Micropulse Transscleral Cyclophotocoagulation Research Articles

FIRST EXPERIENCE WITH COMBINED CYCLOPHOTOCOAGULATION TECHNIQUE USING TRANSILLUMINATION

Relevance: сurrently, micropulse transscleral cyclophotocoagulation is widely used for the treatment of refractory glaucoma. It has a high safety profile and can be applied to eyes with high visual potential. Continuous-wave cyclophotocoagulation has a more pronounced hypotensive effect; however, it is accompanied by a significant number of complications. During transscleral cyclophotocoagulation, it is suggested to use a standard position for the sensor, though the position of the ciliary processes may vary.Purpose: to analyze the effectiveness and safety of the combined cyclophotocoagulation technique using transillumination.Materials and Methods: the study included 22 patients (22 eyes) who underwent combined cyclophotocoagulation with transillumination. The observation period was 6 months, with control examinations conducted at 1, 3, and 6 months. At each visit, refractokeratometry, visual acuity assessment, ultrasound examination (B-scan), tonometry using the Maklakov method were performed. There was one case of postoperative uveitis in the form of iridocyclitisResults: after six months, intraocular pressure decreased by 45% from the baseline level-from 35.5 (34–38.5) mm Hg to 20 (20–21) mm Hg. The number of hypotensive therapy drops was also reduced-from 7 (5.75–7) to 4 (3.25–4) drops per day.Conclusion: combined cyclophotocoagulation with transscleral transillumination demonstrated a stable hypotensive effect over 6 months, with no significant complications such as prolonged hypotony, phthisis bulbi, or persistent refractory uveitis, which are commonly seen with continuous-wave cyclophotocoagulation. Thus, this technique may become an effective alternative to standard methods of cyclophotocoagulation.

Efficacy of new two-stage methods of surgical and laser treatment for primary open-angle glaucoma combined with cataract

Background. Lowering the intraocular pressure (IOP) is the only proven method to slow the progression of glaucomatous optic neuropathy. Successful conservative treatment or surgery do not guarantee the preservation of visual fields throughout life. Despite the current advances in conservative treatment of primary open-angle glaucoma, about 5.3 % of patients still require surgical or combined treatment. There is no consensus yet on approaches to the treatment of patients with glaucoma and cataract. The objective was to evaluate the effectiveness of new two-stage methods for surgical and laser treatment of patients with primary open-angle glaucoma associated with cataract. Materials and methods. Seventy patients (70 eyes) with primary open-angle glaucoma stages I–IV complicated by cataract were included in this study. There were two observation groups. All patients received a two-stage treatment — micropulse transscleral cyclophotocoagulation (MP-TSCPC) and phacoemulsification with a monofocal intraocular lens (IOL) implantation. The first group (n = 34) included participants who underwent phacoemulsification with IOL implantation (stage 1) one month prior to MP-TSCPC (stage 2). The second group (n = 36) consisted of patients who underwent MP-TSCPC (stage 1) and phacoemulsification with IOL implantation a month after (stage 2). These groups did not statistically differ in terms of age, gender, baseline IOP, and stage of primary open-angle glaucoma. The primary outcome measure was the normalization of IOP with or without the use of antiglaucoma medications and without a need for further laser and incisional procedures in 1, 3 and 6 months. The secondary outcome was stabilization or expansion of visual fields when evalua­ting 1, 3, and 6 months after stage 2. Results. The average IOP level with antihypertensive medications before the treatment in group 1 was 27.5 ± 1.3 mmHg, in group 2 — 27.0 ± 1.1 mmHg. One month after the treatment, patients of group 1 had normal IOP in 94.2 % of eyes and in 5.8 % of eyes with local antihypertensive medications; in group 2, IOP was normal in 100 % of eyes without antiglaucoma medications (p < 0.05). In 3 and 6 months, better hypotensive results were in group 2, but outcomes were not statistically significant. The visual fields were preserved at the preoperative level or expan­ded in patients from groups 1 and 2 one month after the treatment in 91.2 and 97.2 % of the eyes, respectively, 3 months after — in 91.2 and 97.2 %, 6 months after — in 88.2 and 94.4 % of the eyes, respectively. In group 2, better functional results were obtained at all time points, but it was not statistically significant. Conclusions. The studies have established a high efficacy and safety of new two-stage methods for surgical and laser treatment of patients with primary open-angle glaucoma and cataract with a follow-up period of 6 months. There was a tendency to greater efficacy of the method, where MP-TSCPC as stage 1 was followed by phacoemulsification with IOL implantation as stage 2. The nature and frequency of surgical and postoperative complications in both groups did not differ.

Comparison of Iridex MP3 and P3 probes on long-term intraocular pressure control after MicroPulse Transscleral-Cyclophotocoagulation

PurposeMicropulse transscleral cyclophotocoagulation (MP-TSCPC) is a glaucoma procedure that delivers energy to the ciliary body with minimal collateral-damage. We aim to assess the long-term effectiveness of MP-TSCPC using the original MP3 and revised P3 probe. Methods and designBaseline Retrospective cohort study was performed to obtain baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, and best-corrected visual acuity (BCVA) were obtained from pre- and post-operative visits of patients treated with MP-TSCPC. Failure was defined as IOP>21 mmHg, reduced IOP<20% below baseline, or IOP<5 mmHg on 2 consecutive follow-up visits after post-operative month 1, reoperation for glaucoma, or loss of vision to no light perception. ResultsA total of 113 eyes were enrolled, 44 using the MP3 probe and 69 with the revised P3 probe. Survival analysis found a 75% failure rate in patients treated with the revised P3 probe by the final visit with a mean time to failure (MTTF) of 4.8 ± 0.7 months which was higher than the original probe at 66% failure rate with a MTTF of 6.1 ± 1.1 months (p = 0.04). All causes of failure were due to high IOP and 67% required repeat treatment with MP-TSCPC or incisional surgery. Prior to censure of data from failure, both probes had significant reduction in IOP compared to pre-operative IOP at all time points. No significant changes in BCVA were found. Both groups were associated with low rates of complications. ConclusionBoth probes had a very low rate of visually significant complications when performed in a standardized method in accordance with surgical procedure and power settings recommended by Iridex; however, were associated with a high rate of single procedure failure due to uncontrolled IOP over the long term. The revised P3 probe was associated with a higher rate of failure. Patients experienced a reduction in IOP; however, a large proportion required additional treatment compared to the original MP3 probe.

Comparison of Efficacy and Safety of Slow Coagulation Transscleral versus Micropulse Cyclophotocoagulation in Refractory Glaucoma

Background Cyclodestructive laser technology has been developed with the aim of achieving a greater reduction in Intraocular Pressure (IOP) with minimal complication. Micropulse transscleral cyclophotocoagulation (MP-TSCPC) and slow-coagulation continuous-wave transscleral cyclophotocoagulation (SC-TSCPC) are considered to have less complications than conventional techniques using continuous-wave transscleral cyclophotocoagulation. Purpose To compare IOP reduction and complications in refractory glaucoma after SC-TSCPC and MP-TSCPC procedures. Methods This study is a prospective interventional study in refractory glaucoma patients. Measurement of IOP using Goldmann applanation tonometry was performed preoperatively, and all patients were monitored at days 1, 7, and 30 in the postoperative period. Success was defined as postoperative IOP reduction of &gt; 20% from baseline with or without glaucoma medication. Complications were identified by evaluating subjective complaints and slit lamp examination. Results The study included a total of 66 eyes, with 33 eyes in each group. Baseline IOP was 50.58 ± 9.937 mmHg and 48.45 ± 12.792 mmHg in SC-TSCPC and MP-TSCPC group, respectively. The mean IOP reduction was 27.44 ± 19.96% vs 14.39 ± 23.52% (p=0.018) in day 1, 46.19 ± 27, 7 3% vs 45.83 ± 24,80% (p=0,956) in day 7 and 46.49 ± 24.63% vs 27.09 ± 23.86% in day 30 (p=0.002), in SC-TSCPC and MP-TSCPC group respectively. Complications between groups were not significantly different. However, hypotonia (IOP &lt; 6 mmHg) was found in the SC-TSCPC group. Conclusion SC-TSCPC showed greater IOP reduction than MP-TSCPC, with no significant differences in complications between the two groups.

Comparison of Efficacy of Micropulse Laser Settings for Glaucoma Management.

Objectives: This study aims to compare micropulse transscleral cyclophotocoagulation (MP-TSCPC) laser parameters and determine the optimal laser setting. Methods: A retrospective study was performed on 351 eyes from patients who underwent MP-TSCPC at four power settings (1500 mW, 2000 mW, 2250 mW, and 2500 mW) from June 2018 to December 2021. The primary measurements of the efficacy of MP-TSCPC were the degree of intraocular pressure (IOP) reduction and the number of glaucoma medication reductions. The rate of hypotony was obtained to assess the safety of MP-TSCPC. Results: At 1500, 2000, and 2500 mW, the mean IOP reduction at each visit was statistically significant compared to the baseline, and at 2250 mW, the mean IOP was only significantly different at 18 months (p < 0.05). The change in the number of medications with 2000 mW has shown significance at 1 and 3 months from the baseline; with 2500 mW, statistical significance was shown at 3, 6, 12, and 18 months (p < 0.05) compared to the baseline. Mean IOP reductions (%) were greater in 2000 mW than in 1500 mW at 1 week, 1 month, and 3 months and were greater in 2500 than in 1500 mW at 1 week (p < 0.05). There was no significance for mean IOP reductions at 6, 12, and 18 months across all powers. Only two occurrences of hypotony were reported. Conclusions: MP-TSCPC at 1500 mW, 2000 mW, and 2500 mW is a safe and effective treatment for IOP reduction. MP-TSCPC at 2250 mW is safe but may show delayed effectiveness in IOP reduction. In the long term, no one specific power setting was found to be superior for IOP reduction.

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.

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. 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. 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. 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.

Efficacy and Safety of Micropulse Trans-Scleral Cyclophotocoagulation in Cambodian Patients with Glaucoma

Efficacy and Safety of Micropulse Trans-Scleral Cyclophotocoagulation in Cambodian Patients with Glaucoma

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