Abstract
Purpose :
MicroPulse transscleral diode laser cyclophotocoagulation (MP-TSCPC) delivers a series of repetitive short pulses of energy with rest periods in between pulses which is different from the traditional CPC. This study is to evaluate the efficacy and safety of MP-TSCPC in the treatment of refractory glaucoma.
Methods :
This is a prospective interventional case series study. Patients with refractory glaucoma who underwent MPTSCPC rom Aug 2016 to this abstract submission day at Doheny Eye Institute UCLA were included in our study. Laser settings were 2000 mW of 810 nm infrared diode laser set on MicroPulse P3 Glaucoma Device (Iridex, Mountain View, CA, USA). The laser was delivered over 360° for 180-240 milliseconds, 90-140 milliseconds for each hemisphere. The duty cycle was 31.3 %, which translated to 0.5 ms of "on time" and 1.1 ms of "off time." Visual acuity (VA) and intraocular pressure (IOP) before the surgery and at different time point after the surgery were documented. Post operative inflammation in the anterior chamber and the complications were also recorded.
Results :
One-hundred and three eyes of one-hundred patients (46 male and 54 female) who underwent MP-TSCPC were enrolled in this study. The mean age of patients was 66.48 +/- 17.13 years. The mean follow-up period was 118 +/- 60 days. The mean intraocular pressure (IOP) before MP-TSCPC was 22.15 +/- 7.73 mmHg mmHg. Mean IOP decreased to 16.46 +/- 7.04 mmHG at 1 day (P=0.001), 15.39 +/- 6.56 mmHG at 1 month (P=0.001), 16.28 +/- 6.52 mmHG at 3 months (P=0.001) and 17.15 +/- 7.67 mmHG at 6 months (P=0.001). At the last visit, VA was equal or better than the pre-surgery in 61 eyes (59%); 40 patients decreased VA by an average of 1.6 lines of vision. Twenty-nine patients had mild inflammation first day post-operatively, two patients of these twenty-nine patients had prolonged inflammation that resolved in 60 days. Two patients developed hypotony and choroidals post-operatively which resolved within 30 days. One patient developed a hypertensive episode immediately following the procedure and then developed hypotony within a week, which also self-resolved in 13 days.
Conclusions :
The novel MP-TSCPC laser is a safe and effective method of lowering IOP after a short follow-up period in patients with refractory glaucoma. Further long-term evaluation is warranted.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.