This glaucoma treatment option allows for earlier laser intervention for cyclophotocoagulation [TCP] when medical treatment is not effective enough. Typically, glaucoma treatment algorithm moves from medical therapy to laser procedures and then to traditional surgical procedures. Now, laser procedures can increase aqueous outflow, such as with laser trabeculoplasty, or decrease aqueous production, such as with cycloablative procedures.
Previously, cyclophotocoagulation was oftentimes relegated to cases of refractory glaucoma with poor visual potential due to the risks associated with the TCP procedure. However, now cyclophotocoagulation has proven to be a viable modality for glaucoma cases with good vision potential with the use of an 810-nm laser and a transscleral approach.
In a study evaluating the long-term results of TCP in eyes with ambulatory vision (6/36 or better), results showed a mean reduction of IOP of 43% and mean visual acuity preserved in the subgroups with good vision.
This very directed modality delivers just enough laser energy to be absorbed by pigment granules in cells of the pigmented ciliary epithelium that are being targeted, while preventing thermal build-up and collateral damage to surrounding tissue. When applied to TCP, this “MicroPulse” strategy results in a much safer procedure that retains the efficacy of a traditional continuous wave TCP procedure.