Micropulse Trabeculoplasty in Open Angle Glaucoma

Document Type : Original Article

Authors

1 Universidad Peruana Cayetano Heredia; Research Department of Vista Clinic, Lima, Peru

2 Universidad Peruana Cayetano Heredia; Research Department of Vista Clinic; Glaucoma Departament of Instituto Nacional de Oftalmología, Lima, Peru

3 Universidad Peruana Cayetano Heredia; Research Department of Vista Clinic, Lima; Ophthalmology Department of Huancavelica General Hospital, Huancavelica, Peru

4 Research Department of Vista Clinic; Universidad Nacional Mayor de San Marcos, Lima, Peru

5 Research Department of Vista Clinic; Glaucoma Departament of Instituto Nacional de Oftalmología; Universidad Nacional Mayor de San Marcos, Lima, Peru

Abstract

Background: We report the effect of micropulse laser trabeculoplasty (MLT) in the intraocular pressure (IOP) of patients with uncontrolled open-angle glaucoma (OAG). Materials and Methods: In this retrospective review, 30 eyes with OAG were treated with a single session of MLT at the Vista Clinic in Lima Perú. We used a 532 nm frequency doubled Nd: YAG laser to 360° of the trabecular meshwork with a power of 1000 mW, 15% of the duty cycle, and 300 ms of exposure. The IOP was measured at baseline and at 1 day, 1 week, 3 months, and 6 months post-treatment and were followed up for one last control. Results: The mean baseline IOP was 15.6 mmHg and in the last control was 12.8 mmHg, mean follow-up time of 19 months (±10 standard deviation [SD]). The mean reduction of IOP in the 1st day was 1.6 mmHg (±2.6 SD) and 1.2 mmHg (±3.3 SD) in the last follow-up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction >20%. No statistical significant difference in relation to demographic characteristics of the patients. The greatest reduction was achieved in the 1st day with a median of 2.00 (P < 0.001). A tendency to achieve a higher reduction of IOP in patients with higher baseline IOP was found but was not statistically significant. No adverse reactions occurred. Conclusions: MLT slightly reduced the IOP in a few patients with uncontrolled OAG for a very short time and may not be suitable for these patients.

Keywords

1.
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614-8.  Back to cited text no. 1
    
2.
Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2004;82:844-51.  Back to cited text no. 2
    
3.
Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7.  Back to cited text no. 3
    
4.
Quigley HA, West SK, Rodriguez J, Munoz B, Klein R, Snyder R. The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER. Arch Ophthalmol 2001;119:1819-26.  Back to cited text no. 4
    
5.
Campos B, Cerrate A, Montjoy E, Dulanto Gomero V, Gonzales C, Tecse A, et al. National survey on the prevalence and causes of blindness in Peru. Rev Panam Salud Publica 2014;36:283-9.  Back to cited text no. 5
    
6.
Wise JB, Witter SL. Argon laser therapy for open-angle glaucoma. A pilot study. Arch Ophthalmol 1979;97:319-22.  Back to cited text no. 6
    
7.
Latina MA, Park C. Selective targeting of trabecular meshwork cells:In vitro studies of pulsed and CW laser interactions. Exp Eye Res 1995;60:359-71.  Back to cited text no. 7
    
8.
Latina MA, Sibayan SA, Shin DH, Noecker RJ, Marcellino G. Q-switched 532-nm Nd: YAG laser trabeculoplasty (selective laser trabeculoplasty): A multicenter, pilot, clinical study. Ophthalmology 1998;105:2082-8.  Back to cited text no. 8
    
9.
Latina MA, Tumbocon JA. Selective laser trabeculoplasty: A new treatment option for open angle glaucoma. Curr Opin Ophthalmol 2002;13:94-6.  Back to cited text no. 9
    
10.
Bowes O, Coutts S, Ismailjee A, Trocme E, Vilella AJ, Perry H, et al. Pulsed light accelerated corneal collagen cross-linking: 1-year results. Cornea 2017;36:e15-6.  Back to cited text no. 10
    
11.
Kramer TR, Noecker RJ. Comparison of the morphologic changes after selective laser trabeculoplasty and argon laser trabeculoplasty in human eye bank eyes. Ophthalmology 2001;108:773-9.  Back to cited text no. 11
    
12.
Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: A prospective, nonrandomized pilot study. Arch Ophthalmol 2003;121:957-60.  Back to cited text no. 12
    
13.
Wong MO, Lee JW, Choy BN, Chan JC, Lai JS. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol 2015;60:36-50.  Back to cited text no. 13
    
14.
Sayin N, Alkin Z, Ozkaya A, Demir A, Yazici AT, Bozkurt E, et al. Efficacy of selective laser trabeculoplasty in medically uncontrolled glaucoma. ISRN Ophthalmol 2013;2013:975281.  Back to cited text no. 14
    
15.
Ingvoldstad DD, Krishna R, Willoughby L. MicroPulse diode laser trabeculoplasty versus argon laser trabeculoplasty in the treatment of open angle glaucoma. Invest Ophthalmol Vis Sci 2005;46:123.  Back to cited text no. 15
    
16.
Gossage DD. 532 nm MicroPulseTM Laser Trabeculoplasty Successfully Lowers IOP as Primary Treatment. Clinical Case Reports. Available from: http://www.iridexcomportals0 physicianeducationpdfGossage2053220MLT202012pdf. [Last accessed on 2014 May 07].  Back to cited text no. 16
    
17.
Fea AM, Bosone A, Rolle T, Brogliatti B, Grignolo FM. Micropulse diode laser trabeculoplasty: A phase II clinical study with 12 months follow-up. Clin Ophthalmol 2008;2:247-52.  Back to cited text no. 17
    
18.
Chadha N, Belyea D, Lamba T, Abramowitz B. 90 A Randomized, Prospective Comparison of 360 Degree Selective Laser Trabeculoplasty (SLT) vs. 577 nm Micropulse Laser Trabeculoplasty (MLT) in Eyes with Open-Angle Glaucoma. Available from: http//www.clinicaltrialsgovct2shownct01956942. [Last accessed on 2014 May 01].  Back to cited text no. 18
    
19.
Lavinsky D, Cardillo JA, Melo LA Jr., Dare A, Farah ME, Belfort R Jr. Randomized clinical trial evaluating mETDRS versus normal or high-density micropulse photocoagulation for diabetic macular edema. Invest Ophthalmol Vis Sci 2011;52:4314-23.  Back to cited text no. 19
    
20.
Koss MJ, Beger I, Koch FH. Subthreshold diode laser micropulse photocoagulation versus intravitreal injections of bevacizumab in the treatment of central serous chorioretinopathy. Eye (Lond) 2012;26:307-14.  Back to cited text no. 20
    
21.
Luttrull JK, Sramek C, Palanker D, Spink CJ, Musch DC. Long-term safety, high-resolution imaging, and tissue temperature modeling of subvisible diode micropulse photocoagulation for retinovascular macular edema. Retina 2012;32:375-86.  Back to cited text no. 21
    
22.
Ogata N, Tombran-Tink J, Jo N, Mrazek D, Matsumura M. Upregulation of pigment epithelium-derived factor after laser photocoagulation. Am J Ophthalmol 2001;132:427-9.  Back to cited text no. 22
    
23.
Detry-Morel M, Muschart F, Pourjavan S. Micropulse diode laser (810 nm) versus argon laser trabeculoplasty in the treatment of open-angle glaucoma: comparative short-term safety and efficacy profile. Bull Soc Belge Ophtalmol. 2008;(308):21–8.  Back to cited text no. 23
    
24.
Fudemberg SJ, Myers JS, Katz LJ. Trabecular meshwork tissue examination with scanning electron microscopy: A comparison of micropulse diode laser (MLT), selective LASER (SLT), and argon laser (ALT) trabeculoplasty in human cadaver tissue. Invest Ophthalmol Vis Sci 2008;49:1236-6.  Back to cited text no. 24
    
25.
Lee JW, Yau GS, Yick DW, Yuen CY. MicroPulse laser trabeculoplasty for the treatment of open-angle glaucoma. Medicine (Baltimore) 2015;94:e2075.  Back to cited text no. 25
    
26.
Kagan DB, Gorfinkel NS, Hutnik CM. Mechanisms of selective laser trabeculoplasty: A review. Clin Exp Ophthalmol 2014;42:675-81.  Back to cited text no. 26
    
27.
Binz N, Graham CE, Simpson K, Lai YK, Shen WY, Lai CM, et al. Long-term effect of therapeutic laser photocoagulation on gene expression in the eye. FASEB J 2006;20:383-5.  Back to cited text no. 27
    
28.
Babalola OE. Micropulse diode laser trabeculoplasty in Nigerian patients. Clin Ophthalmol 2015;9:1347-51.  Back to cited text no. 28
    
29.
Abouhussein M. Micropulse laser trabeculoplasty for open-angle glaucoma. Delta Journal of Ophthalmology. 2016;17(2):80.  Back to cited text no. 29
    
30.
Hodge WG, Damji KF, Rock W, Buhrmann R, Bovell AM, Pan Y. Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: Results from a randomised clinical trial. Br J Ophthalmol 2005;89:1157-60.  Back to cited text no. 30
    
31.
Ayala M, Chen E. Predictive factors of success in selective laser trabeculoplasty (SLT) treatment. Clin Ophthalmol 2011;5:573-6.  Back to cited text no. 31