Micropulse diode laser therapy in refractory glaucoma

Purpose:Description of safety and efficacy of micropulse lYanssderal cydophotocoagulation as a treatment option for refractory glaucoma.Mahods:This is a prospective study including 39 eyes of 31 patients foil owed for refractory glaucoma,who benefited from transsderal cyclophotocoagulation using a mic topi used laser.The main indication for tire pro­cedure was increased ocular pressure refractory to quadri therapy in various types of glaucoma.Ihe patients were tieated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 nm.The pa­rameter for tire procedure were a duration of 90 s per hemisphere with a power of 2000 mW and an eneigy of 180 J.Both tire upper and lower hemispheres were treated in tire same procedure,sparing tire 3 o'clock and 9 o'clock meridians,and aD tire patients benefited from a single treatment session.The following parameters were evaluated;ocular pain and overall tolerance;visual acuity;and tire evolution of IOP postoperatively up to 9 months.Results:The glaucoma subtypes treated are as follows:primaty 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 inflammatoiy glaucoma(n=02).The mean pre-operative intraocular pressure was 42.3±5.2 mmHg and tire 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 tire average number of medications used at tire 9-month post­operative visit was 2.0±1.2(703%of patients were on dual therapy).The overall success rate was 60.9%.Conclusions:Micropulse transsderal cydophotocoagulation appears to be a safe and effident treatment for re­fractory glaucoma.Its indications should therefore be broadened and proposed early in various situations.