Selective laser trabeculoplasty vs micropulse laser trabeculoplasty in open-angle glaucoma.

AIM: The aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients. PATIENTS AND METHODS: In all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1 hour and 1, 1-6, 6-12, 6-24, 24-36, and 36-52 weeks. Patients completed a survey 1 week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3 mmHg from baseline. RESULTS: IOP was lowered to ≥3 mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24-52 weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24-52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52 weeks post treatment. There were more treatment failures in the micropulse group up to 52 weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005). CONCLUSION: Micropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure.

Clinical Efficacy and Safety Profile of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma.

PURPOSE: To investigate the clinical efficacy and safety profile of micropulse transscleral cyclophotocoagulation (MP-CPC) in patients with refractory glaucoma. MATERIALS AND METHODS: Retrospective case series of 79 consecutive patients who underwent MP-CPC at the Wills Eye Hospital from March 23, 2014 to June 23, 2016 and who had at least 3 months of follow-up. Treatment success was defined as an intraocular pressure (IOP) of 6 to 21 mm Hg or a reduction of IOP by 20%. Failure was defined as an inability to meet the criteria for success, need for retreatment >3 times, or need for incisional glaucoma surgery. RESULTS: Patients had a mean follow-up time of 7.8±4.5 months. The mean IOP before MP-CPC was 31.9±10.2 mm Hg. The IOP was reduced by an average of 51% at the last follow-up and the mean number of IOP lowering medications was reduced from 2.3 at baseline to 1.5 at last follow-up. Treatment success rates were 75% at 3 months, 66% at 6 months, and 67% at last follow-up. Complications of MP-CPC included 7 patients with hypotony (8.8%), 21 patients with prolonged anterior chamber inflammation (1+ cell or flare for >3 mo, 26%), 13 patients with loss of ≥2 lines of best-corrected visual acuity at 3 months (17%), 4 patients with macular edema (5%), 2 patients with corneal edema and 2 patients with phthisis. CONCLUSIONS: MP-CPC is an effective treatment for patients with refractory glaucoma. Shorter treatment times with more frequent repeat treatments, if necessary, should be considered given the incidence of significant vision loss in this study.

Pilot Study Assessing the Use of High-density Polyethylene (Su-Por) for Tube Shunt Patch Grafts.

PURPOSE: To assess the viability of a manufactured high-density polyethylene patch graft material (Su-Por) for prevention of tube shunt exposure. MATERIALS AND METHODS: Retrospective review of the first 11 patients from the Wills Eye Hospital Glaucoma Service to receive the high-density polyethylene patch graft during tube shunt surgery. RESULTS: Four patients (36.3%) experienced an extrusion of the Su-Por patch without a leak within 2.5 months of postoperative follow-up. All 4 patients developed either symptomatic or progressive extrusion. Operative repair was completed with Su-Por removal and replacement with a new human donor patch graft. No patient developed any sign of infection despite the extrusions. The remaining 7 patients had an uneventful postoperative course and continue to have no complications from the Su-Por patch with 9 months of follow-up. CONCLUSIONS: Given the high rate of extrusion of the Su-Por graft, this material seems to be an inadequate alternative for covering tube shunts. Harvested human tissue or other more flexible, manufactured grafts remain the standard of care for covering tube shunts.

Infection Rates after Periocular Surgery Utilizing New versus Re-Processed Monopolar Electrocautery.

BACKGROUND: To determine if there is a difference in periocular post-operative infection rates when utilizing new versus re-processed monopolar electrocautery tips. METHODS: Retrospective cohort study of 4,976 consecutive surgical cases involving 17,149 procedures. Post-operative infections were identified using chart review, facility infection surveillance records, and surgeon reporting. The main outcome measure was the presence or absence of infection within 30 post-operative days. The Fischer exact test was used to compare infection rates between cautery modalities. All statistical analysis was conducted at the 0.05 α level. RESULTS: There was no statistically significant difference between new and re-processed monopolar cautery infection rates (p=0.3879). CONCLUSIONS: Post-operative infection rates are similar for periocular surgery using both new and re-processed monopolar cautery. These findings suggest that re-processed cautery is a viable option for periocular surgery to decrease cost and reduce material waste without affecting the quality of care.