Micropulse Transscleral Cyclophotocoagulation Research Articles

Experience of micropulse transscleral cyclophotocoagulation in glaucoma with decompensated intraocular pressure

Experience of micropulse transscleral cyclophotocoagulation in glaucoma with decompensated intraocular pressure

Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uveitic Glaucoma.

To report a case series of patients with uveitic glaucoma who were treated with micropulse transscleral cyclophotocoagulation (mpCPC). This retrospective case series consists of patients from the University of Colorado Sue Anschutz-Rodgers Eye Center from 2015 to 2020 who were diagnosed with uveitic glaucoma. Information collected includes demographic data, type of uveitis, glaucoma severity, and prior glaucoma surgeries. Pre- and postoperative best corrected visual acuity, intraocular pressure (IOP), glaucoma medications, degree of inflammation, and uveitis therapies were included up to 36months postoperatively. Surgical success was defined as an IOP reduction of 30% with achievement of IOP goal using the same number of glaucoma medications or less at 6months or 1year. Uveitis success was defined as the absence of persistent anterior uveitis at 3months. Six patients and seven eyes with uveitic glaucoma underwent mpCPC. Types of uveitis included idiopathic anterior uveitis, HLA-B27-associated anterior uveitis, varicella zoster virus anterior uveitis, juvenile idiopathic arthritis-associated chronic anterior uveitis, lichen planus-associated intermediate uveitis, and sarcoidosis-associated panuveitis. Two of six eyes (33.3%) at 6months and three of five eyes (60%) at 1year achieved surgical success. Around 6months postoperatively, two out of seven eyes (28.6%) required Ahmed glaucoma valve placement (n = 1) or repeat mpCPC (n = 1). One eye (14.3%) required phacoemulsification with goniotomy followed by an Ahmed glaucoma valve 18months after mpCPC. There were no cases of persistent anterior uveitis, hypotony, or phthisis after mpCPC in this cohort. Micropulse transscleral cyclophotocoagulation may safely reduce intraocular pressure in some patients with uveitic glaucoma without exacerbation of intraocular inflammation. Multiple treatments may be required to achieve longer-term success.

Settings and effectiveness of the revised probe compared to the original probe for micropulse transscleral cyclophotocoagulation.

The goal of this study was to compare the settings and effectiveness of the original P3 and revised P3 probes for micropulse transscleral cyclophotocoagulation. This retrospective cross sectional study includes a total of 56 patients with glaucoma who received micropulse transscleral cyclophotocoagulation. 32 patients received treatment with the original P3 probe and 24 received treatment with the revised P3 probe. Success was defined as a 20% reduction in intraocular pressure. Laser settings, pre-op and post-op intraocular pressures, and pre-op and post-op medications were assessed. A 20% IOP reduction was achieved in 50% of patients in the original probe vs. 58.3% in the revised probe at one month (P = 0.536) and 71.9% vs. 50% at three months (P = 0.094), respectively. The revised P3 probe used higher values of power (2500 mW vs. 2023 mW, P < 0.0001), total duration (217s vs. 179s, P < 0.0001), and energy (170J vs. 113J, P < 0.001). There was a significant decrease in IOP lowering meds with the original probe at one month (-0.9 +/- 1.5 vs. -0.0 +/- 0.7, P = 0.010), but this was not seen at three months. There is no significant difference in IOP lowering effect between probes despite the revised probe using higher total energy. The original probe may be associated with fewer medications at 1 month, but not at 3 months. Further studies with longer follow up are needed to optimize the treatment parameters in order to maximize effectiveness while limiting side effects.

Micropulse Transscleral Cyclophotocoagulation in Non-Incisional Eyes with Ocular Hypertension and Primary Open-Angle Glaucoma.

To investigate the safety and effectiveness of micropulse transscleral cyclophotocoagulation (MPTSCPC) in non-incisional eyes with ocular hypertension (OHT) and early, moderate, and severe primary open-angle glaucoma (POAG). Retrospective cohort study of eyes that underwent MPTSCPC from 2016 to 2019 at an outpatient clinic in Canada. Eyes were excluded if any incisional procedures, except cataract surgery, were performed prior to MPTSCPC treatment. Laser power ranged from 900 to 2500mW. A total of 153 eyes from 93 patients were included (OHT n=22; early POAG n=46; moderate POAG n=35; severe POAG n=50). The baseline IOP was 18.37 ± 4.76mmHg in the total cohort. All cohorts experienced a significant mean IOP reduction by final follow-up (total p<0.001; OHT p=0.003; early POAG p<0.001; moderate POAG p=0.022; severe POAG p=0.015). Overall, 52.9% of eyes achieved an IOP reduction of ≥20% from baseline to final follow-up (OHT 59.1%; early POAG 58.7%; moderate POAG 45.7%; severe POAG 50.0%). There was worsening in best-corrected visual acuity in the total cohort (mean difference=0.11 ± 0.36 logMAR, p=0.11), mostly attributable to cataract progression (34.1% of phakic eyes) and ocular surface disease (7.2%). The number of topical medications and drug classes remained unchanged in the total cohort (p=0.425 and p=0.791, respectively). Twenty-two eyes (14.4%) required retreatment, which provided an additional IOP reduction of 1.26mmHg (p=0.344). By final follow-up, 8 eyes (5.2%) required escalation to incisional procedures. MPTSCPC is a safe and effective adjunct IOP-lowering treatment in non-incisional eyes with OHT and POAG.

Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma.

To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.

Micropulse transscleral cyclophotocoagulation (MP-CPC): efficacy endpoints for the treatment of refractory paediatric glaucoma - a retrospective case-series

BackgroundThis study evaluates the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-CPC) in paediatric patients.MethodsThis retrospective case-series recruited 44 eyes for glaucoma patients who were younger than 17 years and were treated with MP-CPC and followed for at least one year. Pre- and post-intervention intraocular pressure (IOP) was compared out to at least one year postoperatively. Success rates at 6 months and 1 year postoperatively were assessed. P < 0.05 was considered statistically significant.ResultsThere were 35 (79.5%) eyes with a history of glaucoma surgery. IOP decreased statistically significantly from a baseline of 32.7 (standard deviation:8.7 mmHg) to 23.2 (8.6) and 21.7 (7.9) mmHg at the 6 months and 1-year follow-up, respectively (P < 0.0001, all comparisons). Overall success was noted in 19 (47.5%) eyes at the 6 months follow-up, and 23 (53.5%) eyes at 1 year.ConclusionsMP-CPC reduces IOP and the burden of medications in paediatric patients with glaucoma. Additionally, its safety profile favours the use of MP-CPC as an adjunctive modality for refractory glaucoma.

The Challenges of Handling Neovascular Glaucoma at Undaan Eye Hospital Surabaya, Indonesia

Introduction &amp; Objectives : The management of neovascular glaucoma is challenging because frequently it is incurable with poor visual prognosis. Delay in treatment can lead to sight threatening glaucoma. This study aimed to provide an overview of incidence and management of neovascular glaucoma at Undaan Eye Hospital.&#x0D; Methods : This descriptive epidemiology study comprised 111 eyes of 102 patients. The inclusion criteria were patients diagnosed with NVG who came to Undaan Eye Hospital for 1 year (January 2021 to December 2021). Patients with incomplete medical records were excluded. The patient’s age, gender, risk factors, and treatment were reviewed.&#x0D; Results : There were 102 patients (111 eyes) diagnosed with NVG. The patients were mostly men (53,2%) and the mean age was 54.98 ± 12,4 years. Diabetes Mellitus (DM) was observed in 70 (63,1%) eyes, hypertension in 60 (54,1%) eyes, central retinal vein occlusion (CRVO) in 11 (9,9%) eyes, cholesterol in 7 (6,3%) eyes, and branch retinal vein occlusion (BRVO) in 1 (0,9%) eyes. Mean IOP at the time of diagnosis was 42,8 ± 11,2 mmHg. Anti-VEGF (25,2%), trabeculectomy (59,5%), glaucoma drainage device (17,1%), micropulse transscleral cyclophotocoagulation (5,4%) were done as an option of the treatment.&#x0D; Conclusion : NVG is more common in men. Most patients presenting NVG had DM and hypertension with mean IOP of 42,8 mmHg. Trabeculectomy is the most commonly performed procedure.

Cyklofotokoagulacja przeztwardówkowa za pomocą mikropulsowego lasera diodowego

Laser and surgical treatments are widely used in ophthalmology. Micropulsive transscleral cyclophotocoagulation is a safe, minimally invasive method of treating glaucoma. The MicroPulse laser can be used in children and adults. The success of treatment aimed at preventing eye damage or slowing the progression of the disease depends on proper patient preparation and proper post-operative care. The purpose of the following study is to present the criterion of qualification for the procedure, treatment protocol, effectiveness and safety profile of micropulse transscleral cyclophotocoagulation.

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.

Comparative evaluation of transscleral laser exposure in anatomical experiment

This study comparatively analyzed the morphology of eye tissues after laser exposure using the latest generation of transscleral laser techniques - micropulse transscleral cyclophotocoagulation (MP-TSCPC) and laser activation of scleral hydropermeability (LASH) - in an anatomical experiment. The study used pulsed-periodic radiation of an Er-glass fiber laser (λ=1.56 μm) and radiation of a diode laser (λ=0.81 μm) in the micropulse mode. A comparative morphological evaluation of histological preparations of target scleral and ciliary body (CB) tissues was performed with the study of laser-induced changes occurring after LASH and MP-TSCPC. The study of histological preparations obtained after MP-TSCPC and LASH did not reveal any noticeable signs of an inflammatory reaction or significant destructive changes. There were no signs of pronounced coagulative changes in the form of disorganization of connective and muscle tissue in the exposure area. At the same time, MP-TSCPC was accompanied by thinning and discontinuity of the CB pigment epithelium in the projection of its flat part and expansion of the gaps between the anterior connective tissue fibers fixing the CB to the sclera, which is likely a factor contributing to uveoscleral outflow. After LASH, in the irradiated areas at the level of the outer layers of the sclera (¾ of its thickness) located in the projection of the flat part of the ciliary body, multiple slit-like cavities and enlargements (stretching) of interfiber spaces were revealed with simultaneous compaction of the inner part of the sclera (¼ of its thickness). The identified morphological changes may indicate certain differences in the mechanisms of intraocular pressure (IOP) reduction after MP-TSCPC and LASH. The results of this study suggest that the enhancement of uveoscleral outflow of intraocular fluid and the hypotensive effect after MP-TSCPC may be associated with laser-induced expansion of the interspaces between the anterior connective tissue fibers of the CB in the suprachoroidal space. With LASH, the possible mechanism of lowering IOP may be related rather to an increase in transscleral filtration due to the appearance of slit-like interfiber spaces in the sclera, caused by local contraction of scleral fibers in the area of laser exposure. The absence of pronounced destructive changes at the histological level indicates the gentle nature of both laser techniques and the possibility of expanding the indications for the use of LASH in the treatment of glaucoma, including at its earlier stages.

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).&#x0D; 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.&#x0D; 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.&#x0D; 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.

Evaluation of laser power stability of repeatedly used SubCyclo probe in micropulse transscleral cyclophotocoagulation for glaucoma: A step towards sustainable ophthalmic surgery

Purpose To evaluate the laser power stability of the SubCyclo probe for micropulse transscleral cyclophotocoagulation after repeated use. Materials and methods This experimental study involved 6 new probes. Each probe was connected to the SubCyclo mode (2,000 mW power, 31.3% duty cycle, and 100 seconds duration) of the Vitra 810 laser delivery system (Quantel Medical, France). Laser power measurements were taken using a calibrated laser power meter (Nova, Ophir Optronics Solutions, Israel) every 10 seconds from 10 to 90 seconds during each of the 40 cycles. Intra-rater reliability was assessed using intraclass correlation (ICC). A linear mixed model for repeated measures and pairwise comparisons with Bonferroni adjustment were used for the analysis. Results The mean (SD) power outputs of all probes for the first cycle and all cycles were 421.9 (19.7) mW and 436.7 (16.1) mW, respectively. During the first cycle, the mean (SD) laser power gradually decreased from 444.3 (13.4) mW at 10 seconds to 407.3 (17.0) mW at 90 seconds (Fig 3). For all cycles, the power was 446.0 (13.6) mW at 10 seconds and gradually declined to 426.8 (21.0) mW at 90 seconds. Pairwise comparisons revealed significant differences in mean laser power outputs after 16 cycles of repeated use compared to the first cycle. The ICC estimate (95% CI) for intra-rater reliability was 0.96 (0.89, 0.99). Conclusions The SubCyclo probe maintains stable laser power outputs throughout repeated use for up to 16 cycles, with a significant increase observed after 16 cycles.

The Challenges of Handling Neovascular Glaucoma at Undaan Eye Hospital Surabaya, Indonesia

Introduction: Neovascular glaucoma (NVG) is a secondary glaucoma, frequently incurable, and can cause blindness. It is characterized by neovascularization over the iris, IOP elevation, and glaucomatous optic neuropathy. Retinal ischemia, which supplies the release of angiogenesis factors, is the leading factor of NVG. Anti-vascular endothelial growth factor (Anti-VEGF) agents are effective at iris and iridocorneal angle neovascularization. Furthermore, laser and surgery are still necessary to decrease intraocular pressure in the condition with ineffective medication. Delay in treatment can lead to sight-threatening glaucoma. Purpose: This study aimed to provide an overview of the incidence and management of NVG at Undaan Eye Hospital, Surabaya, Indonesia. Methods: This descriptive epidemiology study comprised 111 eyes of 102 patients. The inclusion criteria were patients diagnosed with NVG who came to Undaan Eye Hospital for one year (January 2021 to December 2021). Patients with incomplete medical records were excluded. The patient's age, gender, risk factors, and treatment were reviewed. Results: There were 102 patients (111 eyes) diagnosed with NVG. The patients were primarily men (53.2%), and the mean age was 54.98 ± 12.4 years. Diabetes mellitus (DM) was observed in 70 (63.1%) eyes, hypertension in 60 (54.1%) eyes, central retinal vein occlusion (CRVO) in 11 (9.9%) eyes, cholesterol in seven (6.3%) eyes, and branch retinal vein occlusion (BRVO) in one (0,9%) eye. The mean IOP at the time of diagnosis was 42.8 ± 11.2 mmHg. Anti-VEGF (25.2%), trabeculectomy (59.5%), glaucoma drainage device (17.1%), micropulse transscleral cyclophotocoagulation (5.4%) were done as an option of the treatment. Conclusions: NVG is more common in men. Most patients presenting NVG had DM and hypertension with a mean IOP of 42.8 mmHg. Trabeculectomy is the most commonly performed procedure.

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

Bilateral Fixed Dilated Pupils after MicroPulse Transscleral Cyclophotocoagulation: A Case Report and Review of Urrets-Zavalia Syndrome

MicroPulse transscleral cyclophotocoagulation (MP-TSCPC) is a relatively new procedure for treating refractory advanced glaucoma. It uses repetitive micropulses of diode laser in an "on-off" cyclic manner, delivered with the Cyclo G6 Glaucoma Laser System (IRIDEX Corp., Mountain View, CA). In this unique case, we report the only instance of bilateral Urrets Zavalia Syndrome (UZS) in medical literature following MP-TSCPC in a 33-year-old Asian female with refractory angle-closure glaucoma. The patient developed bilateral fixed dilated pupils (UZS) after the treatment. The treatment settings included 100 seconds of laser application (50 seconds superiorly and 50 seconds inferiorly). Treated areas were the superior and inferior 180 degrees of the eye, excluding the 3 and 9 o'clock positions. On the first postoperative day, vision and intraocular pressure (IOP) were stable. Six weeks postoperatively, the patient presented with fixed mid-dilated pupils bilaterally and a visual acuity (VA) of 20/200 and 20/300, despite discontinuing Atropine 1% for 42 days. The patient was given pilocarpine 2% for ten days without response; however, vision improved to 20/125 and 20/160 with refraction and a +4.50 add for near vision. One and a half years postoperatively, the patient showed spontaneous partial recovery of the fixed dilated pupils in both eyes, with sectoral paralytic iris superiorly. The overall pupils' size was smaller in both eyes compared to previous visits. This case outlines the patient's symptoms, treatment, and outcome while discussing the potential risk of UZS following MP-TSCPC in specific populations. Further research is needed to better understand and mitigate the UZS complication after MP-TSCPC.

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

Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes.

This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period. Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm2 and a duty cycle of 31.3%. A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028). Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis. Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.

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.

Micropulse Transscleral Cyclophotocoagulation Results in Secondary Glaucoma.

The aim of this study was to analyze the long-term outcome of first session of micropulse transscleral cyclophotocoagulation (MP-CPC) for refractory glaucoma developed after vitreoretinal surgery combined with silicone oil implantation. The inclusion criteria of this consecutive case series were: patients with secondary glaucoma in the refractory stage who underwent MP-CPC between 2018 and 2021, vitreoretinal surgery combined with silicon oil implantation, and at least a 24-month follow-up period after MP-CPC. Success was defined as the baseline eye pressure reduced at least 20%, and it should be ranged between 10 to 20 mmHg without further MP-CPC at the end of the follow-up. For this retrospective study, 11 eyes of 11 patients were selected. The reduction in IOP was found to be significant (p = 0.004) at the end of the follow-up time, and the success rate was 72% according to our results. The change in the number of antiglaucoma agents in the administered eyedrops was not significant compared to the baseline values. At the end of the follow-up period the change in BCVA values was not significant (p = 0.655). Our results confirm significant IOP lowering effect of this subthreshold method preserving visual performance safely even in eyes with previous vitrectomy surgery with a silicone oil implantation.

A prospective comparison of continuous wave and micropulse transscleral laser cyclophotocoagulation for refractory glaucoma in African eyes

Aims: To report the efficacy of transscleral diode laser photocoagulation and compare outcomes between the continuous wave (CW) and micropulse wave (MP) protocols for refractory glaucoma in African eyes. Methods: A non-randomized prospective comparative study of patients who had transscleral diode laser photocoagulation for refractory glaucoma between January 2021 and December 2021in Eye Foundation Hospital Lagos, Nigeria was done. Results: A total of 52 eyes of 52 patients were analyzed. Mean age of patients was 66 ± 12.5 years. The mean preoperative intraocular pressure (IOP) was 31.2 ± 11.9 mmHg. Overall post-operative mean IOP was 17.9 ± 8.6 mmHg at 4 weeks, 21.0 ± 9.9 mmHg at 8 weeks and 20.6 ± 11.4 mmHg at 12 weeks. The difference between mean preoperative and postoperative IOP measured at week 12 was statistically significant (p&lt;0.001). Both continuous wave and micropulse wave protocols were effective at reducing intraocular pressures, the micropulse group had a mean difference between preoperative IOP and postoperative IOP at week 12 of 7.5 ± 6.7 mmHg (p=0.001), while the continuous wave laser group had a mean difference of 11.7 ± 13.7 mmHg (p&lt;0.001). The micropulse group achieved a higher percentage of success in 11 eyes (78.6%) compared with 24 eyes (63.2%) in the continuous wave group. This difference was not statistically significant (p=0.341). Conclusion: Both the continuous wave (CW) and micropulse wave (MP) protocols of transscleral diode laser photocoagulation were found effective at significantly reducing IOP in our study of African eyes with refractory glaucoma. Although the MP group achieved a higher percentage of absolute success, this was not statistically significant.