Benefits and considerations
Micropulse technology, unlike CW laser application, does not induce fatal architectural damage to the cellular structure. It is a repeatable procedure and is proving to be an effective option to fill the gaps between topical medical therapy, MIGS and traditional glaucoma-filtering surgery.
Notwithstanding the progressive nature of glaucoma, any time we can preserve vision and postpone a more aggressive treatment plan, the patient benefits.
Patients like the idea of a non-incisional procedure because it means less pain, little to no downtime, and minimal risk of infection or leaking, which could potentially lead to low IOP or hypotony. Although the procedure is essentially pain free, patients usually prefer a full block for comfort.
Using a block insures a quick, usually three-minute procedure. Side effects include inflammation and blurred vision immediately following the procedure; however, these tend to be transient and resolve quickly.
Micropulse therapy is generally safe on the whole spectrum of patients. I may use it as a first-line therapy on patients with drop intolerance or extreme fear of injections. Patients requiring immediate or aggressive IOP-lowering effects benefit most when the laser is used in combination with MIGS, tube or trabeculectomy.
The technology offers a viable option for patients who are opposed to or who are not incise candidates, such as post-corneal transplant or severe dry eye patients. In these patients, healing tends to be poor, but with micropulse TSCPC, we do not have to worry about how the surface of the eye heals.
Furthermore, patients who have failed another type of surgery, such as trabeculectomy, can benefit from attacking the inflow side of the algorithm in addition to the outflow issues.
A majority of glaucoma patients are using topical medications and as a result have dry eye or an otherwise compromised ocular surface. In some cases, the technology produces minor insult to the peripheral corneal nerves, which can also be potentially exacerbated by postsurgical drops.
Typically a transient side effect, we simply treat it like other ocular surface disease by increasing lubrication or administering anti-inflammatories. As with all glaucoma patients, those with a severely damaged ocular surface are not ideal candidates.