MP3 Plus: A Modified Micropulse Transscleral Cyclophototherapy Technique for the Treatment of Refractory Glaucoma.

PRéCIS:: In advanced refractory glaucoma which has failed prior MP3 laser, MP3 Plus is effective in reducing intraocular pressure (IOP) without significant complications. It is also useful as a temporizing procedure before incisional surgery. PURPOSE: To evaluate the efficacy and safety of MP3 Plus, a novel technique using modified micropulse transscleral cyclophototherapy (MPTCP) in eyes with refractory glaucoma or failed MPTCP treatment. METHODS: This is a retrospective interventional case series. In total, 32 consecutive eyes from 29 patients with uncontrolled IOPs who had previous MPTCP or refractory glaucoma underwent MP3 Plus, a modified MPTCP where additional discrete pulses are applied. The main outcome measurement was IOP at 1, 3, 6, and 12 months postprocedure, with success defined as a 20% reduction in baseline IOP, an IOP of 25 mmHg or less, and no need for further reoperation. We collected and analyzed visual acuity, number of glaucoma medications, and complications. RESULTS: The patients had an average of 1.4±0.9 glaucoma procedures before treatment, where 87.5% underwent one or more previous MPTCP with suboptimal response. Of the eyes presenting for follow-up, 51.6% (n=31), 37.0% (n=27), 35.7% (n=28), and 25.9% (n=27) achieved the primary outcome at 1, 3, 6, and 12 months, respectively. Baseline IOP was 33.7±11.6 mmHg (n=32 eyes) and posttreatment IOP at 1, 3, 6, and 12 months were 21.0±9.0 mmHg (n=31; P<0.0001), 26.2±10.8 mmHg (n=25; P<0.0001), 23.2±9.4 mmHg (n=20; P<0.05), and 24.6±9.8 mmHg (n=16; P<0.001), respectively. There was a reduction in glaucoma medications from 3.4±0.8 preoperatively to 2.8±1.2 (n=16; P<0.05) at 12 months. There were no cases of prolonged inflammation or hypotony. CONCLUSIONS: MP3 Plus is effective and safe in lowering IOP in eyes with refractory glaucoma after previous failed MPTCP.

Success rates of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C for primary angle-closure glaucoma and primary open-angle glaucoma in an Asian population.

PURPOSE: To determine the long-term outcomes of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C (MMC) for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in an Asian population. METHODS: We reviewed the records of all patients with POAG or PACG who underwent phacoemulsification with trabeculectomy using MMC from January 2008 through December 2010 in a tertiary ophthalmology unit in Singapore. The primary outcome measure was cumulative success rates defined as complete [intraocular pressure (IOP) <21, 18, 15 mmHg without medication] and qualified (IOP <21, 18, 15 mmHg with at least 1 medication) success. RESULTS: In total, 168 eyes (110 POAG and 58 PACG) were included (43.5% female; mean age ± SD, 68.3 ± 8.2 years). The respective 3-year qualified success rates were 88.4, 79.3, and 52.5% for IOP <21, 18, and 15 mmHg. The corresponding complete success rates were 79.0, 70.9, and 51.1%. The mean 3-year postoperative IOP was 14.5 ± 4.4 mmHg, and the IOP reduction was significantly greater for PACG than for POAG eyes (P = 0.006). After surgery, the mean number of medications was significantly reduced and visual acuity, significantly improved (both P < 0.001). Occurrence of postoperative complications, higher number of topical medications, younger age, and presence of diabetes mellitus were significant risk factors for surgical failure. CONCLUSION: Two-site phacoemulsification combined with fornix-based trabeculectomy using MMC is a good surgical approach for Asian eyes with concomitant mild-to-moderate primary glaucoma and cataracts.