Eyeworld

DECEMBER 2022 | EYEWORLD | 89 G References 1. TM Grippo, et al. Evidence- based consensus guidelines series for MicroPulse Transscleral Laser Therapy: dosimetry and patient selection. Clin Ophthal- mol. 2022;16:1837–1846. 2. Grippo TM, et al. MicroPulse® Transscleral Laser Therapy – Fluence may explain variability in clinical outcomes: a literature review and analysis. Clin Oph- thalmol. 2021;15:2411–2419. Relevant disclosures Grippo: Iridex Toeteberg-Harms: Iridex TLT and later tapered based on the IOP-lower- ing effect." They said that the maximum IOP-lowering effect can be expected between 4–6 weeks, but an initial response can be seen within the first week. For a more robust effect or if treatment seems to wear off over time, retreatments are possible. "MicroPulse TLT is a titratable procedure that can be repeated without limiting the use of other therapies. The possibility to retreat is one of the benefits of this procedure. In the litera- ture, two to three retreatments over time have been reported for some patients," Drs. Grippo and Toeteberg-Harms said. of moving your finger in and out of a candle flame. The slower you move your finger, the higher the induced tissue temperature. This can be compared to MicroPulse TLT; when we slow down, we deliver more laser energy and heating to that tissue. Until recent work was published, 2 highlighting the importance of sweep velocity as having a high impact on the success of the procedure, this variable was probably the most under-appreciated and significant factor to con- sider with MicroPulse TLT. We see correlation between slower sweep duration and greater IOP reduction." From a safety standpoint, the physicians noted that most articles in peer-reviewed liter- ature conclude that the MicroPulse TLT proce- dure is safe and effective, but like any glaucoma procedure, it is not without the potential for side effects. "Now that we have a better understand- ing of dosimetry, surgical technique, patient selection, and the availability of the revised probe that allows for more posterior and stable treatment, many side effects can be prevented or minimized," they said. In general, postop care is less demanding compared to most glaucoma procedures. "No cycloplegics or antibiotics are rou- tinely required after MicroPulse TLT. Topical steroids and/or NSAIDs are typically the only medications required," Drs. Grippo and Toete- berg-Harms said. "Glaucoma medications are typically initially continued after MicroPulse possibility of MIGS failure and the progressive nature of glaucoma and to avoid taking the pa- tient back to the operating room for a filtering surgery, MIGS procedures may be combined in one session," he said. A combined procedure may increase the chance of hyphema, which in most patients is temporary. Combining MIGS procedures that involve device implantations may hypothetically have some impact on the corneal endothelium, but we need more data, Dr. Razeghinejad said. Dr. Razeghinejad said it's important that patients know that there is no evidence-based data on the safety and efficacy of combined MIGS, and insurance may not cover the com- bined MIGS. Dr. Razeghinejad added that combining MIGS does not seem to increase the chance for endophthalmitis, as the rate of endophthalmitis following MIGS has been similar to phacoemul- sification. Combining MIGS with cyclodestruc- tive procedures increases the risk of postopera- tive inflammation and cystoid macular edema, which could be managed with topical steroid therapy and NSAIDs in most patients, he said. continued from page 87 Placement of the revised MicroPulse P3 Device Source: Brian Jerkins, MD

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