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    Cyclophotocoagulation shows safety in glaucoma case series

    Laser system procedure with probe minimizes collateral damage with excellent safety, efficacy rates

    Take-home message: Charles L. Harris, MD, reviews safety and efficacy rates in a glaucoma case series after adding a proprietary laser system with probe to the surgical armamentarium.

    By Charles L.  Harris, MD, Special to Ophthalmology Times

    Charles L. Harris, MDSavannah, GA—Cyclophotocoagulation (CPC) had once been considered as a last-resort treatment for patients with glaucoma. However, with new treatment paradigms, this is no longer the case.

    A form of cycloablation, CPC is used to treat glaucoma through the destruction of ciliary body epithelium and stroma1,2 resulting in aqueous secretion reduction and lower IOP.

    Recent: Microstent approval makes big news in glaucoma world

    Newer treatments with contact transscleral (TSCPC) methods using an 810-nm, continuous-wave diode laser have proven safer and more efficacious in the treatment of various forms of glaucoma3-7 than traditional cyclocryotherapy, which carries more risks.8,9

    Favorable safety profile

    Safer still is a more recent paradigm (Cyclo G6 Laser System using MicroPulse Transscleral Cyclophotocoagulation [mTSCPC] with the MicroPulse P3 probe [Iridex]).

    The technology breaks up the traditional continuous-wave laser into short bursts that allow the tissue to cool within the intervals between bursts. This minimizes collateral damage and has excellent safety and efficacy rates with most cases experiencing no incidence of visually significant hypotony or other complications, and superior rates of IOP reduction.10-13

    Related: CO2 laser-assisted procedure showing long-term efficacy, safety

    Inflammation is always a risk which can be reduced with the use of a topical steroid. I prescribe the use of prednisolone acetate ophthalmic suspension (Pred Forte Allergan), however, this only needs to be administered for 4 or 5 days instead of weeks or longer as with past treatments.

    Many of my patients present with uncontrolled pressures after numerous treatment paradigms have failed, including rigorous medication regimens and multiple selective laser trabeculoplasty (SLT) treatments.

    More glaucoma: How ABiC targets all sites of outflow resistance

    With the MicroPulse P3, I have seen excellent pressure lowering and minimal recovery for patients other than a few hours of patching post-procedure. Visual acuity is unchanged and the treatment is repeatable if necessary. The primary goal is to control patients’ pressure and reduce or eliminate medications. To that end, I titrate the treatment based on the patients’ response.

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