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Publication Exclusive: Micropulse transscleral diode laser cyclophotocoagulation an option for refractory glaucoma

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Glaucoma can be a difficult management problem in a subset of patients, even for the most experienced glaucoma specialists. The treatment spectrum includes drugs, trabeculoplasty, microincision glaucoma surgery and traditional glaucoma surgery.

While many use glaucoma medications as their initial treatment modality, others use selective laser trabeculoplasty for the initial IOP control. The majority of glaucoma patients’ IOPs may be controlled with one or more topical medications, but there is a subset of patients whose IOPs are not adequately controlled even on maximum medical therapy. Additionally, some patients have limited choice of glaucoma medications due to allergy to glaucoma medications, and others may have compliance issues, all of which may contribute to elevated IOPs and progressive visual field loss. This subset of patients with uncontrolled IOP and/or progressive visual loss often requires surgical intervention.

Surgical interventions are primarily divided into those that facilitate egress of aqueous from the eye to the exterior and a few procedures that focus on decreasing the ingress of aqueous. Excessive egress of aqueous often introduces multiple postoperative complications including hypotony, maculopathy, corneal edema and other surgery-related complications such as hyphema and infection. Previously, the main procedure that decreased ingress of aqueous was cyclocryotherapy, but because it was often not adequately titratable with regard to the level of IOP reduction and it was associated with increased postoperative inflammation, it became a less desirable procedure for ophthalmic surgeons.

In this column, I describe a relatively new surgical technique, namely micropulse transscleral diode laser cyclophotocoagulation for glaucoma management, which decreases IOP with a possible dual mechanism of targeting the ciliary processes and increasing the uveoscleral outflow.

Click here to read the full publication exclusive, Surgical Maneuvers, published in Ocular Surgery News U.S. Edition, February 10, 2015.