Outcomes of a combination of augmented MicroPulse and limited Continuous Wave Cyclophotocoagulation in patients with refractory glaucoma

Abstract

Purpose To assess the safety and effectiveness of augmented MicroPulse (MP-TSCPC) with limited Continuous Wave Transscleral Cyclophotocoagulation (CW-TSCPC) in patients with refractory glaucoma. Methods Thirty-eight eyes of 38 patients underwent combined MP-TSCPC and CW-TSCPC at Massachusetts Eye and Ear. Kaplan–Meier survival curves and Wilcoxon paired sign rank tests were performed to evaluate intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity (BCVA), and adverse events. Results With success defined as IOP reduction ≥ 30% and IOP between 5 and 18 mmHg, the cumulative probability of success at 1 year and 1.5 years were 0.81 (95% confidence interval (CI), 0.68–0.96) and 0.65 (95% CI, 0.50–0.86), respectively. With success defined as IOP reduction ≥ 50% and IOP between 5 and 18 mmHg, the success probability at 1 year and 1.5 years were 0.72 (95% CI, 0.57–0.89) and 0.56 (95% CI, 0.40–0.78), respectively. IOP and medication burden reductions were significant at all follow-up visits compared to baseline. Average IOP decreased from 27.9 mmHg at baseline to 11.4 mmHg at 1 year (p < 0.001) and 10.0 mmHg at 1.5 years (p < 0.001). Average medication burden decreased from 3.8 to 1.7 at 1.5 years (p = 0.001). No significant differences in visual acuity were observed at any time point. No long-term sight-threatening complications due to the combined procedure were observed, and most of the complications observed were mild and transient. Conclusion In patients with refractory glaucoma, the combination of augmented MP-TSCPC with limited CW-TSCPC provides a significant IOP-lowering effect and decrease in medication burden without increased risk of postoperative complications.

Remarkable Improvements After Cataract Surgery in a Presumed “End-Stage” Glaucoma Patient: A Case Report

“…Destructive laser energy is delivered continuously to the ciliary body to reduce aqueous humor production in CW-TSCPC. MP-TSCPC utilizes repetitive pulses of energy separated by periods of rest to achieve more targeted treatment of pigmented tissue in the ciliary processes and minimize collateral damage to neighboring tissues [ 10 ]. CW-TSCPC is effective in reducing IOP and medication burden in refractory glaucoma cases.…”

“…A study by Gupta et al describing the outcomes of this combination technique found a 16.5 mmHg and 17.9 mmHg mean drop in IOP at 12 and 18 months, respectively. The average medication burden decreased from 3.8 to 1.7 at 18 months, and no long-term sight-threatening complications were observed [ 10 ]. This technique thus limits the side effects related to CW-TSCPC while maintaining a satisfactory efficacy.…”

“…Each 180-second application was split into a 90-second “sweeping” technique and a 90-second “stop-and-continue” technique. Following augmented MP-TSCPC, a limited procedure with CW-TSCPC was performed with the G-probe, as previously described by Gupta et al [ 10 ]. Five 800-1600 mW spots were applied to each hemisphere using the G-probe.…”

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

“…In addition, the power used ranged from 1750-2000mW in various studies [14][15][16]. As this study incorporated two different institutions and multiple attending surgeons before the publication of augmented setting for MPCPC [17,18], there were significant variations in power and duration chosen, which are lower than the recently published guidelines. There was a trend towards higher power and the duration on the MPCPC being associated with greater success, but this was not statistically significant (Fig 2).…”

Ahmed glaucoma implant and augmented MicroPulse transscleral cyclophotocoagulation in a monocular Axenfeld-Rieger syndrome patient with glaucoma

“…W e report the case of severe mixed-mechanism glaucoma observed in a monocular Axenfeld-Rieger syndrome (ARS) patient who was successfully managed with an ahmed glaucoma implant (AGI) followed by a novel technique described as augmented MicroPulse transscleral cyclophotocoagulation (MP-TSCPC) [1] . ARS encompasses a heterogeneous spectrum of diseases involving anterior segment dysgenesis and systemic developmental anomalies [2] .…”