Micropulse Laser Trabeculoplasty Research Articles

New approaches to selective laser trabeculoplasty

Selective laser trabeculoplasty (SLT) is the “golden standard” of laser glaucoma surgery. Its efficacy can be compared to pharmacological therapy, while in some cases its advantages may even lead to a more stable hypotensive effect. SLT may be used as a primary treatment for primary open-angle glaucoma patients and patients with ocular hypertension, while also considered safe and effective in cases when a repeat procedure is required. SLT may potentially decrease the demand for antiglaucoma drugs, improve patient’s response to treatment, make the treatment more comfortable and overall increase the patient’s quality of life. New modifications of standard laser treatment procedures have been emerging lately. This article summarizes scientific data on the efficacy and safety of the new generation of laser trabeculoplasty. It specifies the charateristics of micropulse laser trabeculoplasty (MLT), pattern-scanning trabeculoplasty (PLT) and titaniumsapphire laser trabeculoplasty (TSLT) and recounts the latest research dedicated to them.

Selective laser trabeculoplasty vs micropulse laser trabeculoplasty in open-angle glaucoma.

AimThe aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients.Patients and methodsIn all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1 hour and 1, 1–6, 6–12, 6–24, 24–36, and 36–52 weeks. Patients completed a survey 1 week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3 mmHg from baseline.ResultsIOP was lowered to ≥3 mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24–52 weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24–52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52 weeks post treatment. There were more treatment failures in the micropulse group up to 52 weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005).ConclusionMicropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure.

Laser Management of Glaucoma in Exfoliation Syndrome.

Argon laser trabeculoplasty as well as selective laser trabeculoplasty can be used in patients with exfoliation syndrome with similar safety and efficacy. However, treatment effect may abruptly reverse and patients need to be followed regularly to monitor intraocular pressure control. Newer laser treatment modalities including micropulse laser trabeculoplasty, titanium sapphire laser trabeculoplasty and pattern scanning trabeculoplasty show promising results but need to be studied in exfoliation patients. For exfoliation patients with angle closure, peripheral iridectomy, iridoplasty or cataract extraction can be very helpful. For refractory exfoliation glaucoma, transscleral diode laser cyclophotocoagulation offers a reasonable option to lower intraocular pressure. Other approaches to cyclophotocoagulation such as micropulse transcleral diode laser need to be studied further in exfoliation patients.

Micropulse laser trabeculoplasty for uncontrolled open angle glaucoma in Peruvian patients

ABSTRACT Objective: We describe the pressure lowering effect of micropulse laser trabeculoplasty (MLT) in patients with uncontrolled open angle glaucoma (OAG). Design: Retrospective case series. Methods: We retrospective reviewed 30 eyes with Open angle Glaucoma (OAG) at the Vista Clinic in Lima, Peru. A single session of MLT treatment was delivered using a 532 nm Frequency doubled Nd. YAG laser to 360o of the trabecular meshwork with a power of 1000 mW, 25 % of duty cycle, and 300 ms. of exposure. The intraocular pressure (IOP) was measured at baseline and at 1 day, 1 week, 3, 6 months post-treatment and were followed up for one last control. Results: The mean baseline IOP was 15.6 mmHg and in the last control was12.8 mmHg, mean follow up time of 19 months (+/- 10 SD). The mean reduction of IOP in the first day was 1.6 mmHg (± 2.6 SD) and 1.2 mmHg (± 3.3 SD) in the last follow up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction greater than 20%. No statistical difference in relation to demographics characteristics of the patients. The greatest reduction was achieved in the first day with a median of 2.00 (P 0.001). A tendency to achieve higher reduction of IOP in patients with higher baseline IOP was found, but was not statistical significant. No adverse reactions occurred. Conclusions: Micropulse laser trabeculoplasty can temporarily be effective in reducing the IOP in some patients with uncontrolled Open angle glaucoma and appears to be safe.

Micropulse Trabeculoplasty in Open Angle Glaucoma.

Background:We report the effect of micropulse laser trabeculoplasty (MLT) in the intraocular pressure (IOP) of patients with uncontrolled open-angle glaucoma (OAG).Materials and Methods:In this retrospective review, 30 eyes with OAG were treated with a single session of MLT at the Vista Clinic in Lima Perú. We used a 532 nm frequency doubled Nd: YAG laser to 360° of the trabecular meshwork with a power of 1000 mW, 15% of the duty cycle, and 300 ms of exposure. The IOP was measured at baseline and at 1 day, 1 week, 3 months, and 6 months post-treatment and were followed up for one last control.Results:The mean baseline IOP was 15.6 mmHg and in the last control was 12.8 mmHg, mean follow-up time of 19 months (±10 standard deviation [SD]). The mean reduction of IOP in the 1st day was 1.6 mmHg (±2.6 SD) and 1.2 mmHg (±3.3 SD) in the last follow-up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction >20%. No statistical significant difference in relation to demographic characteristics of the patients. The greatest reduction was achieved in the 1st day with a median of 2.00 (P < 0.001). A tendency to achieve a higher reduction of IOP in patients with higher baseline IOP was found but was not statistically significant. No adverse reactions occurred.Conclusions:MLT slightly reduced the IOP in a few patients with uncontrolled OAG for a very short time and may not be suitable for these patients.

Trabekuloplastyka w trybie mikropulsów – doświadczenia własne

Implementation of the micropulse technology in retinal laser therapy has led to the application of the method glaucoma treatment as well. Effectiveness of MicroPulse Laser Trabeculoplasty (MLT) is comparable to the previous ALT and SLT procedures. The therapy may be considered as first-line treatment or as a replacement or supplementation of the eye drop therapy.

Micropulse laser trabeculoplasty as an adjuvant treatment for uncontrolled open angle glaucoma

Micropulse laser trabeculoplasty as an adjuvant treatment for uncontrolled open angle glaucoma

Micropulse laser trabeculoplasty for open-angle glaucoma

Purpose The aim of this study was to evaluate the pressure-lowering effect of 577 nm micropulse laser trabeculoplasty in eyes treated for primary open-angle glaucoma. Patients and methods This prospective interventional case series included 30 eyes of 30 patients treated for primary open-angle glaucoma (one eye of each patient). Treatment was delivered using the IQ 577 nm laser system with fixed treatment parameters: 577-nm (yellow) wavelength, 300-µm spot size, 300-ms envelope duration using 1000 mW of power at a 15% duty cycle, and delivering confluent applications for 360°. Results The mean intraocular pressure at baseline was 18.07±1.91 mmHg. There was a prompt and significant decrease in intraocular pressure that was maintained during the 6-month follow-up, reaching 14.17±1.56 mmHg (P Conclusion Five-hundred and seventy-seven nanometer micropulse laser trabeculoplasty offers a safe, effective adjuvant treatment to pharmacotherapy in treating primary open-angle glaucoma.

Micropulse diode laser trabeculoplasty in Nigerian patients.

IntroductionThe term micropulse laser trabeculoplasty suggests that only a fraction of the laser power is applied to the trabeculum to effect pressure lowering. It has not yet been exclusively used in Negroes, and we wish to report on our experience in Nigerian patients.MethodsThe study design is a retrospective chart review of our patients at the Rachel Eye Center in Abuja. The 810 diode Optos FastPulse laser was used to apply 34 cycles of treatment to 30 eyes of 16 individuals. Patients were selected based on the failure of maximal medical therapy. One patient had two extra rounds of treatment, while two patients were treated in only one eye. The pressure change at 1 hour after the treatment was analyzed. Patients were followed up for a mean period of 160 days with continuous monitoring of pressure changes. Patients’ original therapy was not disturbed.ResultsPostlaser immediate drop in intraocular pressure (IOP) averaged 3.2 mmHg (CI 1.6–4.7, P<0.0001) representing 17.2% drop from baseline prelaser IOP. The drop in IOP was sustained over varying periods, from a few weeks to several months. There was a temporary spike in three instances. No serious side effects were noted.ConclusionMicropulse diode laser trabeculoplasty is a useful adjunct in the management of open-angle glaucoma in Nigerians. This corroborates the findings of other researchers in western populations.