October 08, 2020
2 min read
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MicroPulse transscleral cyclophotocoagulation an option in refractory glaucoma

The technology results in fewer serious adverse events compared with traditional treatments.

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Patients with uncontrolled refractory glaucoma who underwent MicroPulse transscleral cyclophotocoagulation experienced a mean 28.6% IOP reduction from baseline at 2 years, according to a study.

“With the arrival of newer glaucoma treatments, a glaucoma surgeon is now even better at choosing a treatment that suits the type or severity of the glaucoma, fits the risk spectrum or meets the needs of a glaucoma patient. MicroPulse transscleral cyclophotocoagulation offers extra possibilities and is widely applicable within the treatment pattern of glaucoma,” study co-author Ronald M.P.C. de Crom, MD, told Ocular Surgery News.

Patients with primary or secondary glaucoma often undergo cyclodestructive procedures as a last treatment option. However, these procedures can lead to complications such as persistent intraocular inflammation, decreased visual acuity or persistent hypotony, according to the study.

Minimal collateral damage

MicroPulse transscleral cyclophotocoagulation (MP-TSCPC) is a novel procedure that delivers a series of repetitive, short bursts of energy followed by rest periods, de Crom said.

“This technique avoids excessive heat and tissue damage, resulting in minimal collateral damage from, for example, unpigmented epithelium, ciliary stroma and other eye tissues in the treated area,” he said.

De Crom and colleagues evaluated 141 eyes of 136 patients with primary or secondary glaucoma who underwent standardized MP-TSCPC (Cyclo G6 glaucoma laser system with MicroPulse P3 glaucoma device, Iridex) and its effect on IOP lowering at 12, 18 and 24 months. The researchers also evaluated the treatment’s safety and effect on lowering necessary glaucoma medications.

The study included 99 eyes with primary glaucoma and 42 eyes with secondary glaucoma. Mean preoperative IOP at baseline was 23.5 mm Hg, and mean number of IOP-lowering medications was 3.3. Prior glaucoma surgery was performed in 59 of 141 eyes.

Mean IOP dropped to 16.8 mm Hg, 17 mm Hg and 16.8 mm Hg at 12, 18 and 24 months, respectively, after treatment. IOP between 6 mm Hg and 21 mm Hg was achieved in 111 of 141 eyes, 67 of 90 eyes and 40 of 50 eyes with follow-up data available at 12, 18 and 24 months, respectively.

Overall, mean IOP reduction was 27.8%, 24.1% and 28.6% at 12, 18 and 24 months, respectively, de Crom said. The number of IOP-lowering medications decreased from 3.3 at baseline to 2.2 at 2 years.

Fewer complications

In the early postoperative period, less than 3 months after surgery, complications developed in five patients, including two cases of cystoid macular edema and one each of fibrinous anterior chamber reaction, hypotony maculopathy and corneal graft rejection. All complications were reversed after treatment with prolonged use of topical steroids or by reducing glaucoma medications, de Crom said.

When MP-TSCPC was introduced, it was mainly used to treat patients with end-stage glaucoma or those with blind, sore eyes. Later, the procedure was used to treat patients after failed glaucoma surgery and those who did not want to undergo surgery, de Crom said.

“Today we treat different types of glaucoma patients, from patients with an initial stage of glaucoma to patients with previous (multiple) eye operations and/or an end stage of glaucoma. MP-TSCPC is a good and safe treatment option, especially in patients after failed incision glaucoma surgery or in patients with a high risk of incision surgery,” he said.