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Eficacia y seguridad de la ciclofotocoagulación transescleral con micropulsos en el tratamiento del glaucoma
摘要： Objective: To report the results using Micropulse? transscleral cyclophotocoagulation (Iridex) in the treatment of glaucoma. Methods: Retrospective study in adult patients with glaucoma with at least 6 months of follow-up, and only one session of Micropulse?. The same surgical technique was used in all cases. The only laser parameter that could vary was the total treatment duration (in seconds). The remaining parameters were fixed at 2 Watts of power and 0.5 ms (31.3%) of active cycle. Results: A total of 22 eyes of 17 patients with glaucoma of various types and stages were included (mainly congenital and pseudoexfoliation). The mean follow-up time was 7.9 months. The total treatment duration varied from 100 to 180 seconds. Definition of success: 5 mmHg < Intraocular pressure (IOP) < 21 mm Hg and a reduction of ≥ 20% of the baseline value and no addition of oral carbonic anhydrase inhibitors, and no re-operation. The overall success rate was 72.7% in the first month, 54% at 4 months, 41% at 6 months, and 27.3% at final follow-up. Patients with longer treatment durations (180s) achieved better results. The mean reduction in IOP in successful eyes was 36% (from 26.3 to 16.7 mm Hg, SD 4.58, P = .028). No complications were reported. Conclusions: In a heterogeneous population of glaucoma (mostly congenital and pseudoexfoliation types), a low success rate (27.3%) was obtained in the medium-term with a single session of Micropulse?.
关键词： Infrared diode laser,Glaucoma,Micropulse?,Cyclophotocoagulation
更新于2025-09-23 15:23:52
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Micropulse Versus Continuous Wave Transscleral Cyclophotocoagulation in Refractory Pediatric Glaucoma
摘要： The aim of this study was to compare the safety and efficacy of micropulse cyclophotocoagulation (MP-CPC) and transscleral continuous wave cyclophotocoagulation (CW-CPC) for the treatment of refractory glaucoma in the pediatric age group. This prospective study included 45 eyes of 36 children requiring transscleral cyclophotocoagulation, in the period spanning from September 2016 to August 2017, using micropulse (MP-CPC) or continuous wave (CW-CPC) modes. The intraocular pressure (IOP) reduction, success rates, and complications were compared for both groups. Success was defined as an IOP of 5 to 21 mm Hg, in the absence of vision-threatening complications at 6 months. The MP-CPC group included 17 eyes, in patients aged 67.8 ± 48 months, and the CW-CPC group included 28 eyes, in patients aged 61.3 ± 38.3 months. There was a tendency toward lower IOP in the MP-CPC group at all follow-ups, almost reaching statistical significance at 2 weeks and 3 months (P = 0.05). IOP reduction was 63% in the MP-CPC group and 67% in the CW-CPC group (P = 0.6). The success rate was higher in the MP-CPC group (71% vs. 46% in the CW-CPC group), but the difference was not significant (P = 0.1). No significant complications were noted in the MP-CPC group whereas, in the CW-CPC group, 1 eye developed phthisis bulbi, and 2 eyes had severe pain and uveitis (P = 0.3). Both the MP-CPC and CW-CPC are effective in lowering the IOP in children with refractory glaucoma. However, the rate of complications, pain, and inflammation seem to be lower with the micropulse mode, making it a safer alternative for cyclophotocoagulation, especially since retreatments are often needed.
关键词： micropulse laser,cyclophotocoagulation,pediatric glaucoma
更新于2025-09-23 15:23:52
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Focusing on surgical and laser advances in glaucoma management
摘要： Introduction: Lowering the IOP remains the mainstay treatment to stop the progression of glaucoma. Different modalities can be used to achieve this including IOP lowering medications, laser, and surgeries. Nowadays, minimally invasive glaucoma surgeries and newer lasers are becoming more popular due to their safety profile, and their efficacy, allowing the patients to be less dependent on life long medications and substituting more invasive procedures as trabeculectomy, and shunt operations. Areas covered: This review will go through how lasers and surgery are used to lower the IOP, and the newest techniques, and modalities used to achieve this. Expert opinion: the authors of this review believe that in five years’ time lasers and minimally invasive glaucoma procedures will replace eye drops and surgeries like trabeculectomy and shunt procedures.
关键词： cyclophotocoagulation,trabeculectomy,shunt procedures,minimally invasive glaucoma procedures,non-penetrating glaucoma procedures,laser Trabeculoplasty,Intraocular pressure
更新于2025-09-23 15:19:57
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Diode laser transscleral cyclophotocoagulation for uveitis-glaucoma-hyphema syndrome
摘要： Rationale: To report a case of diode laser transscleral cyclophotocoagulation (DLTSC) for uveitis-glaucoma-hyphema syndrome (UGH). Patient concerns: The patient developed UGH on the right eye (OD) after vitrectomy and intraocular lens (IOL) implantation. Diagnoses: Best corrected visual acuity (BCVA) was HM/50 cm, intraocular pressure (IOP) was 51.3 mm Hg on the OD. He was found to have 3+ anterior chamber cells. A B-scan ultrasound showed vitreous opacity. Ultrasound biomicroscopy (UBM) showed the chafing between the IOL and the posterior surface of the iris. Thus, he was diagnosed as UGH on the OD. Interventions: The patient was worried about the complications for removal of the IOL, a DLTSC approach was performed. Outcomes: BCVA was 20/40 on the OD, IOP was 12 mm Hg on the OD. There were no anterior chamber inflammation and no vitreous opacity. UBM showed there was no contact between IOL and the posterior surface of the iris, the fundus of the eye was clearly visible. Lessons: UGH syndrome is a severe complication of cataract extraction. IOL extraction has been the traditional approach to treatment. DLTSC can be an option when the IOL is slightly tilted.
关键词： acrylic single-piece intraocular lens,uveitis-glaucoma-hyphema (UGH) syndrome,diode laser transscleral cyclophotocoagulation,case report
更新于2025-09-19 17:13:59
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Safety and Efficacy of Diode Laser Transscleral Cyclophotocoagulation in Eyes With Good Visual Acuity
摘要： The main aim of this study was to evaluate the safety and efficacy of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with good visual acuity. A retrospective chart review identified patients who underwent TSCPC for uncontrolled intraocular pressure (IOP) from 2014 to 2016. Enrollment criteria included pretreatment best-corrected visual acuity (BCVA) of 20 of 40 or better, and a minimum of 6 months of postoperative follow-up. Thirty-three eyes of 33 patients(mean age, 72.1 ± 16.0 y) were enrolled (mean follow-up 12.6 ± 6.1 mo). The mean (SD) IOP was reduced 48.3% from 27.1 mm Hg (7.8) at baseline to 13.1 mm Hg (4.2) at last follow-up. Reduction of ≥ 1 glaucoma medications was achieved in 17 eyes (51.5%) at last follow-up. The cumulative probability of complete success (BCVA loss <2 Snelling lines, 20% reduction IOP, no reoperation for glaucoma, no IOP < 5 mm Hg) was 78.8% and 50% at months 6 and 12, respectively. The cumulative probability of qualified success (BCVA ≥ 2 lines with ≥ 20% reduction IOP, no reoperation for glaucoma, no IOP < 5 mm Hg) was 90.1% and 81.3% at month 6 and 1 year, respectively. Significant vision loss, defined as BCVA ≥ 2 lines, occurred in 33% of patients. The most common complications were postoperative iritic (56.3%) and cystoid macular edema (12.5%). TSCPC demonstrates a strong reduction in IOP and glaucoma medication use. However, with significant vision loss in 33% of patients, future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine comparative safety and efficacy.
关键词： transscleral cyclophotocoagulation,diode laser,visual acuity,cyclodestruction
更新于2025-09-16 10:30:52
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Transscleral Diode Laser Cyclophotocoagulation
摘要： To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma. Design: Retrospective case series. Participants: Seventy-eight eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course. Methods: This study compared 52 eyes treated with slow-coagulation TSCPC with 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings, and outcomes were assessed. Main Outcome Measures: Visual acuity (VA), intraocular pressure (IOP), and postsurgical complications. Results: The initial mean VA was 1.94 logarithm of the minimum angle of resolution (logMAR; standard deviation [SD], 0.73 logMAR) in the slow-coagulation TSCPC group and 1.71 logMAR (SD, 0.90 logMAR) in the standard TSCPC group (P ? 0.507). Initial IOP was 37 mmHg (SD, 13 mmHg) in the slow-coagulation group and 39 mmHg (SD, 13 mmHg) in the standard group (P ? 0.297). The follow-up periods were 16.36 and 24.68 months for the slow-coagulation and standard groups, respectively (P ? 0.124). Visual acuity remained better than light perception in 71.1% of slow-coagulation TSCPC patients and 65.0% of standard TSCPC patients (P ? 0.599). Intraocular pressure remained less than 20 mmHg in 46% of slow-coagulation TSCPC patients and 44% of standard TSCPC patients (P ? 0.870). The mean number of complications was higher in the standard group (1.46; SD, 1.24) versus the slow-coagulation group (0.62; SD, 0.75; P ? 0.002). The incidence of the need for a second procedure (slow-coagulation group, 28.8%; standard group, 23.1%; P ? 0.588) and maximum number of medications needed to control IOP after surgery (P ? 0.771) were similar between the 2 groups. Conclusions: In this case series, slow-coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques also were comparable, although standard TSCPC showed a higher incidence of prolonged inflammation after surgery. This study suggests that slow-coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged postoperative inflammation—a feared complication of TSCPC—when compared with standard pop-titrated TSCPC.
关键词： intraocular pressure,visual acuity,glaucoma,complications,slow-coagulation,transscleral cyclophotocoagulation,standard pop-titrated
更新于2025-09-12 10:27:22
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Micropulse Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma
摘要： Purpose: To assess the short-term ef?cacy and safety of micropulse transscleral diode laser cyclophotocoagulation (MP-TSCPC) in the management of refractory glaucoma and to compare outcomes based on prior glaucoma surgeries. Design: Retrospective analysis. Participants: Patients with refractory glaucoma who underwent MP-TSCPC at a single institution by 1 of 4 surgeons. Methods: Chart review of cases of MP-TSCPC using the Iridex Cyclo G6 (Mountain View, CA) laser with standard parameters and laser duration at the discretion of each treating physician. Main Outcome Measures: Probability of postoperative success was estimated by the Kaplan-Meier method. Success parameters included intraocular pressure (IOP) 6 to 21 mmHg with or without topical antihypertensive therapy, 20% or more IOP reduction from baseline for any 2 consecutive visits after 3 postoperative months, and no subsequent glaucoma surgery. Results: One hundred sixteen eyes of 116 patients (mean age, 65.8±16.9 years) were included. Baseline IOP was 22.2±7.9 mmHg, and mean postoperative follow-up time was 6.3±3.4 months (range, 3e12 months.) Postoperative IOP at the ?nal follow up was 15.3±6.6 mmHg (P < 0.01), corresponding to a reduction of approximately 6.9 mmHg (31.1%). Most eyes (66.4%) underwent at least 6 months of follow-up. Short-term probability of success was 93.1% at 3 months and 74.3% at 6 months. Eyes that had undergone prior traditional glaucoma surgery (trabeculectomy, tube shunt, excessive pressure-regulating shunt system miniature glaucoma shunt [Alcon, Fort Worth, TX], or a combination thereof) demonstrated a higher probability of success (67.6%) compared with eyes that had not (41.4%; P ? 0.014). The most common complications were decline in best-corrected visual acuity (7.8%) and hypotony (1.7%). Conclusions: Micropulse transscleral diode laser cyclophotocoagulation has a signi?cant short-term ocular hypotensive effect and favorable safety pro?le in eyes with refractory glaucoma. The probability of successful outcome was greater in eyes that had undergone prior traditional glaucoma surgery. Ophthalmology Glaucoma 2019;-:1e11 a 2019 by the American Academy of Ophthalmology
关键词： efficacy,micropulse transscleral diode laser cyclophotocoagulation,intraocular pressure,safety,refractory glaucoma
更新于2025-09-12 10:27:22
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Double-Session Micropulse Transscleral Laser (CYCLO G6) as a Primary Surgical Procedure for Glaucoma
摘要： PURPOSE: To evaluate the safety and effectiveness of double-session micropulse transscleral laser (MP3) as a primary treatment modality for glaucoma. METHODS: Patients who underwent MP3 therapy with double sessions in each hemifield, with a follow-up period of at least 6 months, were retrospectively considered. Patients were categorized into two groups: GI (no previous glaucoma surgery) and GII (with previous glaucoma surgery). Success was defined by either achieving a final intraocular pressure (IOP) between 6 and 18 mmHg and an IOP reduction of more than 20%, or a minimum 50% reduction in the number of glaucoma medications, at the last visit, without any serious complications. RESULTS: Eighty-four eyes were included in the GI group and 101 in the GII group, with the latter demonstrating relatively higher preoperative IOP (31.1±5.4 vs. 26.2±6.9 mmHg, p<0.001). Final IOP (14.9±5.2 vs. 13.6±4.1 mmHg, p=0.06), average MP3 treatment time (358.0±50.7 vs. 362.7±67.8 seconds, p=0.5), and follow-up duration (10.8±5.1 vs. 12.3±5.4 months, p=0.06) were similar between the groups. The percentage reduction with regard to glaucoma medication was higher in GI than in GII (49.1±28.8 vs. 38.8±30.1%, p=0.02). GI underwent fewer MP3 procedures than GII (1.2±0.5 vs. 1.5±0.8, p=0.002). No hypotony or phthisis bulbi was observed in GI (1 and 2 in GII, respectively). Procedural success was noted in 92.9% of the cases in GI and 87.1% in GII. CONCLUSION: Double-session MP3 therapy could be considered as a safe and effective procedure to treat glaucoma in eyes that have not undergone any previous glaucoma surgery. Primary eyes achieved a success-rate similar to those with refractory glaucoma with fewer MP3 procedures and fewer glaucoma medications.
关键词： Cyclophotocoagulation,Glaucoma,Laser,Intraocular Pressure,Micropulse
更新于2025-09-12 10:27:22
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Evaluating the Laser Output of the Micropulse P3 Laser Delivery Device Following Repeated Use
摘要： Repeated use of the Micropulse P3 (MP3) probe during micropulse transscleral cyclophotocoagulation is associated with an increase in laser output over time. The purpose of this study was to examine the laser efficacy of the MP3 probe following repeated use. This was an observational study carried out using Cyclo G6 Glaucoma Laser System with 6 MP3 laser delivery probes. Each probe was fired for 100 seconds, every 10 minutes until the probe was deactivated. The laser output was measured using a laser power meter. Maximum observed laser power output was also noted. All probes were deactivated after 90 minutes (9 cycles) of use. Mean laser output of all 6 probes was determined, and results suggested an increase in output with time. When examining the differences in total laser output for each cycle, no significant differences were observed for the first 4 cycles, but not for the remaining 5 cycles, wherein the increased laser outputs were found to be significantly different from baseline (cycle 1). Findings suggest a possible increase in laser output with repeated use, especially after 4 cycles, and clinicians need to be cautious if they intend to use the probes repeatedly.
关键词： laser delivery,micropulse transscleral cyclophotocoagulation,glaucoma
更新于2025-09-12 10:27:22
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Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients
摘要： This study aimed at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma. Patients with moderate to advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable antiglaucoma medications were selected to undergo MP-TSCPC using the MP3 handpiece with the Iridex Cyclo G6 (IRIDEX Laser Systems). Follow-up examinations took place on a regular basis until 15 months postoperatively. Seventy-five eyes of 69 patients (53.6% male patients) were included. Mean age was 55.5 ± 22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity at baseline ranged between 0 and 2.1 logMAR. Mean prelaser IOP was 26.0 ± 7.91 mm Hg. This was reduced significantly to 13.8 ± 5.6 mm Hg (44.0% reduction, P < 0.001) at week 1, and to 18.0 ± 7.7, 18.4 ± 7.1, 16.7 ± 6.2, 15.1 ± 4.1, 15.7 ± 5.32, and 14.8 ± 5.50 mm Hg at months 1, 3, 6, 9, 12, and 15, respectively. The mean number of antiglaucoma drops decreased significantly up to 12 months of follow-up (P = 0.008) and that of oral acetazolamide tablets decreased significantly up to 15 months (P < 0.001). The success rate decreased progressively with time, reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered, and no eye lost vision completely. MP-TSCPC is an efficient noninvasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.
关键词： intraocular pressure,micropulse transscleral cyclophotocoagulation,glaucoma
更新于2025-09-11 14:15:04