GLAUCOMA 40 EWAP MARCH 2023 W hile glaucoma specialists are likely familiar with MicroPulse Laser Therapy (Iridex) as a non-incisional, non-pharmaceutical glaucoma therapy, Tomas M. Grippo, MD, and Marc Toeteberg-Harms, MD, called it an “ace up your sleeve” and one that can be adopted by any surgeon who treats glaucoma patients. Drs. Grippo and Toeteberg- Harms shared their thoughts with EyeWorld on the technology, which was initially developed in 2015 and has seen a few updates in the years since. First, they described MicroPulse Transscleral Laser Therapy (MicroPulse TLT) as different from continuous wave transscleral cyclophotocoagulation (CW-TSCPC) and endoscopic cyclophotocoagulation (ECP). The company describes it as “tissue sparing,” and Drs. Grippo and Toeteberg-Harms said that with MicroPulse TLT the laser does not fire continuously. Rather, it “chops up the energy into smaller micropulses,” allowing for more thermal control and less tissue damage. In addition, MicroPulse TLT is non-incisional. “While the mechanism of action is not fully understood, it is theorized that MicroPulse TLT enhances the natural aqueous outflow pathways of the eye (conventional and non-conventional) as opposed to restricting aqueous production only,” they said. “MicroPulse TLT also focuses the laser energy on a different part of the ciliary body than both CW-TSCPC and ECP. MicroPulse TLT delivers energy to the pars plana portion of the ciliary body or approximately 3 mm back from the surgical limbus.” They also said that MicroPulse TLT can be performed in many different types of glaucoma and severity levels. “It is a treatment option in moderate to severe glaucoma, prior to or post-incisional surgery, and in general becomes a surgical option once maximal tolerated pharmacological therapy and trabeculoplasty have failed to control the disease,” they said. “Individual patient characteristics, like the status of the angle, conjunctiva, lens, cornea, if the patient is taking or not taking anticoagulation, are less relevant when performing this procedure, and all of this makes this tool a great addition to our surgical armamentarium.” In terms of the learning curve, Drs. Grippo and Toeteberg-Harms said it is minimal and that this procedure is generally performed at an ASC. They said that IOP reduction is generally 25–35% if using settings as described in the dosimetry and patient MicroPulse for the anterior segment surgeon by Liz Hillman Editorial Co-Director Contact information Grippo: tomasgrippo@yahoo.com Toeteberg-Harms: marctoeteberg@aol.com This article originally appeared in the December 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Placement of the revised MicroPulse P3 device. Source: Brian Jerkins, MD
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