Take-home message: Laser therapy that approaches bilateral glaucoma in a single treatment provides greater efficacy for the practice and more convenience for patients.
By Ahad Mahootchi, MD, Special to Ophthalmology Times
Though medical therapy is the typical first line-treatment strategy in glaucoma, there is a lot of interest in developing therapy approaches that effectively lower IOP while reducing the need for drop therapy.
Incisional surgical options typically remain a consideration for end-stage disease, while the largest need in glaucoma management is an approach for the majority of patients with mild to moderate glaucoma.
In particular, laser therapy offers a viable strategy for these patients, although not all platforms for delivery are equal.
The MicroPulse P3 (MP3) probe powered by the Cyclo G6 laser (Iridex) is a powerful-yet-gentle treatment for a range of patients, equally applicable to wide assortment of glaucoma types. This modality represents a new way to treat glaucoma that results in pressure reductions while lessening patientsâ reliance on medical therapy.
A novel treatment
The probe powered by the laser may look similar to traditional transcleral cyclophotocoagulation (TSCPC).
However, there is nothing similar in regard to patient selection or postop experience to the patient or physician. It may look like the laser cyclodestructive procedures of yester-year when performing this 3-minute procedure. That is where the similarity ends.
Patients recover vision in minutes and are free of pain and inflammation. The ciliary body laser treatment does not ablate the ciliary body. The mechanism is believed to enhance uveoscleral outflow in addition to affecting outflow.1
Although seemingly counterintuitive, MicroPulse is not simply a reduction in laser power or a way to adjust the interval; rather, MicroPulse is a different way of applying laserâboth more specific to the target tissue, as well as less destructive to target and adjacent tissue. MP allows for a treatment effect without the inflammation and destructive effect associated with continuous wave laser.
I prefer to perform MicroPulse TSCPC for about 3 minutes total, or about 90 seconds in each hemisphere, in patients with darker colored irises. The treatment duration might increase to 100 to 110 seconds per hemisphere in a blue eye.