (mCPC) in patients with end-stage glaucoma.Material and methods. 38 patients aged 76.6 ± 7.1 years with end-stage refractory glaucoma were examined, revealing subjective complaints, uncompensated IOP at the maximum hypotensive mode, prior multiple surgical interventions. Indications for mCPC to be performed on a SUPRA 810 device (Quantel Medical, France) according to a modified protocol, in which the laser energy flux is 121.8 J/cm2, were determined. In order to prevent postoperative inflammation after mCPC, a combined drug Floas-T® (glucocorticosteroid fluorometholone + tobramycin) was used.Results. A week after mCPC, the hypotensive effect was achieved in all 38 cases. IOP showed a 30.8 % decrease from the baseline. Considering an additional mCPC given to 14 patients, the entire group showed an IOP 22.8 % decrease (from 34.7 to 26.8 ± 2.9 mm Hg, p < 0.05) achieved after an 18 months’ follow-up. The combined drug Floas-T® was found to contribute to a subjective and clinical improvement, revealing no signs of an increased IOP.Conclusion. The use of mCPC in the treatment of patients with repeatedly operated refractory end-stage glaucoma who receive a maximum hypotensive mode should be estimated as a positive measure. The combined drug based on fluoroquinolone and tobramycin has demonstrated high effectiveness of anti-inflammatory prevention. A survey showed a subjective improvement in the patients’ quality of life. The mCPC method can be recommended as one of the components of a comprehensive rehabilitation program for patients with end-stage glaucoma.

Efficacy of micropulse cyclophotocoagulation in acute angle-closure glaucoma

BACKGROUND: An improved technique of cyclophotocoagulation appeared cyclophotocoagulation in micropulse mode with splitting of the continuous stream of laser energy into short micropulse series with intervals.
 AIM: The aim of the study is to clinically evaluate the efficacy and the safety of micropulse cyclophotocoagulation for acute angle-closure glaucoma jugulation.
 MATERIALS AND METHODS: In the study, 14 patients with acute angle-closure glaucoma with 37 days duration were included. The mean intraocular pressure was 35.1 2.4 mm Hg against the background of hypotensive therapy, best corrected visual acuity was from 0.005 to 0.3. All patients on admission underwent laser iridotomy, consistent peripheral colobomas of the iris were obtained. On the following day, taking into account the intraocular pressure level of 3036 mm Hg against the background of hypotensive therapy, all patients underwent micropulse cyclophotocoagulation with Cyclo G6 Glaucoma Laser System (USA).
 RESULTS: After surgery, there were no complications noted. The pain syndrome was completely eliminated in all patients on the first day after the procedure. Intraocular pressure decreased in average to 18.1 2.8 mm Hg. Within 318 months after micropulse cyclophotocoagulation, phacoemulsification was performed in 9 eyes. During the 2 years of the follow-up period, intraocular pressure in all eyes remained normal, from 16 to 23 mm Hg, best-corrected visual acuity varied from 0.4 to 0.9.
 CONCLUSIONS: Cyclophotocoagulation in micropulse mode allowed an effective and safe lowering of intraocular pressure to normal values in all eyes with acute angle-closure glaucoma; this provided pain relief and preservation of visual functions during the follow-up period up to 2 years.

Nationwide Analysis of Glaucoma Surgeries in Fiscal Years of 2014 and 2020 in Japan.

Nationwide trends in glaucoma surgical procedures were assessed by using the NDB Open Data 2014 and 2020. In Japan, 33,340 non-laser, 54,569 laser, and 88,019 total glaucoma surgeries were performed in 2014. In 2020, 60,108 non-laser, 60,547 laser, and 120,655 total glaucoma surgeries were performed. The rates from 2014 to 2020 were 180%, 111%, and 137%, respectively. In each procedure, angle surgery (326%), tube shunt surgery (383%), ciliary coagulation (489%), and gonio-laser (225%) were remarkably increased, while iridectomy (75%) and iris laser (77%) decreased during the same period. An increase in laser surgery was seen in young age groups, namely, 55-59 years old and younger, while non-laser surgery was increased in old age groups, namely, 45-49 years old and older. In 2020, 47.6 non-laser, 48.0 laser, and 95.6 total glaucoma surgeries were performed per 100,000 persons. None of the vital statistics, including prefectural population, mean age, and rate of ≥65-year-old people, were significantly associated with the number of glaucoma surgeries. Glaucoma practice patterns changed each time a new device or procedure was introduced. The results of the current study reflected the use of new procedures, such as minimally invasive glaucoma surgery, tube shunt, selective laser trabeculoplasty, and micropulse cyclophotocoagulation.

Перспективные подходы к лечению катаракты на фоне первичной открытоугольной глаукомы

Purpose. To evaluate a two-stage approach to surgical treatment of patients with cataract and primary open-angle glaucoma based on micropulse transscleral cyclophotocoagulation (MP-TSCPC) and phacoemulsification. Material and methods. The results of surgical treatment of 34 patients with cataract and primary open-angle glaucoma with non-dispersed intraocular pressure (IOP) were analyzed. A safer sequential surgery was chosen: at the first stage, MP-TSCPC was performed, at the second – cataract phacoemulsification. Results. After MP-TSCPC, the hypotensive effect was achieved in all 34 patients: IOP at the moderate stage was 14.6±1,4 mm Hg, at the advanced stage – 15.8±2,2 mm Hg. 1 month after surgery. Carrying out the second stage – phacoemulsification of cataracts 2–4 weeks after MP-TSCPC allowed to avoid reactive hypertension and achieve high functional results. IOP from the first day was 13.8±1,0 mm Hg in patients with moderate stage and 14.9±3,1 mm Hg in patients with advanced stage and remained compensated for 3 months after surgery. Visual acuity 3 months after surgery was 0.85±0.05 in patients with moderate and 0.73±0.05 with advanced stage. Anti-inflammatory prevention based on 0.1% fluorometholone acetate solution, considering the minimal effect on the IOP of the operated eye, showed promising advantages over other glucocorticoids for patients with glaucoma and cataracts. Conclusion. Sequential surgery with MP-TSCPC at the first stage and following phacoemulsification (against the background of stabilized IOP) is characterized by high functional results and minimal risk of complications in patients with comorbid pathology. Anti-inflammatory prevention based on 0.1% fluorometholone acetate solution, considering the minimal effect on IOP of the operated eye, has promising advantages for patients with glaucoma and cataracts. Key words: open-angle glaucoma, intraocular pressure, complicated cataract, micropulse cyclophotocoagulation, phacoemulsification

Эффективность циклофотокоагуляции в микроимпульсном режиме у пациентов с развитой и далеко зашедшей стадией первичной открытоугольной глаукомы

Purpose. To evaluate clinical efficacy and safety of micropulse cyclophotocoagulation (MP-CPC) in treatment patients with advanced and severe stages of primary open-angle glaucoma (POAG). Material and methods. Clinical study was carried out in 74 patients (74 eyes) with POAG aged 49 to 82 years. The advanced stage of glaucoma was detected in 35 eyes, the severe stage - in 39 eyes. The intraocular pressure (IOP) level before surgery varied from 23 to 36 mm Hg, averaging 29,6 ± 2,5 mm Hg. All patients underwent MP-CPC to standard technique using the Cyclo G6 Glaucoma Laser System the MicroPulse P3 glaucoma device (IRIDEX, USA). The observation period was 6 months. Results. All surgeries went without complications. The average IOP level on the 1st day after surgery was 21,1 ± 1,3 mm Hg. On the 1st day after surgery the more pronounced IOP decrease was revealed in patients with a dark (brown) iris color in comparison with a light (blue) iris. It was found that in periods to 6 months, the hypotensive effect of the surgery was more pronounced in patients of the age group under 60 years in comparison with the age group over 71 years. During the 1 year follow-up period, the IOP level was within normal values in 64 eyes (87%), averaging 20.9±1.2 mm Hg. Conclusion. MP-CPC is effective and safe operation to normalize IOP in most patients with advanced and severe stage of POAG with a follow-up period of 1 year. Keywords: micropulse cyclophotocoagulation, primary open-angle glaucoma, mild stage, moderate stage, intraocular pressure

Транссклеральная диод-лазерная циклофотокоагуляция в микроимпульсном режиме у пациентов с рефрактерной глаукомой

The aim of the work was to study clinical efficacy of micropulsed transscleral diode laser cyclophotocoagulation (MTDСFC) in patients with refractory glaucoma. Material and methods. After careful standard ophthalmologic eye examination, 60 patients underwent mTDGFC to compensate the intraocular pressure (IOP) and stabilize the visual and functional indices. Results. Immediately on the next day after the procedure a brightening of the cornea and a decrease of the degree of perilymphalic congestion were observed. IOP level decreased from 42.0 ± 1.2 to 20.97 ± 1.12 in 47.6% of cases, and in a year – to 18.85 ± 0.7. In 40% of cases (n = 24) the visual acuity improved from 0.03 ± 0.01 to 0.06 ± 0.05 which was statistically significant (p < 0,05). In 16.7% of cases (n = 10) there was an increase in the visual field boundaries by an average of 5 degrees. In 15 eyes (25.0%) it became possible to observe fundus. An important advantage of mTDFC was a 52.4% decrease in the number of hypotensive drugs used by the end of follow-up: from 3.0 ± 0.5 to 1.0 ± 0.5 drugs (p < 0.05). In the early postoperative period subconjunctival hemorrhages in 5 (8.3%) patients, hyphema 1 mm in 1 (1,7%) patient were among the available complications; they dissolved after hematase and dexamethasone injection. Conclusions. mTDFC should be performed in patients at earlier stages of refractory glaucoma, providing compensation for varying degrees of elevated IOP. This procedure contributes to the elimination or significant reduction of pain syndrome, which preserves eye function, improves patients'quality of life, and is an alternative to laser treatment of refractory glaucoma. Keywords: refractory glaucoma, surgical treatment, laser cyclophotocoagulation, micropulse cyclophotocoagulation, transscleral cyclophotocoagulation

Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure.

To evaluate the effects of micropulse transscleral cyclophotocoagulation (mCPC) and selective laser trabeculoplasty (SLT) on endothelial cell density (ECD) and reduction of the intraocular pressure (IOP) in patients with primary-open angle glaucoma (POAG). In this observational, retrospective study, 40 eyes with POAG were included. Patients were divided into three groups-group I was treated with SLT (n = 13), group II was treated with mCPC (n = 13), and group III included age-matched patients with medically treated glaucoma (n = 14) (control group). In both treatment groups (SLT and mCPC) preoperative and postoperative findings of best-corrected visual acuity (BCVA), ECD, and IOP were compared to the control group. The mean time interval before and after the treatment was 215 ± 120 days in group I (SLT) and 273 ± 177 days in group II (mCPC). The follow-up for group III (control group) was 209 ± 103 days. In both treatment groups (SLT and mCPC) there was a statistically significant reduction of the IOP postoperatively (group I: 3.5 ± 3.7 mm Hg (p = 0.005) and group II: 4.3 ± 4.1 mm Hg (p = 0.003)). The mean IOP for group III was 12.9 ± 3.7 mm Hg at visit 1 and did not change significantly (p = 0.353) at visit 2. In all three groups, there was no statistically significant change in ECD at the last visit. According to our results, both SLT and mCPC seem to be effective in lowering the IOP, without showing any statistically significant effect on ECD in patients with POAG.However, larger and longer-term studies are necessary to understand the effects of the SLT and mCPC procedures on ECD. Garip Kuebler A, Priglinger S, Reznicek L. Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure. J Curr Glaucoma Pract 2023;17(1):40-43.

Results of micropulse cyclophotocoagulation in patients with early stages of primary open-angle glaucoma

PURPOSE. To evaluate the capabilities of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with early stages of glaucoma.METHODS. The study included 38 patients with early stages of primary open-angle glaucoma who underwent MP-TSCPC with SUPRA 810 (“Quantel Medical”, France) as primary surgical treatment. The follow-up period averaged 17±11 months (from 6 to 30 months). The Kaplan-Meier scale was used to assess the cumulative success of laser treatment.RESULTS. The postoperative period was uneventful. One month after MP-TSCPC a  significant hypotensive  effect was  observed,  averaging  41.5%  from  the  baseline.  After 6 months, the hypotensive effect continued to  persist  and averaged 36.1%. By 12 months, the hypotensive effect remained stable, IOP averaged 16.0±3.5 mm Hg, which was 31% from the baseline. No changes in best corrected visual acuity (BCVA) were detected during the observation period. Target intraocular pressure (IOP) was achieved in all cases. Optical coherence tomography and perimetry findings remained stable or improved.CONCLUSION. MP-TSCPC in patients  with  early  stages  of glaucoma leads to a pronounced stable hypotensive  effect during the follow-up period, averaging 31%  (from  20% to 50%). An improvement in the quality of life was noted due to the cease or reduction in the number of instillations. Monitoring of patients continues in order to develop practical recommendations for the indications and regimens of MP-TSCPC in the early stages of glaucoma.

Safety and efficacy of micropulse transscleral cyclophotocoagulation: 2-year follow-up in a tertiary Canadian centre

ObjectifDécrire les résultats à long terme de la cyclophotocoagulation au laser micropulsé (CPC-MP). MéthodesIl s'agit de l'examen rétrospectif des dossiers de patients qui ont fait l'objet d'une CPC-MP aux mains d'un seul chirurgien entre juillet 2016 et janvier 2017. Parmi les données recueillies, citons la pression intraoculaire (PIO) préopératoire, le nombre de médicaments, la prise quotidienne d'acétazolamide et le type de CPC-MP réalisée (inférieure, supérieure ou circonférentielle). Les patients ont été évalués 1 semaine, puis 1, 3, 6, 12, 18 et 24 mois après l'intervention. RésultatsL’étude incluait 49 patients qui avaient subi une CPC-MP et pour lesquels on disposait de données de suivi sur 2 ans. Les patients étaient âgés de 20 à 91 ans (âge moyen : 69 ans; 50 % de femmes). Après la CPC-MP, la PIO était significativement plus faible à chacune des mesures réalisées pendant le suivi (p < 0,05). Après 2 ans de suivi, la PIO moyenne était de 15 mm Hg (baisse de 35 %). Six patients ont continué de prendre l'acétazolamide (dose quotidienne moyenne : 333 mg). Le nombre moyen de médicaments a diminué pour atteindre 2,6 (p > 0,05). Il ne s'est produit aucune complication structurelle significative, mais 53 % des patients ont dû subir une nouvelle CPC-MP. La complication la plus fréquente, survenue chez 33 % des patients, tenait à l’échec de la CPC-MP, qui commandait la réalisation d'une nouvelle intervention chirurgicale en vue d'abaisser la PIO. Les chirurgies antiglaucomateuses subséquentes comprenaient la trabéculotomie transluminale assistée par gonioscopie ou encore l'insertion d'un implant de type iStent, d'un implant pour glaucome Xen et d'une valve d'Ahmed. ConclusionsLa CPC-MP a permis de réduire efficacement la PIO et s'est accompagnée d'une baisse non significative du recours à des collyres antiglaucomateux. Cela dit, on a dû répéter la CPC-MP ou réaliser une chirurgie antiglaucomateuse invasive en vue d'obtenir une maîtrise de la PIO chez une importante proportion de patients, ce qui laisse croire que l'efficacité clinique de la CPC-MP pourrait être moindre que celle documentée dans la littérature médicale.