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Maria Cecilia D. Aquino, Anna Marie Tan, Seng Chee Loon, Paul T. Chew; Transscleral Micropulse Diode Laser Cyclophotocoagulation as Effective Adjunctive Treatment prior to Glaucoma Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5962.
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Diode laser cyclophotocoagulation is currently the preferred cycloablative procedure of last resort in cases where glaucoma is refractory to medical and surgical treatment. It is commonly employed in patients with poor visual potential needing further intraocular pressure reduction. A novel approach in delivering diode laser energy by micropulsing has been shown to be effective and extremely useful in some difficult glaucoma cases unresponsive to maximum medical and laser treatment needing definitive operative management. We report four cases treated with transscleural micropulse diode cyclophotocoagulation before glaucoma filtration and drainage implant procedures.
Micropulse cyclophotocoagulation (mCPC) was used to treat patients with iridocorneal endothelial (ICE) syndrome, juvenile glaucoma, chronic angle closure and open angle glaucoma unresponsive to maximum medical treatment. The following laser parameters were used: 2Watt, 100s pulse envelop with 0.5ms ON and 1.1ms OFF delivering 62.6J per treatment for 100 seconds. Definitive glaucoma surgeries were performed 2 weeks to 3 months after mCPC in all patients.
To widen the margin of safety without compromising efficacy, a new approach of diode CPC via micropulse delivery of laser energy was applied in these difficult glaucoma cases. All patients treated responded favorably to pre-operative intervention of micropulse diode CPC. Intraocular pressure decreased by 25 -50% with mild anterior chamber inflammation post mCPC. Glaucoma surgery proceeded free of devastating complications of expulsive and suprachoroidal hemorrhage associated with very high opening intraocular pressure.
Micropulse diode transscleral cyclophotocoagulation in medically unresponsive cases needing immediate therapy proved effective in lowering intraocular pressure prior to definitive glaucoma surgery.
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