Surgical Treatment of Primary Open-angle Glaucoma Using Micropulse Laser Exposure

Purpose. Analysis of the results of micropulse transscleral cyclophotocoagulation in patients with primary open-angle glaucoma. Materiales and methods. The study analyzed medical records of 91 patients with primary open-angle glaucoma (POAG) stages II–IV in 93 eyes. Of these, 42 (46 %) were men and 49 (54 %) were women. The average age of the study participants was 70 ± 15 years. Stage II of the disease occurred in 28 % of cases, stage III — in 59 %, and stage IV — in 13 %. The initial intraocular pressure (IOP) averaged 29.0 ± 4.2 mm Hg. Corrected visual acuity was 0.2 and higher in half of the cases. All patients used two or more antihypertensive drugs, three on average. The follow-up period after micropulse transscleral cyclophotocoagulation (mCPC) was 15 months. Results. No intraoperative complications were recorded. In the early postoperative period, complications were observed in 7.6 % of patients: short-term pain syndrome — 4.3 %, an increase in IOP above the preoperative level — 3.3 % of cases. The target IOP level was achieved in 94.7 % of cases. On average, IOP after surgery was 19.0 ± 3.5 mm Hg (p = 0.04). The number of antihypertensive drugs used decreased by 27 % (to 2.2 on average). Visual acuity remained stable in 100 % of cases, and subsequently increased in 6 patients (6.5 %), after cataract phacoemulsification with intraocular lens implantation. Conclusion. Our experience with mCFC has confirmed the effectiveness of the method in reducing and maintaining IOP at target values, as well as in reducing the number of antihypertensive drugs used. The method has proven its safety and effectiveness with a low number of complications.

1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014 Nov;121(11):2081–2090. doi: 10.1016/j.ophtha.2014.05.013.

2. Balalin SV, Fokin VP. Risk factors and target intraocular pressure in primary open-angle glaucoma. Kuban Scientific Medical Bulletin. 2013;2:7–10 (In Russ.).

3. Alekseev IB, Samoilenko AI, Aylarova AK. Prolongation of the hypotensive effect of antiglaucoma surgery. Clinical ophthalmology. 2019;19(2):93–98. doi: 10.32364/2311-7729-2019-19-2-93-98.

4. Erichev VP, Abdullaeva EH, Mazurova UV. Frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries. Russian Annals of Ophthalmology. 2021;137(1):54–59 (In Russ.). doi: 10.17116/oftalma202113701154.

5. Boyko EV, Kulikov AN, Skvortsov VYu. Comparative evaluation of diode laser thermotherapy and laser coagulation as methods of cyclodestruction (experimental study). Practical Medicine. 2012;1(4(59)):175–179 (In Russ.).

6. Egorova EV, Sokolovskaja TV, Uzunjan DG, Drobnica AA. Parameter calculation of contact transscleral diode-laser cyclophotocoagulation with the changes of ciliary body during exploration by the method of ultrasound biomicroscopy in patients with terminal glaucoma. Fyodorov Journal of Ophthalmic Surgery. 2013;3:72–77 (In Russ.).

7. Sokolovskaya TV, Tikhonova MI. Cyclodestructive interventions in refractory glaucoma treatment: history, reality, perspectives. Ophthalmology Journal. 2019;12(3):45–58 (In Russ.). doi: 10.17816/OV11132.

8. Avetisov SE, Bol’Shunov AV, Khomchik OV, Fyodorov AA, Siplivyj VI, Baum OI, Omelchenko AI, Shcherbakov EM, Panchenko VYa, Sobol EN. Laser-induced increase of scleral hydropermiability in the treatment of resistant forms open-angle glaucoma. National Journal glaucoma. 2015;14(2):5–13 (In Russ.).

9. Kazennova IA, Kazennov AN. Treatment efficacy of patients at different glaucoma stages using micropulse cyclophotocoagulation. Modern technologies in ophthalmology. 2020;4:150 (In Russ.). doi: 10.25276/2312-4911-2020-4-130-131.

10. Bodea F, Bungau SG, Bogdan MA, Vesa CM, Radu A, Tarce AG, Purza AL, Tit DM, Bustea C, Radu AF. Micropulse Laser Therapy as an Integral Part of Eye Disease Management. Medicina (Kaunas). 2023 Jul 28;59(8):1388. doi: 10.3390/medicina59081388.

11. Sobyanin NA, Grinev AG, Gavrilova TV. Micropulse transscleral cyclophotocoagulation in the treatment of various forms of glaucoma. Saratov Journal of Medical Scientific Research. Supplement: Ophthalmology. 2022;18(4):703–706 (In Russ.). EDN: SXQJBD.

12. Aquino MC, Barton K, Tan AM, Sng C, Li X, Loon SC, Chew PT. Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Exp Ophthalmol. 2015 Jan-Feb;43(1):40–46. doi: 10.1111/ceo.12360.