MP3 as a Treatment of Medically Uncontrolled Glaucoma - University of Pittsburgh

MicroPulse® P3 Glaucoma Device (MP3) Innovative Cyclophotocoagulation with MicroPulse Technology Powered by the NEW CYCLO G6™ Glaucoma Laser System | Source: iridex.com

When glaucoma is not sufficiently controlled with eye drops it’s time to choose a surgical treatment. Fortunately, there are now multiple FDA-approved options that are safer than trabeculectomy or glaucoma drainage devices. Unfortunately, most of these newer Minimally Invasive Glaucoma Surgeries (MIGS) are only approved for use at the time of cataract surgery or are not covered by many insurances. For those with glaucoma but without a visually significant cataract fewer options are available.

Continuous Wave Transscleral Cyclophotocoagulation has been around long enough that it is both FDA approved and covered by most insurances. Unfortunately, it is also too risky to use on anyone with only mild to moderate uncontrolled glaucoma. 

Micropulse™ P3 Transscleral Cyclophotocoagulation as a First Surgical Therapy for Glaucoma

A newer development in Transscleral Cyclophotocoagulation, however, significantly reduces the risk of treatment while not affecting FDA approval or insurance reimbursement. Micropulse P3 Transscleral Cyclophotocoagulation (MP3) uses less energy than Continuous Wave Transscleral Cyclophotocoagulation. This reduction in energy translates into less damage to eye tissue, reduced inflammation, diminished post-op pain, and fewer risks. But is this newer iteration of Transscleral Cyclophotocoagulation really appropriate for use as a first surgical therapy for glaucoma?

Dr. Tarek A. Shazly and colleagues attempted to address this question in a poster at the recent American Glaucoma Society (AGS) 2017 Annual Meeting in San Diego, CA (March 2-5) entitled, “Outcomes of Micropulse transscleral cyclophotocoagulation in medically uncontrolled glaucoma”.

This was a small study of only 34 eyes of 32 patients with multiple types of glaucoma ranging from primary open angle glaucoma (POAG) to neovascular glaucoma (NVG). Success was defined as a drop in intraocular pressure (IOP) of at least 20%. Six months after surgery the 82% of eyes met the criteria for success. The average IOP dropped from 29.2mmHg to 13.3mmHg. The need for glaucoma medications was also reduced (on average) from 3.3 to 2.4.

Five patients (15%) required a second treatment of Micropulse Transscleral Cyclophotocoagulation. Six patients (18%) required additional surgery. There were no reported complications.

Although a small study, it does demonstrate that Micropulse Transscleral Cyclophotocoagulation can be an effective glaucoma treatment in a wide variety of glaucoma types that are not responding to medical therapy. Indeed, some of the types of glaucoma in this study (neovascular, uveitic, steroid-induced, and mixed mechanism) are notoriously difficult to control. That, combined with a lack of reported complications, positions Micropulse Transscleral Cyclophotocoagulation as a near-ideal option for those with medically uncontrolled glaucoma with a target IOP in the mid-teens.

Don’t delay getting checked for glaucoma.

Make an appointment with an eye doctor in your area now.  If you live in the greater Los Angeles area and would like Dr. Richardson to evaluate your eyes for glaucoma call 626-289-7856 now. No referral required. Same day or next day appointments are available, Tuesday through Saturday.

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, MD 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. → Learn more about Dr. David Richardson

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