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Pamela Cepeda, David Jesus Islas Hernández; Early outcomes of Micropulsed Transcleral Cyclophotocoagulation in a mexican population with moderate-to-advanced uncontrolled Glaucoma. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5233.
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To evaluate effectiveness and potential complications for micropulsed transcleral cyclophotocoagulation (MP3-CPC) in a Mexican group of patients with maximal-tolerated medical therapy and moderate-to-severe glaucoma.
28 eyes(19 patients) were treated by 2 glaucoma-specialists at the a private practice center from December 2018-September 2019. Pre and postoperative data was collected including reported adverse events and visual acuity (VA) (see table 2).Success was defined as intraocular pressure(IOP) 5-21 mmHg or a reduction of at least 20% from baseline. Subjects were treated within MP3-CPC parameters suggested by the manufacturer IRIDEX Cyclo G6™Laser System Operator Manual, using a mean power of 2118.2 mW(1800-2250),duration 83.21s (50-100s), 31.3% duty cycle and total energy 55.16J (28.17-70.42J).
Mean age 58 y(12-86),12 female (63.1%).The most frequent type of glaucoma was primary open-angle (causes of glaucoma are shown in table 1) with a mean of 8.6 years from diagnosis (0.5-30). 1 patient (1 eye) excluded for loss of follow-up. Mean follow-up was 6 months(1-13 m).Prior to laser, the mean IOP was 29.03 mmHg (14-65mmHg) under a mean of 3.39 (2-5) topical medications. In addition, 48.15% had oral acetazolamide.Mean post-op IOP and number of topical medications were respectively 18.1mmHg and 2.33 at day 1;16.8 mmHg with 2.18 at day 7; 21.14 mmHg with 2.14 at week 4; 20.59mmHg with 2.48 at week 12 and 21.55 mmHg with 2.55 at 6 months. 2 eyes of 2 different patients required 1 additional MPCPC. At 6 months success rate was 55.5% and mean reduction of IOP was 24.9% (0-73%) (p=0.003). Acetazolamide was withdrawn in 76.9% of patients. Reported events:subconjunctival hemorrhage(11.1%), conjunctival hyperemia lasting < 1 week(92%) and corneal abrasion(11.1%). Pre and postoperative VA were similar (p=0.05). 29.6% eyes had VA 20/40 or better and 40.7% had 20/80 or better.
MP3-CPC was effective for 55.5% of the subjects & a reduction of topical medications can be expected from 3.39 to 2.55 (at 6 months of the procedure). Although not superior to incisional techniques it is an acceptable alternative for patients who have undergone other surgical treatments or lack IOP control in spite of topical medications but are unwilling to undergo an incisional procedure.There were not threatening complications and VA remained stable.
This is a 2020 ARVO Annual Meeting abstract.
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