Real-world outcomes of micropulse transscleral laser therapy in glaucoma patients: Efficacy of initial and repeated treatment, transient intraocular pressure spikes

Thomas Dervos; Laura L Fortuna; Konstantin Gugleta; Hendrik P N Scholl; Zisis Gatzioufas; Pascal W Hasler; Valentin Arabin; Tim J Enz

doi:10.1016/j.heliyon.2024.e36019

Real-world outcomes of micropulse transscleral laser therapy in glaucoma patients: Efficacy of initial and repeated treatment, transient intraocular pressure spikes

Heliyon. 2024 Aug 10;10(16):e36019. doi: 10.1016/j.heliyon.2024.e36019. eCollection 2024 Aug 30.

Authors

Thomas Dervos¹, Laura L Fortuna¹, Konstantin Gugleta¹, Hendrik P N Scholl^{1

2}, Zisis Gatzioufas¹, Pascal W Hasler¹, Valentin Arabin¹, Tim J Enz¹

Affiliations

¹ Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.
² Institute of Molecular and Clinical Ophthalmology Basel (IOB), Switzerland.

Abstract

Purpose: To investigate the clinical outcomes of micropulse transscleral laser therapy (MP-TLT) in a cohort of glaucoma patients, including safety profile, post-operative transient intraocular pressure (IOP) spikes, long-term efficacy and prognostic factors in terms of IOP-lowering.

Methods: This was a retrospective observational cohort study. Medical records of all patients who consecutively underwent MP-TLT between May 2019 and February 2023 at a tertiary referral centre were scrutinised and relevant data were retrospectively analysed.

Results: A total of 131 patients (138 eyes) with a mean age of 73.2 ± 14.2 years were included. Mean pre-interventional IOP was 24.1 ± 9.1 mmHg. Within 6-12 h following the intervention on the same day, an IOP spike was regularly observed, reaching on average 31.7 ± 10.3 mmHg (p < 0.001 to baseline). Two years after the intervention, mean IOP was 16.1 ± 5.6 mmHg (p < 0.005 to baseline). In 18 eyes, the treatment was repeated, and the IOP lowering effect was more durable after the second intervention compared to the first one (Cox-Mantel test, p=<0.005). Apart from the transient post-interventional IOP spikes, no severe complications were observed.

Conclusions: MP-TLT is associated with significant IOP spikes in the first post-operative hours. Thus, close post-interventional IOP monitoring or even preventive (additional) IOP-lowering treatment may be considered. In the long term, the procedure yields favourable outcomes in terms of safety and IOP reduction. Repeated MP-TLT treatment, if necessary, seems to achieve more sustained IOP reduction than the initial treatment.

Keywords: Glaucoma; Micropulse transscleral laser therapy.