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Logan Vincent, Ahmad Kheirkhah, Brian Planchard, Corey Waldman; Outcomes of Micropulse Transscleral Cyclophotocoagulation in a Hispanic Population. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3765. doi: https://doi.org/.
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Micropulse transscleral cyclophotocoagulation (MP-CPC) is a non-invasive treatment for many types of glaucoma and provides a favorable side effect profile compared to trabeculectomy and glaucoma tube shunts. The efficacy in the Hispanic population has not been studied. This work reports outcomes of MP-CPC in this population, which is a minority group that faces significant barriers to medical and surgical therapy for glaucoma.
A retrospective chart review of 24 Hispanic patients treated with MP-CPC between Jan. 2017 and Aug. 2018. For the MP-CPC (Iridex CYCLO G6TMlaser), a power of 2000mW and duration of 90 seconds was used, for a total of four passes, two for each the superior and inferior 180 degrees. Patient demographics and outcomes were reported in Table 1 and 2, respectively. Success was defined as a ≥ 20% decrease in IOP at last visit compared to baseline regardless of medications and complete success was the same IOP decrease off medications. Failures did not achieve this level of IOP lowering, required additional surgery, lost light perception vision, or developed hypotony (IOP ≤ 6).
All 24 patients were Hispanic and 20.8% had a previous Ahmed glaucoma valve (AGV). The mean pre-op LogMAR acuity was 1.43 compared to 1.50 at the last follow-up. The mean pre-op IOP was 31.1 mmHg on a mean of 3.4 drops compared to 14.1 mmHg on a mean of 2.7 drops at last follow-up. The mean length of last follow-up was 7.8 months (range 4-12 months). Four patients (8.3%) required AGV after MP-CPC while 6 (25%) required repeat MP-CPC. One patient developed hypotony and none lost LP vision. Patients with previous AGV had better mean IOP at all time points. For the primary outcome measure, 8.3% and 62.5% obtained complete success and success, respectively, while 29.2% met criteria for failure. The Wilcoxon signed rank test showed statistical significant between pre-op and last IOP (p<0.001), but there was no statistical significance between pre-op and last number of drops (p=0.03) or visual acuity (p=0.39).
MP-CPC is an effective procedure to lower IOP for multiple glaucoma types in the Hispanic population, and it may be useful as an adjunct for patients with prior AGV. The population studied is unique given an entirely Hispanic population and a disproportionally high incidence of neovascular glaucoma. Limitations include retrospective study, small sample size, and limited post-op follow-up.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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