Short pulse grid and subthreshold micropulse laser (the sandwich grid) plus intravitreal ranibizumab for the treatment of diabetic macular edema.

OBJECTIVE: To investigate the effects of two laser treatment procedures combined, short pulse grid laser (SP) and subthreshold micropulse laser (MP) (the sandwich grid [SWG] technique), plus intravitreal ranibizumab (IVR) on central subfield thickness (CSFT), best-corrected visual acuity (BCVA) and macular sensitivity in patients with diabetic macular edema (DME). METHODS: Forty-five eyes (of 33 patients) with center-involving DME were treated with the SWG laser technique plus IVR and followed for 12 months. Laser treatment was performed at baseline: SP laser spots were placed in a grid pattern in the macular area (500 µm from the fovea) according to the extension of DME; subsequently, MP laser was delivered up to the edge of the fovea. MP laser re-treatment sessions could be performed every 3 months if DME was present and CSFT was ≥ 300 µm on SD-OCT. IVR injection was performed at baseline and repeated monthly if CSFT > 300µm. Preoperatively and monthly, ophthalmological examination was performed including measurements of BCVA, CSFT, and macular sensitivity. RESULTS: One-year follow-up data is available for 37 eyes of 27 patients. Mean ± SE CSFT (µm) was 509.36 ± 25.14 and 325.76 ± 15.34 at baseline and 12 months, respectively. A significant reduction in mean CSFT was observed at all study visits compared to baseline (p < 0.001). Mean ± SE BCVA (logMAR) was 0.62 ± 0.04 and 0.45 ± 0.04 at baseline and 12 months, respectively. A significant improvement in mean BCVA was observed at all study visits compared to baseline (p < 0.001). Mean ± SE macular sensitivity (dB) was 17.85 ± 0.80 and improved to 19.05 ± 0.59 after one year of follow-up (p = 0.006). The mean number of IVR injections was 8.29 ± 0.63. The mean number of MP laser procedures including the initial SWG laser session was 3.67 ± 0.22. No ocular or systemic adverse effects were observed. CONCLUSION: The SWG laser technique plus IVR was associated with significant improvement in macular edema, BCVA, and macular sensitivity in patients with center-involving DME. CLINICAL TRIAL NUMBER (CAAE): 22969019.4.0000.5440.

Real-world outcomes of micropulse transscleral laser therapy in glaucoma patients: Efficacy of initial and repeated treatment, transient intraocular pressure spikes.

Purpose: To investigate the clinical outcomes of micropulse transscleral laser therapy (MP-TLT) in a cohort of glaucoma patients, including safety profile, post-operative transient intraocular pressure (IOP) spikes, long-term efficacy and prognostic factors in terms of IOP-lowering. Methods: This was a retrospective observational cohort study. Medical records of all patients who consecutively underwent MP-TLT between May 2019 and February 2023 at a tertiary referral centre were scrutinised and relevant data were retrospectively analysed. Results: A total of 131 patients (138 eyes) with a mean age of 73.2 ± 14.2 years were included. Mean pre-interventional IOP was 24.1 ± 9.1 mmHg. Within 6-12 h following the intervention on the same day, an IOP spike was regularly observed, reaching on average 31.7 ± 10.3 mmHg (p < 0.001 to baseline). Two years after the intervention, mean IOP was 16.1 ± 5.6 mmHg (p < 0.005 to baseline). In 18 eyes, the treatment was repeated, and the IOP lowering effect was more durable after the second intervention compared to the first one (Cox-Mantel test, p=<0.005). Apart from the transient post-interventional IOP spikes, no severe complications were observed. Conclusions: MP-TLT is associated with significant IOP spikes in the first post-operative hours. Thus, close post-interventional IOP monitoring or even preventive (additional) IOP-lowering treatment may be considered. In the long term, the procedure yields favourable outcomes in terms of safety and IOP reduction. Repeated MP-TLT treatment, if necessary, seems to achieve more sustained IOP reduction than the initial treatment.

Safety and efficacy of subthreshold micropulse yellow laser for persistent subretinal fluid after scleral bucking a randomized clinical trial.

Persistent subretinal fluid (PSF) after scleral bucking of rhegmatogenous retinal detachment may delay recovery and affect the final visual quality, but with no effective treatment. This study firstly investigated the safety and efficacy of 577 nm yellow subthreshold micropulse laser (SML) on PSF after scleral bucking surgery. This double-masked randomized clinical trial was conducted from December 2020 to October 2022 at Chongqing Aier Eye Hospital. Participants with PSF last for 1 month after scleral bucking surgery with break closed and retina reattachment were recruitment. These participants were treated by 577 nm yellow SML or sham treatment. Funduscopy, optical coherence tomography (OCT) volume change, best corrected vision acuity (BCVA) and visual field test were evaluated for six mouths follow-up. A total of 24 participants were randomized into SML group or Sham group equally. Compared with Sham group, the OCT volume within 6 mm of macular fovea was significantly less in SML group 6 months after therapy (P = 0.048). There were no statistically significant differences of OCT volume at 1, 2 and 3 months from baseline between groups. BCVA of ETDRS letters had no statistically significant difference. Pattern Standard Deviation amelioration (P = 0.039) had statistically significance in SML group compared with Sham group. There were no complications in the 2 groups. These preliminary findings suggest that 577 nm yellow SML therapy could accelerate PSF absorption after scleral bucking surgery.Trial registration: Chinese Clinical Trial Registry No. ChiCTR2000037838, 02/09/2020, https://www.chictr.org.cn/showproj.html?proj=51885 .

532 nm versus 810 nm subthreshold micropulse laser in treatment of non-resolving central serous chorioretinopathy: A randomized controlled trial.

Background: The relative efficacy of 532 nm subthreshold micropulse laser in comparison to the 810 nm subthreshold micropulse laser, in the treatment of central serous chorioretinopathy is not known. Methods: This randomized controlled trial included 99 eyes each in groups A and B. Key inclusion criteria were: (i) vision loss for minimum three months due to persistent central serous chorioretinopathy; (ii) focal leaks (upto two leaks) on fundus fluorescein angiography. Key exclusion criteria were: (i) history of prior treatment for central serous chorioretinopathy; (ii) absence of any leak/ presence of diffuse leaks/ >2 leaks on fundus fluorescein angiography; (iii) chronic central serous chorioretinopathy. All eyes were treated with subthreshold micropulse laser (group A: 532 nm green laser; group B: 810 nm diode laser). Best-corrected visual acuity, autofluorescence, spectral domain optical coherence tomography, and fundus fluorescein angiography, were evaluated at baseline and at 1, 3, and 6 months. Laser was repeated in nor-responders at 3 months. Results: There was a statistically significant improvement in BCVA in both groups six months post laser. Between the two groups, a comparable proportion of eyes showed complete resolution of subretinal fluid at one month, three months and at six months. No adverse effect of laser was observed in either group. Conclusion: Both 532 nm STMP laser and 810 nm STMP laser have comparable structural and functional outcomes in the treatment of non-resolving CSC. There are no adverse effects related to either of the two wavelengths.

Comparison of two laser power levels in the subthreshold micropulse yellow laser treatment of acute central serous chorioretinopathy.

AIMS: To compare the efficacy of two power levels in the 577 nm sub-threshold micro pulse laser (SML) treatment of acute central serous chorioretinopathy (aCSC). METHODS: A retrospective comparative study was conducted. A total of 65 patients (65 eyes) with aCSC were enrolled. Of which, 32 patients received low power treatment and 33 patients received high power treatment of 577 nm SML. Best-corrected visual acuity (BCVA), central macular thickness (CMT), fundus-monitored microperimetry and height of subfoveal choroidal thickness (SFCT) as well as subretinal fluid (SRF) were evaluated at baseline and 3 months. RESULTS: The height of SFCT and retinal sensitivity in the low power treatment group was significantly better than that in the high power treatment group at 4 weeks (all p < 0.001). Mean BCVA improved from baseline to 3 months after treatments but with no significant difference between the two groups after 3 months (p > 0.05). In the low power group, the CMT decreased from 379.76 ± 139.23 µm at baseline to 176.56 ± 37.78 µm at 3 months, and in the high power group, the CMT decreased from 364.97 ± 143.08 at baseline to 191.77 ± 38.26 µm at 3 months. There was no significant difference at 3 months between the two groups (p > 0.05). Similar results were also found in term of SRF. CONCLUSIONS: Timely intervention with 577 nm SML with low power treatment can improve visual acuity, and included anatomic success without adverse events.

Outcomes of Micropulse Laser Trabeculoplasty Compared to Selective Laser Trabeculoplasty: A Systematic Review and Meta-Analysis.

Purpose: To perform a meta-analysis and systematic review to compare the efficacy and complications of micropulse laser trabeculoplasty (MLT) and selective laser trabeculoplasty (SLT) in adult patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). Methods: We performed a systematic review utilizing PubMed, Embase, and Scopus, on April 8, 2024. Meta-analyses were performed for the mean change in intraocular pressure (IOP) at one-month, six-month, and one-year follow-up visits, rate of IOP spikes (>5 mmHg increase from the pre-procedure baseline IOP), rate of treatment failure (<20% or <3 mmHg reduction in IOP or requiring additional medications or procedures), and mean change in number of medications. Results: Six studies, with a total of 593 eyes, were included: 283 underwent MLT, while 310 underwent SLT. A statistically significant difference in the efficacy of MLT versus SLT at one-month and six-month follow-ups was present, with SLT reducing IOP by 0.83 mmHg (95% CI: 0.20, 1.47; P = 0.01) more and 0.55 mmHg (95% CI: 0.02, 1.08; P = 0.04) more than MLT, respectively. At the one-year follow-up, there was no significant disparity in IOP reduction between SLT and MLT (WMD = 0.16; 95% CI: -0.40, 0.71; P = 0.58). There was a significantly lower rate of IOP spikes in the MLT treatment group (RR = 0.37; 95% CI: 0.16, 0.89; P = 0.03). There was no statistically significant difference in the rate of treatment failures (RR = 1.05; 95% CI: 0.68, 1.62; P = 0.84) or number of topical medications reduced (WMD = 0.06; 95% CI: -0.13, 0.26; P = 0.53). Conclusion: While SLT may offer greater short-term reductions in IOP, it may be associated with more postoperative IOP spikes when compared to MLT. At one-year follow-up, there were no significant differences in IOP reduction or failure rates between the MLT and SLT groups.

Optimizing Diabetic Macular Edema Treatment: A Meta-Analysis of Subthreshold Micropulse Laser and Anti-Vascular Endothelial Growth Factor Combination Therapy.

Background: Diabetic macular edema (DME) is the primary cause of visual impairment in individuals with diabetes. Anti-vascular endothelial growth factor (VEGF) is the current first-line treatment for DME owing to its effectiveness. However, frequent anti-VEGF injections may be inconvenient for patients. Therefore, this study aimed to investigate whether the addition of subthreshold micropulse laser (SML) to anti-VEGF therapy could reduce the requirement for anti-VEGF injections while maintaining the treatment efficacy for DME. Methods: Clinical trials retrieved from the databases of PubMed, EMBASE, and the Cochrane Library were evaluated to determine the effectiveness of combination treatment with SML and anti-VEGF medication compared with that of anti-VEGF treatment alone. The primary outcome measures were the changes in CMT, best-corrected visual acuity (BCVA), and the total number of intravitreal injections (IVIs). Results: The IVI + SML group revealed a substantial increase in the logarithm of the minimum angle of the resolution BCVA and a reduction in CMT at the 12-month follow-up (BCVA: random-effects; mean difference [MD], -0.05; 95% confidence interval [CI]: -0.10 to -0.01; p-value = 0.28, and CMT: random-effects; MD, -18.27; 95% confidence interval, -27.36 to -9.18; p-value = 0.20). The number of required IVIs in the IVI + SML group was lower than that in the IVI only group (random-effects; MD, -2.22; 95% CI: -3.13 to -1.31; p-value < 0.01). Conclusions: Combining SML therapy with anti-VEGF injections may reduce the total number of injections required, improve VA, and reduce CMT at the 12-month follow-up. Although the included studies used different SML regimens and anti-VEGF agents, this review indicates that the application of additional SML therapy results in positive clinical outcomes.

Case report: Topical pilocarpine ameliorated the accommodation loss and pupillary dilation after micropulse transscleral laser treatment.

BACKGROUND: The present study elucidates a common significant postoperative complication of micropulse transscleral laser treatment (mTLT) and explores its potential management strategies for younger patients with good central vision. CASE PRESENTATION: Three younger Chinese glaucoma patients with good central vision maintained high intraocular pressures (IOPs) (36, 25, and 30 mmHg) on maximally tolerated topical anti-glaucoma medications. All patients were treated with mTLT because of a higher risk of complications with filtering surgery. After the procedure, their best-corrected visual acuities were not significantly changed, IOPs were significantly decreased, and the number of topical anti-glaucoma medicines was gradually decreased. However, all patients complained about reduced near visual acuity (NVA) for 1-5 months. Slit-lamp examination revealed pupillary dilation, and binocular accommodative function examination indicated accommodation loss. After treatment with 2% topical pilocarpine, all patients reported an improvement in NVA. Among them, we could observe pupillary constriction, recovery of accommodation function, and improved NVA, even discontinuation of pilocarpine in Patient 2. CONCLUSION: In younger patients with good central vision, topical pilocarpine might ameliorate accommodation loss and pupillary dilation after mTLT.

Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uveitic Glaucoma.

PURPOSE: To report a case series of patients with uveitic glaucoma who were treated with micropulse transscleral cyclophotocoagulation (mpCPC). METHODS: This retrospective case series consists of patients from the University of Colorado Sue Anschutz-Rodgers Eye Center from 2015 to 2020 who were diagnosed with uveitic glaucoma. Information collected includes demographic data, type of uveitis, glaucoma severity, and prior glaucoma surgeries. Pre- and postoperative best corrected visual acuity, intraocular pressure (IOP), glaucoma medications, degree of inflammation, and uveitis therapies were included up to 36 months postoperatively. Surgical success was defined as an IOP reduction of 30% with achievement of IOP goal using the same number of glaucoma medications or less at 6 months or 1 year. Uveitis success was defined as the absence of persistent anterior uveitis at 3 months. RESULTS: Six patients and seven eyes with uveitic glaucoma underwent mpCPC. Types of uveitis included idiopathic anterior uveitis, HLA-B27-associated anterior uveitis, varicella zoster virus anterior uveitis, juvenile idiopathic arthritis-associated chronic anterior uveitis, lichen planus-associated intermediate uveitis, and sarcoidosis-associated panuveitis. Two of six eyes (33.3%) at 6 months and three of five eyes (60%) at 1 year achieved surgical success. Around 6 months postoperatively, two out of seven eyes (28.6%) required Ahmed glaucoma valve placement (n = 1) or repeat mpCPC (n = 1). One eye (14.3%) required phacoemulsification with goniotomy followed by an Ahmed glaucoma valve 18 months after mpCPC. There were no cases of persistent anterior uveitis, hypotony, or phthisis after mpCPC in this cohort. CONCLUSIONS: Micropulse transscleral cyclophotocoagulation may safely reduce intraocular pressure in some patients with uveitic glaucoma without exacerbation of intraocular inflammation. Multiple treatments may be required to achieve longer-term success.

[Comparative evaluation of transscleral laser exposure in anatomical experiment]. / Sravnitel'naya otsenka lazernogo transskleral'nogo vozdeistviya v usloviyakh anatomicheskogo eksperimenta.

PURPOSE: This study comparatively analyzed the morphology of eye tissues after laser exposure using the latest generation of transscleral laser techniques - micropulse transscleral cyclophotocoagulation (MP-TSCPC) and laser activation of scleral hydropermeability (LASH) - in an anatomical experiment. MATERIAL AND METHODS: The study used pulsed-periodic radiation of an Er-glass fiber laser (λ=1.56 µm) and radiation of a diode laser (λ=0.81 µm) in the micropulse mode. A comparative morphological evaluation of histological preparations of target scleral and ciliary body (CB) tissues was performed with the study of laser-induced changes occurring after LASH and MP-TSCPC. RESULTS: The study of histological preparations obtained after MP-TSCPC and LASH did not reveal any noticeable signs of an inflammatory reaction or significant destructive changes. There were no signs of pronounced coagulative changes in the form of disorganization of connective and muscle tissue in the exposure area. At the same time, MP-TSCPC was accompanied by thinning and discontinuity of the CB pigment epithelium in the projection of its flat part and expansion of the gaps between the anterior connective tissue fibers fixing the CB to the sclera, which is likely a factor contributing to uveoscleral outflow. After LASH, in the irradiated areas at the level of the outer layers of the sclera (¾ of its thickness) located in the projection of the flat part of the ciliary body, multiple slit-like cavities and enlargements (stretching) of interfiber spaces were revealed with simultaneous compaction of the inner part of the sclera (» of its thickness). CONCLUSION: The identified morphological changes may indicate certain differences in the mechanisms of intraocular pressure (IOP) reduction after MP-TSCPC and LASH. The results of this study suggest that the enhancement of uveoscleral outflow of intraocular fluid and the hypotensive effect after MP-TSCPC may be associated with laser-induced expansion of the interspaces between the anterior connective tissue fibers of the CB in the suprachoroidal space. With LASH, the possible mechanism of lowering IOP may be related rather to an increase in transscleral filtration due to the appearance of slit-like interfiber spaces in the sclera, caused by local contraction of scleral fibers in the area of laser exposure. The absence of pronounced destructive changes at the histological level indicates the gentle nature of both laser techniques and the possibility of expanding the indications for the use of LASH in the treatment of glaucoma, including at its earlier stages.

Functional and anatomical results of subthreshold micropulse laser as rescue treatment for central serous chorioretinopathy after verteporfin shortage.

BACKGROUND: To evaluate the anatomical and functional outcomes of high-density subthreshold micropulse laser (HSML) treatment in a cohort of patients diagnosed with chronic central serous chorioretinopathy (CSCR) whose treatment with photodynamic therapy (PDT) was delayed due to the worldwide shortage of verteporfin. METHODS: Prospective interventional study which included 42 eyes of 40 patients diagnosed with chronic CSCR and on the waiting list for PDT who received rescue therapy with HSML using the Navilas® System device (OD-OS GmBH, Teltwo, Germany). Best corrected visual acuity (BCVA), subretinal fluid (SRF), and subfoveal choroidal thickness (SFCT) were measured at inclusion and during the follow-up visits at 2, 4, and 6 months. RESULTS: The mean waiting time from the indication of PDT until treatment with HSML was 14.6 ± 9.7 months (range 5-21). There were no differences in the pre-treatment BCVA compared with the 6-month follow-up visit (67 ± 16.7 letters and 67.5 ± 8.2 letters respectively, p = 0.136). However, there was a significant decrease in the mean SFCT of -39.6 ± 37.1 µm (p = 0.030). Additionally, there was a decrease in SRF height between the pre-treatment measure (123.0 ± 49.8 µm) and the 2, 4, and 6-month follow-up visits after HSML of -58.5 ± 68.2 µm, -53.2 ± 76.3 µm, and -65.4 ± 53.6 µm respectively (p < 0.001). A complete resolution of the SRF was observed in 16/42 eyes (38.1 %) and a reduction of the SRF height in 85.7 % of the overall cohort was observed after HSML treatment. CONCLUSION: A significant anatomical improvement in SRF and a decrease in SFCT were observed in patients with CSCR who were previously waiting for PDT and were rescued by HSML. However, the rate of complete SRF resolution was low.

Uveoscleral Outflow Routes after MicroPulse Laser Therapy for Refractory Glaucoma: An Optical Coherence Tomography Study of the Sclera.

To analyze in vivo scleral changes induced by MicroPulse transscleral laser therapy (MP-TLT) in refractory glaucoma using anterior segment-optical coherence tomography (AS-OCT). Forty-two candidate patients for MP-TLT were consecutively enrolled and underwent AS-OCT at baseline and after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction by one-third. The main outcome measures were the mean superior (S-), inferior (I-), and total (T-) intra-scleral hypo-reflective space area (MISHA: mm2) and scleral reflectivity (S-SR, I-SR, T-SR; arbitrary scale) as in vivo biomarkers of uveoscleral aqueous humor (AH) outflow. The IOP was the secondary outcome. The relations between the baseline-to-six months differences (D) of DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, DT-SR, and DIOP, were investigated. At 6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baseline S-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR were higher in the successes (p < 0.05). At six months, successful and failed MP-TLTs showed a 50% increase in S-MISHA (p < 0.001; p = 0.037), whereas I-SR and T-SR reduced only in the successes (p = 0.002; p = 0.001). When comparing DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, and DT-SR, there were no significant differences between the groups. In the successful procedures, DIOP was positively correlated with DT-MISHA and DI-MISHA (ρ = 0.438 and ρ = 0.490; p < 0.05). MP-TLT produced potentially advantageous modifications of the sclera in refractory glaucoma. Given the partial correlation between these modifications and post-treatment IOP reduction, our study confirmed that the activation of the uveoscleral AH outflow route could significantly contribute to the IOP lowering after MP-TLT.

Micropulse Transscleral Cyclophotocoagulation in Non-Incisional Eyes with Ocular Hypertension and Primary Open-Angle Glaucoma.

Purpose: To investigate the safety and effectiveness of micropulse transscleral cyclophotocoagulation (MPTSCPC) in non-incisional eyes with ocular hypertension (OHT) and early, moderate, and severe primary open-angle glaucoma (POAG). Methods: Retrospective cohort study of eyes that underwent MPTSCPC from 2016 to 2019 at an outpatient clinic in Canada. Eyes were excluded if any incisional procedures, except cataract surgery, were performed prior to MPTSCPC treatment. Laser power ranged from 900 to 2500mW. Results: A total of 153 eyes from 93 patients were included (OHT n=22; early POAG n=46; moderate POAG n=35; severe POAG n=50). The baseline IOP was 18.37 ± 4.76mmHg in the total cohort. All cohorts experienced a significant mean IOP reduction by final follow-up (total p<0.001; OHT p=0.003; early POAG p<0.001; moderate POAG p=0.022; severe POAG p=0.015). Overall, 52.9% of eyes achieved an IOP reduction of ≥20% from baseline to final follow-up (OHT 59.1%; early POAG 58.7%; moderate POAG 45.7%; severe POAG 50.0%). There was worsening in best-corrected visual acuity in the total cohort (mean difference=0.11 ± 0.36 logMAR, p=0.11), mostly attributable to cataract progression (34.1% of phakic eyes) and ocular surface disease (7.2%). The number of topical medications and drug classes remained unchanged in the total cohort (p=0.425 and p=0.791, respectively). Twenty-two eyes (14.4%) required retreatment, which provided an additional IOP reduction of 1.26mmHg (p=0.344). By final follow-up, 8 eyes (5.2%) required escalation to incisional procedures. Conclusion: MPTSCPC is a safe and effective adjunct IOP-lowering treatment in non-incisional eyes with OHT and POAG.

Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma.

PURPOSE: To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. METHODS: This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. RESULTS: For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. CONCLUSION: GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.

Clinical Outcomes of MicroPulse Transscleral Laser Therapy with the Revised P3 Delivery Device.

Aim: To evaluate the success and safety of MicroPulse transscleral laser therapy (TLT) on intraocular pressure (IOP) reduction in adults with uncontrolled glaucoma using different total treatment durations, sweep velocities, and a number of sweeps utilizing the revised MicroPulse P3 delivery device. Materials and methods: A single-center Institutional Review Board (IRB) approved multiple cohort studies of MicroPulse TLT with the revised MicroPulse P3 delivery device, which was conducted in 61 eyes from 40 adults with uncontrolled glaucoma. Eyes that received 50-second (GI, GII, and GIII) and 60-second (GIV, GV, and GVI) treatment applications between May and October 2020 were reviewed. Each hemisphere received a total of five, four, or three sweeps. The patient's IOP and glaucoma medications were monitored over 12 months follow-up. Qualified success was defined as an IOP of ≤21 mm Hg and/or reduction of ≥20% from baseline at 12 months, with no secondary glaucoma reinterventions. Complete success was defined as meeting the above criteria with no increase in glaucoma medications at 12 months. All eyes requiring a glaucoma surgical intervention were considered a failure. Results: Qualified success was achieved in 83.6% of eyes, while complete success was achieved in 75.4% of eyes. In eyes receiving 50-second applications of five, four, or three sweeps (GI, GII, and GIII), 70, 90, and 91% achieved qualified success, respectively; in eyes receiving 60-second applications of five, four, or three sweeps (GIV, GV, and GVI), 78, 82, and 90% achieved qualified success, respectively. Within each subgroup, mean IOP reductions ranged from 32.8 to 49.4% and were statistically significant (p < 0.008). The failure rate was 16.4%, and at least one eye failed in each subgroup. Conclusions: MicroPulse TLT with the revised MicroPulse P3 delivery device and relatively low total energy levels is safe and effective at lowering IOP. Efficacy appears to increase with longer treatment durations and slower sweep velocities, but statistical differences between age and clinical differences between baseline IOP measurements limit comparison between subgroups. Clinical significance: There is a lack of literature evaluating the safety and IOP-lowering success of the revised MicroPulse P3 delivery device using different total treatment durations, sweep velocities, and number of sweeps. How to cite this article: Checo LA, Dorairaj S, Wagner IV, et al. Clinical Outcomes of MicroPulse Transscleral Laser Therapy with the Revised P3 Delivery Device. J Curr Glaucoma Pract 2024;18(1):10-15.

Subthreshold micropulse laser combined with anti-vascular endothelial growth factor therapy for diabetic macular edema: a systematic review and meta-analysis.

PURPOSE: To evaluate the effects of subthreshold micropulse laser (SML) in addition to anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME). METHODS: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were systematically searched for studies that compared anti-VEGF with SML and anti-VEGF monotherapy for DME. Outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of anti-VEGF injections. RESULTS: Eight studies including 493 eyes were selected. Four studies were randomized controlled, and the other four were retrospective. Meta-analysis showed that there was no significant difference in BCVA (mean difference [MD] -0.04; 95%CI -0.09 to 0.01 logMAR; P = 0.13;). CMT was thinner in the group of anti-VEGF with SML (MD -11.08; 95%CI -21.04 to -1.12 µm; P = 0.03); however, it was due to a single study that weighed higher, and the sensitivity and subcategory analyses did not support the finding. The number of anti-VEGF injections was significantly decreased in the group of anti-VEGF with SML (MD -2.22; 95%CI -3.02 to -1.42; P < 0.0001). CONCLUSION: Current evidence indicates that adding SML to anti-VEGF therapy could significantly reduce the number of anti-VEGF injections compared to anti-VEGF monotherapy, while achieve similar BCVA and CMT.

Six-month results of 577 nm subthreshold micropulse laser therapy in non-center involving diabetic macular edema.

BACKGROUND: This study aimed to evaluate the efficacy of 577 nm subthreshold micropulse laser (SML) therapy in patients with non-center involving diabetic macular edema (DME). METHODS: Twenty-two eyes of 18 patients diagnosed with non-center involving DME were included in this prospective, observational study. The patient's baseline best corrected visual acuity (BCVA), maximum retinal thickness (MRT), central macular thickness (CMT), and the area of macular exudates were determined and re-evaluated at 1, 3, and 6 months after laser treatment. RESULTS: There was no statistically significant change in BCVA at the 1st, 3rd and 6th months compared to the baseline in the follow-up (p = 0.067, p = 0.270, p = 0.027 according to Bonferroni correction p < 0,01). 1st, 3rd, and 6th month MRT was statistically significantly lower than baseline (p = 0,009, p = 0,006, p = 0,007). No statistically significant change was detected in CMT at the 1st, 3rd and 6th months compared to the baseline in the follow-up (p = 0.384, p = 0.794, p = 0.363). No statistically significant change in the area of macular exudates was detected at the 1st, 3rd, and 6th months compared to the baseline (p = 0.904, p = 0.444, p = 0.277). CONCLUSIONS: This study observed a significant decrease in extrafoveal retinal thickness in patients with DME. There was no progression to central macular involvement, an increase in the area of exudates, and a decrease in BCVA in any patient. SML may be an effective alternative to conventional argon laser in non-center involving DME.

Subthreshold micropulse laser therapy for early postoperative macular thickening following surgical removal of epiretinal membrane.

BACKGROUND: This study aimed to investigate the functional and anatomical outcomes of subthreshold micropulse laser (SMPL) therapy in eyes with early postoperative macular thickening after idiopathic epiretinal membrane (iERM) removal. METHODS: This was a prospective and interventional study. Forty-eight eyes from 48 patients with macular edema at 1 month after iERM removal were randomly divided into two groups. Patients in the SMPL group (n = 24) received SMPL therapy while no special intervention was used for the observation group (n = 24). Baseline demographic data and clinical findings before and at 1 and 3 months after SMPL treatment or observation, including best-corrected visual acuity (BCVA) and the changes in central subfield thickness (CST) and average macular thickness (AMT), were analyzed. RESULTS: An improvement in BCVA with a decrease in CST and AMT from baseline to the 3-month follow-ups were observed in both SMPL and observation groups. No significant difference in BCVA was observed between the SMPL group and observation group either in the 1-month (0.26 [0.15, 0.52] vs. 0.26 [0.15, 0.39], P = 0.852) or the 3-month (0.15 [0.10, 0.30] vs. 0.23 [0.15, 0.30], P = 0.329) follow-up. There was a greater reduction in CST in the SMPL group versus observation group between baseline and the 3-month follow-up (-77.8 ± 72.3 µm vs. -45.0 ± 46.9 µm, P = 0.049). The alteration in AMT did not differ between the two groups in either 1-month (-16.5 ± 20.1 µm vs. -19.7 ± 16.3 µm, P = 0.547) or 3-month (-36.9 ± 26.9 µm vs. -34.0 ± 20.1 µm, P = 0.678) follow-up. CONCLUSIONS: SMPL therapy led to a significant decrease in CST at the 3-month follow-up while did not significantly improve the visual acuity in patients with postoperative macular thickening following iERM surgery. TRIAL REGISTRATION: The study was registered on Aug 27, 2020 (Trial Registration Number: ChiCTR 2000037227).

Micropulse transscleral cyclophotocoagulation in canine glaucoma: A retrospective study evaluating sweep velocity.

OBJECTIVE: To report preliminary results of MP-TSCP in canine patients with glaucoma while evaluating sweep velocity, treatment efficacy, and safety utilizing standardized surgical parameters. ANIMAL STUDIED: Client-owned dogs that underwent MP-TSCP at a veterinary referral hospital. PROCEDURE: Medical records of 19 eyes (14 dogs) treated with MP-TSCP were reviewed. Eleven eyes were treated with a 10 s/sweep (s) velocity and 8 eyes with a 20 s/s. Laser duty cycle was set at 31.3%, mean laser energy was 2766 mW, and mean duration was 120 s per hemisphere. Minimum post-operative follow-up was 6 months. Outcomes of intraocular pressure (IOP), vision status, degree of antiglaucoma medications, and complications were evaluated. RESULTS: There was a significantly lower median (IQR) IOP (<25 mmHg) at each timepoint postoperatively compared to IOP pre-operatively (p < 0.05). The overall success rate for IOP control at 6 months was 84%, 100% for the 10 s/s and 62.5% for the 20 s/s. Vision was preserved in 10/11 (90%) eyes from the 10 s/s group and 4/8 (50%) eyes from the 20 s/s group at 6 months. Average number of glaucoma medications in the 10 s/s group decreased from 4.4 to 1.5 and from 3.3 to 2.5 in the 20 s/s group. Post-operative complications were mild and resolved within 1 week. CONCLUSIONS: MP-TSCP is a non-invasive treatment alternative for canine glaucoma. Employing higher energy levels rendered long-term IOP control while retaining a high safety profile with minimal postoperative complications. There was no statistical difference between a 10 s/s and 20 s/s surgical velocity, both leading to successful surgical outcomes up to 6 months post-operatively.

Continuous Laser Versus Micropulse Laser in the Treatment of Central Serous Chorioretinopathy: A Retrospective Study.

BACKGROUND: Central serous chorioretinopathy (CSCR) is a retinal disorder characterized by complex mechanisms leading to abnormal fluid accumulation under the retina. While management remains controversial, laser therapy has been successfully used. This study compares the efficacy of continuous laser (CL) and micropulse laser (ML) therapy in treating CSCR, focusing on reduction in macular thickness and improvement in visual acuity. METHODS: A retrospective cohort study was conducted, including patients with CSCR treated with either CL or ML. The primary outcome measured was the reduction in average macular thickness (AMT), alongside secondary outcomes like changes in best corrected visual acuity (BCVA), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS: The study evaluated 121 patients with CSCR, treated either with CL or ML. The primary outcome showed that the mean reduction in AMT was 51.14 µm (±20) in the CL group and 29.88 µm (±22) in the ML group, without a statistically significant difference (p=0.10). For the secondary outcomes, the improvement in BCVA was comparable in both groups, with CL at 0.15 (±0.1) and ML at 0.12 (±0.1) and no significant difference (p=0.41). However, in SFCT reduction, CL showed greater efficacy with a mean reduction of 32.19 µm (±15) compared to ML's 4.85 µm (±18), which was statistically significant (p=0.0004). The degree of SRF resolution showed no significant difference between the treatments (p=0.065). CONCLUSIONS: Both CL and ML are effective in the management of CSCR, with CL being more effective in reducing SFCT. These findings suggest the need for personalized treatment strategies based on individual patient characteristics and underline the complexity of CSCR management.