Micropulse Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma

A Review of Cyclodestructive Procedures for the Treatment of Glaucoma

“…For example, Garcia et al found that prior incisional glaucoma surgery was positively correlated with the success rates of MP-TLT and patients who had previously undergone trabeculectomy, tube shunt surgery, or a combination thereof, had a success rate of 67.6% versus a success rate of 41.4% for patients had not had these procedures. 42 Interestingly, a history of Minimally-Invasive Glaucoma surgery (MIGS) did not seem to have this same effect, as no differences in IOP reduction were found between a subgroup of patients that underwent previous MIGS and a subgroup that had not. 42 The notion that prior traditional glaucoma surgery has a favorable effect on the success of MP-TLT is disputed by results reported by Zaarour et al who reported no difference in the success rates of patients who had previous incisional glaucoma surgery and those who had not.…”

“…42 Interestingly, a history of Minimally-Invasive Glaucoma surgery (MIGS) did not seem to have this same effect, as no differences in IOP reduction were found between a subgroup of patients that underwent previous MIGS and a subgroup that had not. 42 The notion that prior traditional glaucoma surgery has a favorable effect on the success of MP-TLT is disputed by results reported by Zaarour et al who reported no difference in the success rates of patients who had previous incisional glaucoma surgery and those who had not. 46 Differences between the studies in the laser settings and population of glaucoma patients studied can potentially explain this discrepancy.…”

“…It has consistently been able to reduce the amount of glaucoma medications, both oral and topical, needed by patients across all studies examined, with a mean reduction at 1 year ranging from 0.5 to 1.6 medications. 37,42,45,[47][48][49] In a study by Tan et al, all 6 patients on oral acetazolamide were able to stop taking it following the procedure, while 17/ 65 (26%) patients in a study by Zaarour et al were able to discontinue oral medication use. 37,48 MP-TLT is a potentially valuable treatment tool for specific types of glaucoma patients, especially post-keratoplasty eyes and pediatric patients.…”

“…Prior studies have indicated that the IOPlowering effect at 1 year can vary widely, ranging from 6.9 to 12.6 mmHg. 37,[41][42][43][44][45][46][47] One plausible explanation for the wide range in reported IOP reduction is the difference in mean baseline IOP, as the magnitude of IOP reduction in MP-TLT also appears to be strongly correlated with baseline IOP. For example, Garcia et al reported a mean IOP reduction of 6.9 mm Hg from a baseline of 22.2 mm Hg, while Emanuel et al reported a mean reduction of 16.6 mm Hg from a baseline of 27.7 mm Hg.…”

“…41 The majority of MP-TLT studies evaluated have used an IOP reduction ≥20% from baseline as the criteria for success. Once again, the reported success rates (at 3-12 months postoperatively) vary widely, ranging from 67.1% by Zaroour et al to 93.1% by Garcia et al 42,46 In addition to lowering IOP, MP-TLT has proven to be effective in reducing the medication burden of glaucoma patients. It has consistently been able to reduce the amount of glaucoma medications, both oral and topical, needed by patients across all studies examined, with a mean reduction at 1 year ranging from 0.5 to 1.6 medications.…”