Eyeworld

77 EW GLAUCOMA October 2016 such a high pressure. Now that we have MicroPulse laser, we can do it right then in the office." IOP. However, he has found Micro- Pulse may not provide much clinical benefit in neovascular glaucoma patients. Technique Dr. Tanaka uses standard parame- ters: 2,000 mW, 31.3% duty cycle, and 320 seconds of total treatment, which is given in two 80-second treatments superiorly and two 80-second treatments inferiorly at the limbus using the specially designed MP3 Probe (Iridex). The 80 seconds of treatment are given using eight 10-second "sweeps," with each sweep going across the limbus from one end to the other, while avoiding the horizontal meridian. Dr. Tanaka, who only performs the treatment in an ambulatory surgery center (ASC), uses monitored anesthesia care, and provides a retro- bulbar block. "The procedure is very painful without a block," Dr. Tanaka said. Dr. Radcliffe applies two 50-sec- ond treatments split between the top half of the eye and the bottom half of the eye. He spares the 3 and 9 o'clock areas where there are nerves and blood vessels. "I have three power settings and I alter my treatment by increasing the power. Some people do it by in- creasing the time," Dr. Radcliffe said. For instance, Dr. Radcliffe uses 2,000 mW in a patient who has not had cataract surgery, has good vision, and who is having his or her first treatment. He uses 2,250 mW for retreatments, patients with vision in the 20/100 to 20/50 range, or those with more severe glaucoma. He uses 2,500 mW in advanced glau- coma cases with very poor vision and elevated pressure despite many surgeries. Dr. Radcliff's technique also includes a subconjunctival steroid injection at the time of the laser. A retrobulbar block is used by Dr. Radcliffe, who performs the pro- cedure in either the office or ASC. "To me, the advantage with this laser is that it can be used instantly (and at odd hours) and in a variety of settings outside of the traditional operating room," Dr. Radcliffe said. "Traditional operating room setups can put the patient through a lot— operating at odd hours is never the ideal setting because you are usually not with your regular team, and you may not feel comfortable letting the patient go over the weekend with Complications The complications that Dr. Radcliffe has seen from the treatment have Discover our universe of ophthalmic solutions ® Explore (800) 225-1195 • www.katena.com ® Instruments: • Cataract surgery • DSEK • Femtosecond procedures • Glaucoma surgery • Vitreoretinal surgery Biologics: Amniotic membrane • • Ambio Surgical allografts • Cornea • Pericardium • Scleral Devices: • Barron trephines and punches • glaucoma implant • Single use and reusable ophthalmic lenses MKT-0111-08/2016 continued on page 78

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