Micropulse diode laser trabeculoplasty (MDLT): A phase II clinical study with 12 months follow-up.
OBJECTIVE
This pilot study evaluates the pressure lowering potential of subthreshold micropulse diode laser trabeculoplasty (MDLT) for a clinically meaningful duration in patients with medically uncontrolled open angle glaucoma (OAG).


METHODS
prospective interventional case series.


METHODS
Thirty-two eyes of 20 consecutive patients with uncontrolled OAG (12 bilateral and 8 unilateral).


METHODS
Confluent subthreshold laser applications over the inferior 180 degrees of the anterior TM using an 810 nm diode laser in a micropulse operating mode. The intraocular pressure (IOP) was measured at baseline and at 1 hour, 1 day, 1 week, 3, 6, 9, and 12 months post-treatment. Flare was measured with a Kowa FM 500 flare-meter at baseline and at 3 hours, 1 day, 1 week, and 12 months post-treatment. After treatment, the patients were maintained on their pre-treatment drug regimen.


METHODS
Criteria for treatment response were IOP reduction >/=3 mm Hg and IOP </=21 mm Hg within the first week after MDLT. Eyes not complying to the above criteria during the follow-up were considered treatment failure. Mean IOP change and percentage of IOP reduction during the follow-up were calculated.


RESULTS
One eye was analyzed for bilateral patients. A total of 20 eyes were thus included. Four eyes (20%) did not respond to treatment during the first week. One additional eye failed at the 6 month visit. The treatment was successful in 15 eyes (75%) at 12 months. The IOP was significantly lower throughout follow-up (p < 0.01). At 12 months, the mean percentage of IOP reduction in the 15 respondent eyes was 22.1% and 12 eyes (60%) had IOP reduction higher than 20%. During the first two postoperative days, one eye with pigmentary glaucoma experienced a significant increase of flare associated with an IOP spike (34 mm Hg) that was controlled with systemic drugs; afterwards it qualified as a respondent and completed the study. No increase of flare was found in any other patient. No peripheral anterior synechiae formed.


CONCLUSIONS
In this case series, MDLT was effective in reducing IOP in 75% of medically insufficiently controlled OAG eyes without significant complications. This justifies randomized clinical studies to compare MDLT with current IOP lowering strategies.
Fea
Antonio Maria
AM
Istituto di Fisiopatologia Clinica, Clinica Oculistica dell' Università di Torino, Torino, Italy.
Bosone
Alex
A
Rolle
Teresa
T
Brogliatti
Beatrice
B
Grignolo
Federico Maria
FM