Micropulse® Laser Trans-Scleral Cyclophotocoagulation (MP-TSCPC) using the Iridex P3 probe (MP3) was a hot topic at the American Glaucoma Society (AGS) 2017 Annual Meeting in San Diego, CA (March 2-5). Multiple posters were presented sharing the results of using this procedure with different types of glaucoma and on different patient populations.
One such poster by Dr. Yelenskiy and colleagues (Tulane Study Group) looked at early results of using MP3 on 163 patients with “intractable glaucoma”. In other words, the glaucoma was not responding to treatment. Traditionally these patients would be advised to have either trabeculectomy (“trab”) or glaucoma drainage device (“tube”).
Surgical success (defined as IOP greater than 6mmHg but less than 18mmHg or 20% reduction) was 83%.
Surgical success (defined as IOP greater than 6mmHg but less than 18mmHg or 20% reduction) was 83%. Average IOP was reduced from 21.5mmHg to 16.5mmHg. The average number of glaucoma medications dropped by 50%. Average vision was not significantly different after surgery.
Only 10% of patients required a second treatment of Micropulse® Laser Trans-Scleral Cyclophotocoagulation. However, 15% of patients did eventually require additional glaucoma surgery.
Risks and complications included:
- post-operative pain (56%),
- inflammation (36%), and
- macular edema/swelling (<2%).
These results are impressive, even more so given that almost all (if not all) of these patients would have otherwise gone on to riskier surgeries such as trabeculectomy, glaucoma drainage device, or continuous wave cyclophotocoagulation. The study, however, does suffer from the following weaknesses: retrospective chart review design and short duration of follow-up (an average of just over 5 months).
In summary, the Tulane Study Group has provided additional evidence that Micropulse® Laser Cyclophotocoagulation (MP3) is both an effective and low-risk surgical glaucoma treatment. For those who require an IOP in the mid-to upper teens and would otherwise require a trab or tube to achieve that IOP, MP3 may be a reasonable option to consider.
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About the Author: David Richardson, MD
Medical Director, San Marino Eye
David Richardson, M.D. is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs Micropulse® "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System.