Micropulse diode laser therapy in refractory glaucoma

Moctar Issiaka; Khalil Zrikem; Adil Mchachi; Leila Benhmidoune; Rayad Rachid; Mohamed El Belhadji; Abdoul Salam Youssoufou Souley; Abdou Amza

doi:10.1016/j.aopr.2022.10.003

Micropulse diode laser therapy in refractory glaucoma

Adv Ophthalmol Pract Res. 2022 Oct 15;3(1):23-28. doi: 10.1016/j.aopr.2022.10.003. eCollection 2023 Feb-Mar.

Authors

Moctar Issiaka¹, Khalil Zrikem¹, Adil Mchachi^{2

1}, Leila Benhmidoune^{2

1}, Rayad Rachid^{2

1}, Mohamed El Belhadji^{2

1}, Abdoul Salam Youssoufou Souley³, Abdou Amza³

Affiliations

¹ Adult Ophthalmology Department, 20 August 1953 Hospital, Ibn Rochd University Hospital of Casablanca, Casablanca, Morocco.
² Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
³ Ophthalmology Department of the Amirou Boubacar Diallo National Hospital, Niamey, Niger.

Abstract

Purpose: Description of safety and efficacy of micropulse Transscleral cyclophotocoagulation as a treatment option for refractory glaucoma.

Methods: This is a prospective study including 39 eyes of 31 patients followed for refractory glaucoma, who benefited from transscleral cyclophotocoagulation using a microplused laser. The main indication for the procedure was increased ocular pressure refractory to quadritherapy in various types of glaucoma. The patients were treated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 nm. The parameters for the procedure were a duration of 90 s per hemisphere with a power of 2000 mW and an energy of 180 J. Both the upper and lower hemispheres were treated in the same procedure, sparing the 3 o'clock and 9 o'clock meridians, and all the patients benefited from a single treatment session. The following parameters were evaluated: ocular pain and overall tolerance; visual acuity; and the evolution of IOP postoperatively up to 9 months.

Results: The glaucoma subtypes treated are as follows: primary open-angle glaucoma (n = 05), chronic angle-closure glaucoma (n = 13), neovascular glaucoma (n = 07), aphakic glaucoma (n = 06), malignant glaucoma (n = 04), post-traumatic angle recession (n = 02), and inflammatory glaucoma (n = 02). The mean pre-operative intraocular pressure was 42.3 ± 5.2 mmHg and the mean post-operative intraocular pressure at 9 months was 16.9 ± 1.9 mmHg. The reduction in IOP was 49.9%. The average number of intraocular pressure-lowering medications used prior to surgery was four, and the average number of medications used at the 9-month post-operative visit was 2.0 ± 1.2 (70.3% of patients were on dual therapy). The overall success rate was 60.5%.

Conclusions: Micropulse transscleral cyclophotocoagulation appears to be a safe and efficient treatment for refractory glaucoma. Its indications should therefore be broadened and proposed early in various situations.

Keywords: Intraocular pressure; Micropulse laser; Refractory glaucoma; Transscleral cyclophotocoagulation.