Comparative efficacy and safety of micropulse transscleral laser cyclophotocoagulation using different duration protocols in eyes with good visual acuity

Tekeli, Oya; Köse, Helin Ceren

doi:10.1007/s00417-021-05265-2

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…One major drawback associated with MP-TSCPC is the lack of a standardized optimal laser setting with regard to both power and duration. Tekeli et al 31 , in their study, compared 2 different energy durations (160 vs. 240 seconds) and concluded that a higher treatment duration is more efficacious in reducing IOP. Similarly, Magacho et al 32 , studied the effect of double session Micropulse laser as a primary surgical modality in glaucoma patients and concluded that a higher amount of energy gives better outcomes but it can result in higher complications.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Micropulse Laser Cyclophotocoagulation Therapy in Primary Angle Closure Glaucoma

Chauhan,

Midha,

Mahalingam

et al. 2023

Journal of Glaucoma

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Précis: In primary angle closure glaucoma (PACG), micropulse cyclophotocoagulation resulted in a significant reduction in intraocular pressure (IOP), and the number of antiglaucoma medications without any sight-threatening complications. However, the IOP lowering efficacy decreased over time. Purpose: The purpose of this study was to evaluate the efficacy and safety of micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) in PACG. Patients and Methods: Thirty-three phakic PACG eyes with patent laser peripheral iridotomy and IOP uncontrolled on maximum tolerable antiglaucoma medications (AGMs), scheduled for trabeculectomy, were given a trial of MP-TSCPC (810 nm laser, 2000 mw power for 180 seconds, 360 degrees). The primary outcome measure was a success at 1 year with IOP ≤18 mm Hg and ≤15 mm Hg with (qualified success) or without (absolute success) AGMs after a single session of MP laser. Secondary outcome measures were changes in pupillary diameter, visual acuity, central macular thickness, and subjective pain perception. Results: Thirty-two out of 33 PACG patients completed 12 months of follow-up. The mean age of patients was 54.7±8.9 years; male:female ratio was 1:1. The baseline IOP was 25.7±5.3 mm Hg, which reduced to 17.9±4.6 mm Hg at the end of 12 months (P<0.0001). Twenty eyes (62.5%) achieved qualified success, and 1 eye (3.125%) had absolute success at 12 months for IOP ≤18 mm Hg; 6 eyes (18.75%) had qualified success, and 1 eye (3.125%) had absolute success for IOP ≤15 mm Hg at 12 months follow-up. A significant reduction was also observed in the number of AGMs (4.4±0.8 at baseline to 2.9±1.1 at 12 months; P <0.0001). Five eyes (15.6%) received additional treatment—3 eyes (9.4%) requiring a subsequent filtering procedure, and 2 eyes (6.2%) requiring an additional MP-TSCPC session. No significant change in pupillary diameter (P=0.489) or central macular thickness (P=0.938) was noted at 12 months. There was a transient drop of visual acuity >2 lines in 1 patient due to cystoid macular edema, and no major postlaser complications were noted. Conclusions: MP-TSCPC can be used as an interim procedure to reduce IOP in PACG eyes and delay the need for invasive surgery. Most patients require continued use of glaucoma medications, and target IOPs achieved are in the high teens.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Micropulse Laser Cyclophotocoagulation Therapy in Primary Angle Closure Glaucoma

Chauhan,

Midha,

Mahalingam

et al. 2023

Journal of Glaucoma

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“…Aquino et al [21] reported the highest retreatment rate of 46% among previous publications, which may be explained by a higher baseline IOP, a greater proportion of NVG patients, and a lower level of the total energy use (62.6 J) compared to our study (100 J). Additionally, Tekeli et al [51] compared the efficacy of two different duration protocols (160 s vs 240 s) and found that the only variable factor associated with a higher hazard for retreatment was the treatment duration. A higher treatment duration (240-s group) tends to be more effective for adequate and sustained IOP control.…”

Section: Discussionmentioning

confidence: 99%

Micropulse Transscleral Cyclophotocoagulation as Primary Surgical Treatment for Primary Open Angle Glaucoma in Taiwan during the COVID-19 Pandemic

et al. 2021

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Glaucoma is the leading cause of irreversible blindness worldwide, with primary open angle glaucoma (POAG) accounting for the greatest number of total glaucoma cases. This study aimed to evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) as a primary procedure in POAG during the COVID-19 pandemic. We retrospectively analyzed 60 eyes of 52 patients, who were diagnosed with mild-to-end-stage POAG without previous glaucoma surgery and received MP-TSCPC between 1 January 2020 and 31 August 2020. The mean preoperative intraocular pressure (IOP) significantly decreased from 27.8 mm Hg to 19.8, 20.1, 20.3, 20.4, and 20.2 mm Hg at 1, 3, 6, 9, and 12 months, respectively (all p < 0.05). The mean number of IOP-lowering medications used significantly decreased from 3.3 at the baseline to 1.6, 1.8, 1.8, 1.9, and 1.9 at 1, 3, 6, 9, and 12 months, respectively (all p < 0.001). Total withdrawal of antiglaucoma medications was fulfilled in five patients. The main outcome was achieved in 81.7% at postoperative month 12. The most common adverse effect was transient mydriasis (28.3%). No major complications were encountered. MP-TSCPC seems to be an effective and safe treatment to reduce IOP and the medication burden with minimal vision-threatening complications in mild-to-end-stage POAG patients without previous glaucoma surgery.

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“…Coagulative necrosis of ciliary epithelium and capillary bed Sparing of the ciliary muscle and stroma 47,48 Thermic necrosis of ciliary epithelium Increased uveoscleral outflow 49,50 Settings 31.3% duty cycle (each pulse is "on" for 0.5 ms and "off" for 1. suggested that MP-TLT can be offered as a primary surgical treatment for refractory glaucoma in patients with good VA and that a 240-second protocol appeared more effective for IOP control. 53 In patients with glaucoma with visually significant cataracts, MP-TLT can also be performed together with phacoemulsification (phacoemulsification-MP-TLT). A retrospective study of 64 eyes showed a mean IOP reduction of 6.0 ± 4.3 mm Hg a year after phacoemulsification-MP-TLT.…”

Section: Mode Of Applicationmentioning

confidence: 99%

“…Given its favorable safety profile, MP-TLT was studied in eyes with good visual acuity (VA). In a retrospective study of 76 eyes with refractory glaucoma and good best-corrected VA (20/60–20/20), 88.6% and 87.5% had unchanged or improved VA after a 240 and 160-second treatment, respectively 53 . The retreatment rate was higher in the 160-second group (37.5% vs 15.9%), but both groups had similar 12-month success rates (160 s: 75%; 240 s: 79.5%) after retreatment.…”

Section: Treatment Of the Ciliary Body For Intraocular Pressure Controlmentioning

confidence: 99%

“…The retreatment rate was higher in the 160-second group (37.5% vs 15.9%), but both groups had similar 12-month success rates (160 s: 75%; 240 s: 79.5%) after retreatment. The authors suggested that MP-TLT can be offered as a primary surgical treatment for refractory glaucoma in patients with good VA and that a 240-second protocol appeared more effective for IOP control 53 …”

Section: Treatment Of the Ciliary Body For Intraocular Pressure Controlmentioning

confidence: 99%

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Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

Chan,

Larson,

Dickerson

et al. 2023

Asia-Pacific Journal of Ophthalmology

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The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the “traditional” MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.

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Comparative efficacy and safety of micropulse transscleral laser cyclophotocoagulation using different duration protocols in eyes with good visual acuity

Cited by 10 publications

References 22 publications

Efficacy of Micropulse Laser Cyclophotocoagulation Therapy in Primary Angle Closure Glaucoma

Efficacy of Micropulse Laser Cyclophotocoagulation Therapy in Primary Angle Closure Glaucoma

Micropulse Transscleral Cyclophotocoagulation as Primary Surgical Treatment for Primary Open Angle Glaucoma in Taiwan during the COVID-19 Pandemic

Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

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