Experience of micropulse cyclophotocoagulation for treatment patients with early stages of glaucoma

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Abstract

Aim – to evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) modality in patients with early stages of glaucoma.

Material and methods. We examined 38 patients with early stage of primary open-angle uncompensated glaucoma (POAG) (17 patients with early stage, 18 patients with advanced stage) before and during 12 months after the MP-TSCPC treatment (SUPRA device 810, Quantel Medical, France) using the modified laser parameters - power W=2000 MW, 31.3 % - exposure cycle, total treatment time in 4 sectors - 200 s, the total energy 125 J. Fluence - 121.8 J/m².

Results. There were no complications after the procedure. In all patients, BCVA did not change during the observation period. A decrease in IOP was achieved in all patients. In 6 months of follow-up, the level of IOP remained stable and averaged 15.5 ± 4.5 mm Hd. Up to 12 months of follow-up, the hypotensive effect persisted up to 31% of the initial IOP, which averaged 16.0 ± 3.5 mm Hg. As a result, the persistent hypotensive effect helped to reduce the number of IOP-lowering medications in general, and to cancel them in 6 cases of 17 patients with early stage glaucoma.

Conclusion. MP-TSCPC modified protocol showed high efficiency (up to 31% of the initial value during the year) in reducing the intraocular pressure in patients with early stages of glaucoma. The use of MP-TSCPC in patients with high visual acuity demonstrated a good safety profile due to areactive postoperative period. Further monitoring of patients after MP-TSCPC is necessary to develop practical recommendations for indications and regimens.

About the authors

Igor E. Ioshin

Clinical Hospital of the Administrative Directorate of the President of the Russian Federation

Email: igor.ioshin@gmail.com

PhD, Professor, Head of the Center of Ophthalmology

Russian Federation, Moscow

Anna I. Tolchinskaya

Clinical Hospital of the Administrative Directorate of the President of the Russian Federation

Email: atolchinskaya@mail.ru
ORCID iD: 0000-0002-8116-1038

PhD, Ophthalmologist

Russian Federation, Moscow

Anna V. Rakova

Clinical Hospital of the Administrative Directorate of the President of the Russian Federation

Author for correspondence.
Email: ranetka2004@inbox.ru
ORCID iD: 0000-0001-9086-8716

PhD, Ophthalmologist

Russian Federation, Moscow

References

  1. Alexeev VN, Egorov EA, Malevannaya OA, et al. Analysis of the main causes of a progression of the primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2014;4:218-223. (In Russ.). [Алексеев В.Н., Егоров Е.А., Малеванная О.А., и др. Анализ основных причин прогрессирования первичной открытоугольной глаукомы. РМЖ. Клиническая офтальмология. 2014;4:218-223].
  2. Glaucoma. National leadership. Ed. E.A. Egorov. M., 2013. (In Russ.). [Глаукома. Национальное руководство. Под ред. Е.А. Егорова. М., 2013].
  3. Boland MV, Chang DS, Frazier T, et al. Electronic monitoring to assess adherence with once-daily glaucomamedications and risk factors for nonadherence: the automated dosing reminder study. JAMA Ophthalmol. 2014;132(7):838-844. doi: 10.1001/jamaophthalmol.2014.856
  4. Dietlein TS, Rosentreter A, Lappas A. Complexities of medical glaucoma therapy – the elderly patient in focus. Klin Monbl Augenheilkd. 2016;233(2):138-142.
  5. Friedman DS, Quigley HA, Gelb L, et al. Using pharmacy claims data to study adherence to glaucoma medications: methodology and findings of the Glaucoma Adherence and Persistency Study (GAPS). Invest Ophthalmol Vis Sci. 2007;48(11):5052-5057.
  6. Emanuel ME, Grover DS, Fellman RL, et al. Micropulse cyclophotocoagulation: initial results in refractory glaucoma. J Glaucoma. 2017;26:726-729. doi: 10.1097/IJG.0000000000000715
  7. Grippo MT, Sanchez GF, Stauffer J, Marcellino G. MicroPulse® Transscleral Laser Therapy – Fluence May Explain Variability in Clinical Outcomes: A Literature Review and Analysis. Clinical ophthalmology (Auckland, N.Z.). 2021:15:2411-419. doi: 10.2147/OPTH.S313875
  8. Kuchar S, Moster MR, Reamer CB, et al. Treatment outcomes of micropulse transscleral cyclophotocoagulation in advanced glaucoma. Lasers Med Sci. 2016;31:393-396.
  9. Latina M, Lachkar Y. Ranking Laser in Glaucoma Treatment. Jan/Feb 2021. Insert to glaucoma today. January/February 2021 Insert - Glaucoma Today
  10. Maslin JS, Chen PP, Sinard J, et al. Histopathologic changes in cadaver eyes after MicroPulse and continuous wave transscleral cyclophotocoagulation. Canadian Journal of Ophthalmology. 2020;55(4):330-335. doi: 10.1016/j.jcjo.2020.03.010
  11. Nguyen AT, Maslin JS, Noecker JR. Early results of micropulse trans-scleral cyclophotocoagulation for the treatment of glaucoma. European Journal of Ophthalmology. 2020;30(4):700-705. doi: 10.1177/1120672119839303
  12. Sanchez FG, Lerner F, Sampaolesi J, et al. Efficacy and Safety of Micropulse(R) Transscleral Cyclophotocoagulation in Glaucoma. Arch Soc Esp Oftalmol. 2018;93(12):573-579. doi: 10.1016/j.oftal.2018.08.003
  13. Sarrafpour S, Saleh D, Ayoub S, Radcliffe NM. Micropulse transscleral cyclophotocoagulation: A look at long-term effectiveness and outcomes. Ophthalmology Glaucoma. 2019;2(3):167-71. doi: 10.1016/j.ogla.2019.02.002
  14. Tan AM, Chockalingam M, Aquino MC, et al. Micropulse transscleral cyclophotocoagulation in the treatment of refractory glaucoma. Clin Experiment Ophthalmol. 2010;38(3):266-272. doi: 10.1111/j.1442-9071.2010.02238
  15. Varikuti VNV, Shan P, Rai O, et al. Outcomes of micropulse transscleral cyclophotocoagulation in eyes with good central vision. J Glaucoma. 2019;28:901-905. doi: 10.1097/IJG.0000000000001339
  16. Al Habash A, Al Ahmadi AS. Outcome of MicroPulse(®) transscleral photocoagulation in different types of glaucoma. Clinical Ophthalmology (Auckland, N.Z.). 2019;(13):2353-2360. doi: 10.2147/opth.s226554
  17. Magacho L, Lima FE, Avila MP. Double-session micropulse transscleral laser (cyclo G6) as a primary surgical procedure for glaucoma. J Glaucoma. 2019. doi: 10.1097/ijg.0000000000001426

Supplementary files

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2. Figure 1. OCT of a patient with POAG Ib OU before mCPC. OU signs of GON: thinning of peripapillary fibers in the lower sector.

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3. Figure 2. OCT of a patient with POAG IIb OD before mCPC. OD signs of GON: thinning of peripapillary fibers in the upper and lower (more) sectors. OS parameters of the thickness of the nerve fibers are within the normal range.

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4. Figure 3. Dynamics of IOP indicators after mCPC.

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Copyright (c) 2022 Ioshin I.E., Tolchinskaya A.I., Rakova A.V.

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