Comparative Analysis of Treatment of Patients with Refractory Glaucoma of Various Stages by Microimpulse Transscleral Cyclophotocoagulation

Objective: to analyze the results of treatment in patients with refractory glaucoma of various stages of the disease by microimpulse cyclophotocoagulation.

Patients and methods. We examined 43 patients aged 68.5 ± 13.2 years with primary open-angle repeatedly operated subcompensated glaucoma (POAG) of advanced (13) and advanced (30) stages before and after performing MCPC (SUPRA 810 device, QuantelMedical, France) using standard laser parameters: energy W = 2000 MJ, 31.3 % — duty cycle, exposure time — 80 seconds per hemisphere.

Results. The operation and postoperative period were uneventful. The hypotensive effect was achieved in all cases up to 6 months of follow-up. In the advanced stage of the disease, IOP decreased from 26.8 ± 7.8 mm Hg to an average of 17.1 ± 8.1 mm Hg (p < 0.05), and the amount of antihypertensive agents decreased from 2.89 ± 0.74 to 2.4 ± 0.6. in patients with advanced stage, IOP decreased from 29.9 ± 7.8 mm Hg to 21.0 ± 8.3 mm Hg (p < 0.05), and the amount of antihypertensive agents decreased from 3.1 ± 0.4 to 2.8 ± 0.5. The maximum corrected visual acuity (MCI) in all patients remained at the preoperative level during the entire follow-up period.

Conclusion. Analysis of the results has shown that the use of microcyclophotocoagulation in patients with refractory glaucoma has not led to the development of postoperative complications, reduced intraocular pressure by 36.2 % from baseline, when developed and 29.8 % in advanced stages of the disease, reduced the number of antihypertensive drugs was 17 % in the second and 10 % at third stage and have not led to a decrease in visual function at 6 months follow-up. Thus, it is proved that the use of a diode laser in micro-pulse mode during microcyclophotocoagulation is a safe and effective method of treating refractory forms of glaucoma at various stages of the disease. 

1. Egorov E.A. National glaucoma guidelines for medical practitioners. Moscow: GEOTAR-Media, 2011. 279 p. (In Russ.).

2. Flaxman S.R., Bourne R.R.A., Resnikoff S. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017;5:1221–1234. DOI: 10.1016/S2214-109X(17)30393-5

3. Gazizova I., Avdeev R., Aleksandrov A. et al. Multicenter study of intraocular pressure level in patients with moderate and advanced primary open-angle glaucoma on treatment. Invest. Ophthalmol.Vis. Sci.2016;57(12):6470. DOI: 10.17816/ OV2015143-60

4. Quigley H.A., Broman A.T. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90(3):262–267. DOI: 10.1136/bjo.2005.081224 pmid:16488940

5. Egorov E.A. International guide to glaucoma. Vol. 2. Glaucoma Clinic. Moscow; 2016. 183 p. (In Russ.).

6. Janz N.K., Wren P.A., Lichter P.R. The Collaborative Initial Glaucoma Treatment Study: interim quality of life findings after initial medical or surgical treatment of glaucoma. Ophthalmology. 2001;108:1954–1965. DOI: 10.1016/s01616420(01)00874-0

7. Dastiridou A.I., Katsanos A., Denis P. Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options. Adv. Ther. 2018;35(12):2103–2127. DOI: 10.1007/s12325-018-0837-3

8. Boyko E.V., Kulikov A.N., Skvortsov V.Yu. Comparative evaluation of diode laser thermotherapy and laser coagulation as methods of cyclodestruction (experimental study). Practical medicine. Ophthalmology. Kazan = Prakticheskaya meditsina. Oftal’mologiya. Kazan. 2012;4-1(59):175–179 (In Russ.).

9. Schlote T., Greb M., Kynigopoulos M. Long-term results after transscleral diode laser cyclophotocoagulation in refractory posttraumatic glaucoma and glaucoma in aphakia. Graefes Arch Clin Exp Ophthalmol. 2008;246(3):405–410. DOI: 10.1007/s00417-007-0708-0

10. Iliev M.E., Gerber S. Long-term outcome of trans-scleral diode laser cyclophotocoagulation in refractory glaucoma. Br J Ophthalmol. 2007;91:1631–1635. DOI: 10.1136/bjo.2007.116533

11. Aquino M.C., Barton K., Tan A.M., Sng C., Li X., Loon S.C., ChewP.T.K.. Micropulse versus continuous wave transscleral diodecyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Exp Ophthalmol. 2015;43(1):40– 46. DOI: 10.1111/ceo.12360 pmid: 24811050

12. Tan A.M., Chockalingam M., Aquino M.C., Lim Z.I., See J.L., Chew P.T. Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma. Clin Exp Ophthalmol. 2010;38(3):266–272. DOI: 10.1111/j.14429071.2010.02238.x

13. Aquino M.C., Lim D., Chew P.T.K. Micropulse P3™(MP3) Laser for Glaucoma: An Innovative Therapy. J Curr Glaucoma Pract. 2018;12(2):51–52. DOI: 10.5005/jpjournals-10008-1244

14. Williams A.L., Moster M.R., Rahmatnejad K., Resende A.F., Horan T., Reynolds M., Yung E., Abramowitz B., Kuchar S., Waisbourd M. Clinical efficacy and safety profile of micropulse transscleral cyclophotocoagulation in refractory glaucoma. J Glaucoma. 2018 May;27(5):445–449. DOI: 10.1097/IJG.0000000000000934

15. Khodzhaev N.S., Sidorova A.V., Starostina A.V., Eliseeva M.A. Micropulse transscleral cyclophotocoagulation in combined surgical treatment of refractory glaucoma. Modern technologies in ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2019;4:95–98 (In Russ.). DOI: 10.25276/2312-4911-2019-4-95-98

16. Emanuel M.E., Grover D.S., Fellman R.L., Godfrey D.G., Smith O., Butler M.R., Kornmann H.L., Feuer W.J., Goyal S. Micropulse Cyclophotocoagulation: Initial Results in Refractory Glaucoma. J Glaucoma. 2017Aug;26(8):726–729. DOI: 10.1097/IJG.0000000000000715

17. Souissi S., Baudouin C., Labbé A., Hamard P. Micropulse transscleral cyclophotocoagulation using a standard protocol in patients with refractory glaucoma naive of cyclodestruction. Eur J Ophthalmol. 2019 Sep 23:1120672119877586. DOI: 10.1177/1120672119877586

18. Zaarour K., Abdelmassih Y., Arej N., Cherfan G., Tomey K.F., Khoueir Z. Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients. J Glaucoma. 2019 Mar;28(3):270–275. DOI: 10.1097/IJG.0000000000001174

19. Xin C., Johnstone M., Wang N., Wang R.K. OCT Study of Mechanical Properties Associated with Trabecular Meshwork and Collector Channel Motion in Human Eyes. PLoS ONE. 2016;11(9):e0162048. DOI: 10.1371/journal.pone.0162048

20. Stamper R.L., Lieberman M.F., Drake M.V. Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas. Elsevier Health Sciences; 2009. DOI: 10.1007/s00417010-1517-4

21. Liu G.J., Mizukawa A., Okisaka S. Mechanism of intraocular pressure decrease after contact transscleral continuous wave Nd:YAG laser cyclophotocoagulation. Ophthalmic Res.1994;26(2):65–79. DOI: 10.1159/000267395 pmid: 8196935

22. Samples J.R., Singh K., Lin S.C. Laser trabeculoplasty for open-angle glaucoma: a report by the american academy of ophthalmology. Ophthalmology. 2011Nov;118(11):2296-2302. DOI: 1016/j.ophtha.2011.04.037

23. Stein J.D., Kim D.D., Peck W.W. Cost-effectiveness of medications compared with laser trabeculoplasty in patients with newly diagnosed open-angle glaucoma. Arch Ophthalmol. 2012;130:497–505. DOI: 10.1001/archophthalmol.2011.2727

24. Maslin J.S., Chen P.P., Sinard J., Nguyen A.T., Noecker R. Histopathologic changes in cadaver eyes after MicroPulse and continuous wave transscleral cyclophotocoagulation. Canadian Journal of Ophthalmology. May 21, 2020. DOI: 10.1016/j.jcjo.2020.03.010