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    TCP gains traction as modality for glaucoma cases with good visual potential

    Refining laser delivery improves safety for procedures; allows for earlier intervention


    Mean IOP at baseline was 25.8 + 1.3 mm Hg, which was significantly reduced to a mean IOP of 17.1 + 2.1 mm Hg at month 3 (p = 0.027). This 29.8% change was also combined with a mean reduction in ocular hypotensive medications of 0.91 + 0.3 (p = 0.018). This efficacy was delivered with an excellent safety profile. There were no visually significant cases of hypotony, macular edema or phthisis bulbi observed. One patient experienced a reduction in visual acuity due to the worsening of a pre-existing cataract.

    Advantages instead of invasive surgery

    The mTCP procedure offers an effective treatment that can potentially fit anywhere in the glaucoma surgical treatment algorithm.

    Following medication use, individuals with open-angle glaucoma are most likely have selective laser trabeculoplasty (SLT) or the MicroPulse version (MLT). If they are unable to control their pressures, we often move on to more invasive procedures like trabeculectomy or placement of a glaucoma drainage device.

    The first patients I offered mTCP were patients with severe glaucoma and few options, and it worked very well in that population. I found it easy to get IOP reduced from 50 to 20 mm Hg using a relatively straightforward procedure with a preferable safety profile to trabeculectomy or drainage devices.

    Now that I am more comfortable with the procedure, I use it often in patients who still have good visual acuity but need to reduce their pressures significantly. I find the procedure relatively benign and with a favorable recovery period. There are no sutures or risk of infection. Pressures tend to decrease slowly, which I feel plays a role in it being a well-tolerated procedure.

    Postoperative management of mTCP patients includes steroids and then the reduction of hypotensive medications depending on how quickly the pressure falls. The actual procedure can be uncomfortable due to ciliary body spasm during laser application, thus a peribulbar anesthetic injection is typically administered.

    Following the procedure, patients do not have significant issues with discomfort.

    My personal data indicates that 80% of patients who undergo mTCP have their pressures stay down for 6 to 9 months—my longest follow-up to date. I err on the side of under treatment with the knowledge that the procedure is easily repeatable, and an additional treatment will yield a greater effect. In the 20% of patients that require greater IOP reduction following the first treatment, I am able to achieve that with subsequent re-treatment.

    Robert J. Noecker, MD
    Dr. Noecker, vice chair, University of Pittsburgh Medical Center Eye Center, and director, Glaucoma Service and associate professor of ...

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