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As we all know, traditional cyclophotocoagulation, or CPC, lowered IOP through the intentional destruction of ciliary body epithelium and stroma. Although it frequently resulted in dramatic reductions of aqueous secretion and IOP, it was also often associated with numerous undesirable risks. Just as much has been changing in surgical approaches to glaucoma, CPC has also been transforming. Transscleral CPC with an 810 nm continuous wave diode laser was proven to somewhat reduce risks and side effects. Now, we have another platform that is nondestructive, essentially eliminating the side effects of CPC treatment.

MicroPulse technology is a software program that controls how the laser is delivered. It divides continuous wave lasers into a series of short bursts, spaced out with a controlled amount of pause between laser bursts. These intervals between laser delivery bursts allow surrounding tissue time to cool, minimizing collateral thermal damage, which is responsible for the significant pain, inflammation and even hypotony caused by older CPC lasers. While our understanding of the mechanism of action of this nondestructive laser is still in its infancy, it is believed that MicroPulse laser stimulates cell regeneration.

Patients undergoing MicroPulse TSCPC with the Cyclo G6 glaucoma laser system (Iridex) utilizing an 810 nm diode laser experience similar rates of IOP reduction to traditional CPC and more invasive surgeries, but achieve this with less risk, downtime and complications. MicroPulse TSCPC enables us to reduce or eliminate one to two medications in most cases. Particularly valuable, patients who were approaching severe glaucoma and not responsive to milder laser treatments or drops generally have limited options — usually more invasive surgical procedures. For many glaucoma patients, we have found great success with this treatment.

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Disclosure: Toyos reports she is a speaker and consultant for Valeant and Sun; conducts research for Lumenis, Magellan and Kala; is a speaker and consultant and does research for Shire, Mallinckrodt and MixtoLasering; is a consultant and does research for DigiSight; does research for Novaliq; and is a consultant for Iridex.