Purpose: To evaluate the efficacy, safety and
peri-operative pain response of a novel method of transscleral
cyclophotocoagulation(TCP) using micopulse 810nm diode laser in a prospective
pilot study.
Method: TCP was performed on 16 eyes with end-stage
refractory glaucoma using the Iris Oculight SLX diode laser with a modified
Zeiss ball tip probe under periocular anaesthesia. 28 shots of 2 Watts, 2
seconds pulse envelope with micropulse duration of 100 microseconds &
interpulse duration of 300 microseconds was applied over 360 degrees in each
eye. Total energy delivered was less than most published settings for
conventional diode TCP.
Results: Statistically significant intraocular
pressure(IOP) lowering from pre-operative mean of 44 mmHg to post-operative
means of 28 mmHg at 1 week and 35 mmHg at 3 weeks was achieved (p<0.05,
paired t-test). Percentages of patients with at least 20% & 30% IOP
lowering were 75 & 63 at 1 week, 50 & 36 at 3 weeks, 42 & 25 at 6
weeks and 40 & 20 at 12 weeks respectively. Intra- & post-operative
pain scores as well as post-operative inflammation appeared to be significantly
less than conventional TCP. No significant complications including
post-operative hypotony or phthisis were encountered.
Conclusions: Micropulse TCP appears to be safe &
effective in lowering IOP in refractory glaucoma in the short term, with
decreased peri-operative pain & inflammation compared to conventional diode
TCP. Controlled comparative studies may further define its role in glaucoma
management.