Advances in Ophthalmology Practice and Research (Feb 2023)
Micropulse diode laser therapy in refractory glaucoma
Abstract
Purpose: Description of safety and efficacy of micropulse Transscleral cyclophotocoagulation as a treatment option for refractory glaucoma. Methods: This is a prospective study including 39 eyes of 31 patients followed for refractory glaucoma, who benefited from transscleral cyclophotocoagulation using a microplused laser. The main indication for the procedure was increased ocular pressure refractory to quadritherapy in various types of glaucoma. The patients were treated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 nm. The parameters for the procedure were a duration of 90 s per hemisphere with a power of 2000 mW and an energy of 180 J. Both the upper and lower hemispheres were treated in the same procedure, sparing the 3 o'clock and 9 o'clock meridians, and all the patients benefited from a single treatment session. The following parameters were evaluated: ocular pain and overall tolerance; visual acuity; and the evolution of IOP postoperatively up to 9 months. Results: The glaucoma subtypes treated are as follows: primary open-angle glaucoma (n = 05), chronic angle-closure glaucoma (n = 13), neovascular glaucoma (n = 07), aphakic glaucoma (n = 06), malignant glaucoma (n = 04), post-traumatic angle recession (n = 02), and inflammatory glaucoma (n = 02). The mean pre-operative intraocular pressure was 42.3 ± 5.2 mmHg and the mean post-operative intraocular pressure at 9 months was 16.9 ± 1.9 mmHg. The reduction in IOP was 49.9%. The average number of intraocular pressure-lowering medications used prior to surgery was four, and the average number of medications used at the 9-month post-operative visit was 2.0 ± 1.2 (70.3% of patients were on dual therapy). The overall success rate was 60.5%. Conclusions: Micropulse transscleral cyclophotocoagulation appears to be a safe and efficient treatment for refractory glaucoma. Its indications should therefore be broadened and proposed early in various situations.
