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Eric Grisham, Sara Hooshmand, Jella Angela An; Outcomes of MicroPulse Cyclophotocoagulation in Adult Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2019;60(9):702.
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© ARVO (1962-2015); The Authors (2016-present)
MicroPulse Transscleral Cyclophotocoagulation (mTSCPC) is used to reduce intraocular pressure (IOP) and medication burdens in glaucoma patients. However, there is no meta-analysis comparing various laser settings and the resulting potential outcomes of mTSCPC in peer-reviewed journals to date. We performed a systematic review of all published peer-reviewed literature to evaluate efficacy and safety of mTSCPC. Secondary goal was to identify the optimal setting for the IRIDEX MicroPulse P3™ device resulting in the greatest decreases in IOP and in number of ocular hypotensive medications with the least number and severity of postoperative complications.
Two PubMed searches were performed using combinations of keywords and Medical Subject Headings evaluating safety and efficacy related to mTSCPC. Results from randomized controlled trials and review articles discussing treatment outcomes of mTSCPC procedures were included in this analysis. Reported laser settings were compared against weighted averages of preoperative and postoperative IOP and in the number of ocular hypotensive medications. Definite success was defined as an IOP reduction of 20% or more without additional medication or IOP lowering procedures, or a reduction of medication while remaining at target IOP of 18mmHg or lower.
The mean number of eyes from studies analyzed at 3, 6 and 12 months was 49.3. The mean total duration of laser application was 194.44 s (SD±87.83) and the mean total weighted laser power was 1992mW. Standard weighted mean differences in IOP were -1.94 (SD±0.61), -2.04 (SD±0.53), and -2.24 (SD±0.58) for 3, 6 and 12-month follow-ups, respectively (p<0.0002). After 1 month of follow up, a significant effect was observed in changes in IOP-lowering medications. However, there was no statistically significant decrease in the number of medications 6 and 12 months post-operatively (p=0.11). Reported laser power settings did not vary statistically between studies and the effect of laser energy settings could not be measured.
Overall, our meta-analysis of mTSCPC literature showed that it is a safe and effective IOP-lowering procedure for many types of glaucoma patients. We identified that a number of laser settings which may be relevant to treatment outcomes are not consistently reported and studies may have excluded relevant outcomes and settings relevant to this study that were not the focus of their investigation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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