Clinical Ophthalmology (Jun 2022)
Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy: Dosimetry and Patient Selection
Abstract
Tomas M Grippo,1 Ronald MPC de Crom,2 Michael Giovingo,3 Marc Töteberg-Harms,4 Brian A Francis,5 Brian Jerkins,6 Jacob W Brubaker,7 Nathan Radcliffe,8 Jella An,9 Robert Noecker10 1Department of Ophthalmology, Hospital Aleman, Buenos Aires, Argentina; 2University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands; 3Department of Ophthalmology, Cook County Health, Chicago, Illinois, USA; 4Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA; 5Department of Ophthalmology, Doheny and Stein Eye Institutes, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA; 6Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA; 7Sacramento Eye Consultants, Sacramento, CA, USA; 8New York Eye and Ear Infirmary, New York, NY, USA; 9Department of Ophthalmology, Wilmer Eye Institute, John Hopkins School of Medicine, Bethesda, MD, USA; 10Department of Ophthalmology, School of Medicine, Yale University, New Haven, CT, USACorrespondence: Tomas M Grippo, 250 Luis Maria Campos, 1st Floor, Suite O, Capital Federal, Buenos Aires, 1426, Argentina, Tel +54-11-4-774-2930, Email [email protected]: To provide consensus-based current guidelines on optimal dosimetry and patient selection for MicroPulse Transscleral Laser Therapy (TLT) based on a review of the literature and a Delphi method.Methods: A comprehensive search of Pub Med led to the identification and analysis of 61 studies on MicroPulse TLT that contained information on laser settings and patient selection. To determine consensus in areas where there was not enough available literature, a three-round Delphi method was conducted.Results: The response rate was 90% in the first round, 90% in the second round, and 80% in the third round of the Delphi technique. Once all responses were aggregated, a live meeting was held with 80% attendance, and consensus was achieved on each of the findings detailed in this manuscript.Conclusion: Micropulse TLT is a useful addition to the glaucoma armamentarium. When used with proper surgical technique at energy settings within the boundaries described in this manuscript, MicroPulse TLT is a safe and effective treatment for many types and stages of glaucoma. Based on current knowledge and experience, the consensus recommendation of this expert panel is that the standard MicroPulse TLT settings using the revised MicroPulse P3 Probe should be 2500 mW, 31.3% duty cycle, and 4 sweeps at a sweep velocity of 20 seconds each per hemisphere. Both hemispheres avoiding the 3 and 9 clock hours should be treated. The panel also reached consensus on patient selection for MicroPulse TLT providing guidance for the use of the procedure.Keywords: glaucoma, MicroPulse, transscleral laser therapy
