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Safety and efficacy of micropulse in pediatric eyes with refractory glaucoma
Raajaraajeshwari Sivasubramanian1, Kumar Siddharth2, Vijayalakshmi A Senthilkumar3
1Department of General Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Insights
Micropulse transscleral cyclophotocoagulation (MP-TSCPC) is safe and effective for pediatric glaucoma. Success rates decreased over time, suggesting individualized treatment for high-risk patients.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma Management
- Surgical Innovation
Background:
- Pediatric glaucoma presents unique management challenges.
- Refractory cases often require advanced treatment modalities.
- Micropulse transscleral cyclophotocoagulation (MP-TSCPC) offers a less invasive option.
Purpose of the Study:
- To evaluate the safety and efficacy of MP-TSCPC in pediatric eyes with refractory glaucoma.
- To assess intraocular pressure (IOP) reduction and success rates over a 6-month period.
- To identify patient subgroups who may benefit most from this procedure.
Main Methods:
- A prospective interventional study included 23 pediatric eyes with refractory glaucoma.
- MP-TSCPC was performed, with evaluations at 1 day, 1, 3, and 6 months post-procedure.
- Success outcomes were measured by IOP reduction and need for further interventions.
Main Results:
- MP-TSCPC demonstrated a significant IOP reduction from baseline (P = 0.000014).
- Overall success was 56.5% at 1 month, decreasing to 34.7% by 6 months.
- No major complications were reported, though 8.6% to 26% of eyes required additional interventions over time.
Conclusions:
- MP-TSCPC is a safe and effective treatment for pediatric refractory glaucoma.
- The study highlights a temporal decline in success rates.
- Individualized application for high-risk patients or those needing immediate IOP reduction is recommended.
Purpose:
To analyze the safety and efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in pediatric eyes with refractory glaucoma.
Design:
Hospital-based prospective interventional study.
Methods:
Patients less than 18 years of age, receiving MP-TSCPC between December 1, 2022 and May 31, 2023 with at least three follow-ups within 6 months period, were included in the study. Post-laser evaluation was done at day 1, 1 month, 3 months, and 6 months. Success outcomes were calculated at 1, 3, and 6 months follow-up.
Results:
A total of 23 eyes of 23 patients were included in the study. Mean intraocular pressure (IOP) lowering agents (P = 0.041) had significant change compared to the baseline value; however, the change was insignificant when eyes requiring additional IOP-lowering surgeries during the follow-up period were excluded. There was a significant reduction in IOP at each follow-up visit compared to the baseline (P = 0.000014). Two (8.6%) eyes required additional intervention within 1-month follow-up, another six eyes (26%) between 1-3 months, and three eyes (13%) between 3-6 months of MP-TSCPC. Total success was highest at 56.5% (13 eyes) at 1-month follow-up and at least 34.7% (8 eyes) at 6-month follow-up. No major complications were reported in our study.
Conclusion:
MP-TSCPC was found to be safe and effective in pediatric population. However, we observed a gradual reduction in the success with time, and thus, it can be individualized to patients with high risk for incisional surgery or those requiring immediate IOP reduction.
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