title: MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma.
abstract: The aim of the study was to investigate the safety and efficacy of using MLT in the treatment of open-angle glaucoma (OAG).This prospective cohort included subjects ≥18 years of age with OAG, defined as the open angle on gonioscopy with glaucomatous optic neuropathy evident from optical coherence tomography. Subjects with IOP < 21 mm Hg were classified as normal tension glaucoma and those with IOP ≥21 mm Hg were classified as primary open-angle glaucoma. Those with angle closure, secondary glaucoma, prior laser trabeculoplasty, use of systemic IOP-lowering medications, corneal pathologies, follow-up <6 months, recent intraocular surgery, or only 1 functional eye were excluded. A single session of unilateral MLT treatment was delivered using a 577 nm diode laser to 360° of the trabecular meshwork to reduce IOP or medication load. Medications were titrated up or down at 1 month after laser to achieve a 25% IOP reduction from presentation or an IOP <18 mm Hg, whichever was lower. The following were compared using the Repeated Measures ANOVA with Bonferroni's Multiple Comparison Test: IOP (on presentation, pre-MLT, day 1, 1 week, 1 month, 3 months, and 6 months after MLT) and the number of medications (pre-MLT, 3 months, and 6 months after MLT). After 6 months, responders with initial success to MLT (IOP reduction ≥20% at 1 month) received treatment in the fellow eye.In 48 subjects with OAG, the mean number of MLT shots applied was 120.5 ± 2.0 shots using a mean energy of 1000 mW per shot. Only 7.5% had a mild, self-limiting anterior uveitis postlaser with no change in the Snellen visual acuity at 6 months (P's > 0.5). The IOP and number of medications were significantly reduced at all time intervals following MLT compared to the pre-MLT level (P's < 0.0001). At 6 months, the IOP was reduced by 19.5% in addition to a 21.4% reduction in medication compared to pretreatment levels. The MLT success rate was 72.9%. During the first 6 months only 2.1% required a repeated laser trabeculoplasty.MLT was effective in reducing IOP and medications in OAG with minimal postlaser inflammation and low failure rate at 6 months following laser.
authors.affiliation: From the Department of Ophthalmology, Caritas Medical Centre (JWYL, GSKY, DWFY, CYFY); and Department of Ophthalmology, The University of Hong Kong, Hong Kong Special Administrative Region, China (JWYL).
authors.forename: Jacky W Y
authors.initials: JWY
authors.lastname: Lee
authors.forename: Gordon S K
authors.initials: GSK
authors.lastname: Yau
authors.forename: Doris W F
authors.initials: DWF
authors.lastname: Yick
authors.forename: Can Y F
authors.initials: CYF
authors.lastname: Yuen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012449:Safety; D014130:Trabeculectomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult