Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy - Surgical Technique, Post-Operative Care, Expected Outcomes and Retreatment/Enhancements

Grippo, Tomás M.; Töteberg‐Harms, Marc; Giovingo, Michael; Francis, Brian A.; Crom, Ronald R M P C de; Jerkins, Brian; Brubaker, Jacob W.; An, Jella; Radcliffe, Nathan M.; Noecker, Robert J.

doi:10.2147/opth.s389198

Cited by 5 publications

(4 citation statements)

References 45 publications

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“…Repeated procedure was warranted if a minimum of 20% decrease was not seen or target IOP was not reached. Expert consensus guidelines published during the data acquisition and processing of this study recommended power of 2.5 Watts, duty cycle of 31.3% and treatment time of 80 s per hemisphere with a sweep velocity/hemisphere of 20 s/sweep [ 24 , 27 ]. The calculated total energy, dwell times, and fluence of this study are 150 J, 0.63 s, and 51.89 J/cm 2 .…”

Section: Discussionmentioning

confidence: 99%

“…The guidelines [ 24 , 27 ] provide a useful collection of evidence-based consensus mainly on the MicroPulse (IRIDEX) machine. On the other hand, data regarding the safety and the efficacy of the Supra 810 and Vitra 810 (Quantel Medical) machines are scarce [ 37 , 39 , 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…Expert consensus guidelines were published [ 24 , 27 ] after the examined treatment period and during the data processing period of this study, and these guidelines recommend a total energy of 125.2 J. Alongside the importance of fluence, we would also advocate that cumulative energy, as proposed by Lim, should be included when designing future studies regarding the safety and efficacy of SL-TSCPC treatment.…”

Section: Introductionmentioning

confidence: 99%

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The effect of cumulative energy in repeated subliminal transscleral cyclophotocoagulation: a retrospective study

Szabó,

Árpádffy-Lovas,

Hagyó

et al. 2024

BMC Ophthalmol

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Background The long-term safety and efficacy of repeated applications of subliminal transscleral cyclophotocoagulation (SL-TSCPC) with a focus on cumulative energy was evaluated in glaucoma patients. Methods In this retrospective, multicentric study the data of a total of 82 eyes with various causes of glaucoma that were treated with a single or multiple applications of SL-TSCPC were collected. Treatments were performed under general or local anesthesia with an 810 nm diode laser. Power was 2000 mW; duty cycle, 31.3%; total treatment duration, 80–320 s; equaling a total energy of 50–200 J per treatment session. Fifty-five eyes (55 patients) presented for all follow-ups, and these eyes were selected for further statistical analysis. The mean age was 60.0 ± 17.1 years, and 22 (40%) of the patients were female. Intraocular pressure (IOP) and dependence on further glaucoma medication were evaluated at 12 months following the initial treatment. Results Eyes underwent 1 or 2 consecutive SL-TSCPC treatments. Median (min–max) baseline IOP of 34 (13–69) decreased to 21.5 (7–61), 22 (8–68), 20 (9–68), and 19.5 (3–60) mmHg at the 1, 3, 6, and 12-month postoperative timepoints respectively. The mean (± SD) IOP decrease at 12 months was 26 ± 27%, 39 ± 32%, and 49 ± 33% in the low (below 120 J, n = 18), medium (120–200 J, n = 24), and high (above 200 J, n = 13) cumulative energy groups respectively. At the 12-month timepoint, oral carbonic anhydrase use was discontinued in ¾ of the cases. Conclusions It was found that the repeated application of SL-TSCPC safely and efficiently decreases IOP in a Caucasian population with heterogenous causes of glaucoma, eyes with silicone oil responded to a greater extent. Inclusion of cumulative energy scales may contribute to better addressing repeated procedures in a standardized fashion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of cumulative energy in repeated subliminal transscleral cyclophotocoagulation: a retrospective study

Szabó,

Árpádffy-Lovas,

Hagyó

et al. 2024

BMC Ophthalmol

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“…Diode micropulse has been shown to be effective at least in the intermediate term in refractory glaucoma and is repeatable with similar efficacy across additional treatments. 1,2 In addition, this nonincisional approach preserves the conjunctiva and conventional outflow system should an additional procedure for IOP reduction be required.…”

Section: Mark Gallardo MDmentioning

confidence: 99%

Managing primary open-angle glaucoma in the setting of suboptimal surgical outcomes in the fellow eye

Huang

Samuelson

Francesco

et al. 2023

J Cataract Refract Surg

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A 62-year-old woman with mild myopia presented to her local optometrist for a routine examination and was found to have intraocular pressure (IOP) of 30 mm Hg in both eyes and cupped nerves. She had a family history of glaucoma in her father. She was started on latanoprost in both eyes and was referred for a glaucoma evaluation. On initial evaluation, her IOP was 25 mm Hg in the right eye and 26 mm Hg in the left eye. Central corneal thickness measured 592 µm in the right eye and 581 µm in the left eye. Her angles were open to gonioscopy without any peripheral anterior synechia. She had 1+ nuclear sclerosis with a corrected distance visual acuity (CDVA) of 20/25 in the right eye and 20/30− in the left eye and uncorrected near visual acuity of J1+ in each eye. Her nerves were 0.85 mm in the right eye and 0.75 mm in the left eye. Optical coherence tomography (OCT) showed retinal nerve fiber layer thinning and a dense superior arcuate scotoma into fixation in her right eye, and superior and inferior arcuate scotomas in her left eye (Figures 1 and 2 JOURNAL/jcrs/04.03/02158034-202307000-00019/figure1/v/2023-06-26T195222Z/r/image-tiff JOURNAL/jcrs/04.03/02158034-202307000-00019/figure2/v/2023-06-26T195222Z/r/image-tiff , Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A882 and http://links.lww.com/JRS/A883). She was successively trialed on fixed combination brimonidine–timolol, dorzolamide, and netarsudil, in addition to her latanoprost, but her IOP remained in the mid- to upper 20s in both eyes. The addition of acetazolamide lowered the pressure to 19 mm Hg in both eyes, but she tolerated it poorly. Methazolamide was also attempted with similar side effects. We elected to perform left eye cataract surgery combined with 360-degree viscocanaloplasty and insertion of a Hydrus microstent (Alcon Laboratories, Inc.). Surgery was uncomplicated with IOP of 16 mm Hg on postoperative day 1 with no glaucoma medications. However, by postoperative week 3, IOP returned to 27 mm Hg, and despite restarting latanoprost–netarsudil and finishing her steroid taper, IOP remained at 27 mm Hg by postoperative week 6. Brimonidine–timolol was added back to her left eye regimen and at postoperative week 8, IOP had elevated to 45 mm Hg. Maximizing her therapy with the addition of topical dorzolamide and oral methazolamide brought her IOP back down to 30 mm Hg. At that point, the decision was made to proceed with trabeculectomy of the left eye. The trabeculectomy was uneventful. However, postoperative attempts to augment filtration were rendered less successful by extremely thick Tenon layer. At her most recent follow-up the pressure in the left eye was mid-teens with brimonidine–timolol and dorzolamide. Her right eye IOP is in the upper 20s on maximum topical therapy. Knowing her postoperative course in the left eye, how would you manage the right eye? In addition to currently available options, would you consider a supraciliary shunt such as the MINIject (iSTAR) if such a device were U.S. Food and Drug Administration (FDA)-approved?

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Lasertherapie bei Glaukomen

Pillunat

2023

Springer Reference Medizin

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Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy - Surgical Technique, Post-Operative Care, Expected Outcomes and Retreatment/Enhancements

Cited by 5 publications

References 45 publications

The effect of cumulative energy in repeated subliminal transscleral cyclophotocoagulation: a retrospective study

The effect of cumulative energy in repeated subliminal transscleral cyclophotocoagulation: a retrospective study

Managing primary open-angle glaucoma in the setting of suboptimal surgical outcomes in the fellow eye

Lasertherapie bei Glaukomen

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