Novel Micropulse Transscleral Cyclophotocoagulation System for Clinical Treatment of Refractory Glaucoma

Summary

This study introduces a novel protocol for micropulse transscleral cyclophotocoagulation (MP-TSCPC) in the clinical management of refractory glaucoma. The proposed MP-TSCPC system demonstrates significant therapeutic efficacy, including substantial reduction in intraocular pressure, decreased dependence on medication, and minimized incidence of treatment-related complications.

Abstract

Traditional transscleral cyclophotocoagulation has been established as an effective intervention for refractory glaucoma. While demonstrating therapeutic efficacy, conventional TSCPC raises concerns regarding potential complications to ocular structures. In contrast, micropulse transscleral cyclophotocoagulation (MP-TSCPC) represents a significant advancement by selectively targeting pigmented epithelium to modulate aqueous humor production. This innovative approach has emerged as a well-tolerated treatment modality with reduced complication risks, supported by an increasing body of clinical evidence. This protocol details the application of a commercially available MP-TSCPC system for intraocular pressure reduction and complication mitigation in refractory glaucoma management. The procedure requires specific instrumentation, including the laser system equipped with the Micropulse Pars Plana Procedure (MP3) handpiece. Treatment efficacy and safety are governed by four critical parameters: power, duty cycle, treatment duration, and dwell time, which collectively determine the total energy delivered to the ciliary body. This paper systematically reviews the methodological framework for implementing MP-TSCPC in refractory glaucoma treatment.

Introduction

Glaucoma represents the predominant cause of irreversible vision loss globally, characterized by progressive optic neuropathy. The pathogenesis is primarily associated with sustained elevation of intraocular pressure (IOP), which induces structural damage to the optic nerve head, resulting in characteristic visual field defects and potential progression to complete vision loss¹. Epidemiological projections indicate a substantial increase in global glaucoma prevalence, with estimates surpassing 100 million cases by 2040, particularly concentrated in Asian populations. China, bearing the largest glaucoma burden in Asia, reported a significant dis....

Protocol

This protocol has been developed in strict accordance with the ethical guidelines established by the local institutional human research ethics committee, the Clinical Research Ethics Committee at Nanjing Medical University Eye Hospital. Informed consent was obtained from all participants. Ensuring compliance with all applicable regulatory standards and ethical principles governing clinical research.

1. Preparation before the treatment

NOTE: Patients with albinism are strongly advised against using MP-TSCPC. Caution should be exercised in patients with congenital/pediatric glaucoma or for those at h....

Results

Data from the above clinical trial evaluating a novel MP-TSCPC was recently presented and is summarized in Table 1. This study included 10 patients (10 eyes) with refractory glaucoma, comprising 2 male patients (2 eyes) and 8 female patients (8 eyes). The cohort comprised 4 eyes (40%) with neovascular glaucoma, 4 eyes (40%) with chronic angle-closure glaucoma, 1 eye (10%) with open-angle glaucoma, and 1 eye (10%) with secondary glaucoma.

The mean preoperative IOP was 37.4 ± 11.......

Discussion

This protocol establishes methodology for MP-TSCPC application in medically refractory glaucoma management, detailing perioperative workflow from preoperative preparation through initial intervention execution. The parameters for a typical treatment session are also introduced. It is important throughout the course of the parameter's determination and subsequent treatment sessions to take care that all steps of this protocol are being followed correctly, and that the patient is communicative with the operator to ensu.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Eyelid Retractor	Nanjing Beden Medical Co .	NA	fully expose the eyeball
Gonioscope	Volk Optical Inc	CS002	Evaluates the anterior chamber angle.
IOL-Master	Carl Zeiss Meditec	Model 700	Precise measurement of axial length, anterior chamber depth, and corneal curvature.
Laser Probe	Iridex	LP-3001	Delivers laser energy to the target tissue.
Levofloxacin Eye Drops	Santen	NA	Antibiotic eye drops to prevent postoperative infection.
Lid Speculum	Katena	SPC-3001	Holds the eyelids open to expose the surgical area.
Lidocaine Injection	Otsuka Pharmaceutical Co.	NA	used to administer retrobulbar anesthesia
MicroPulse Laser System	Iridex	MP3-1001	Example: Iridex MicroPulse P3, used for cyclophotocoagulation.
Non-Contact Tonometer	Topcon	CT-800A	Measures preoperative intraocular pressure (IOP).
Ophthalmic A/B Ultrasonic Scanner	Suowei Electronic Technology Co.	SW-2100	diagnosing eye conditions by providing precise measurements of ocular structures and detailed imaging of the eye and orbit.
Optical Coherence Tomography (OCT)	Carl Zeiss Meditec	CIRRUS5000	Non-invasive imaging for detailed retinal layer analysis.
Povidone-Iodine Solution	JumpCan	NA	Used for preoperative ocular disinfection (typically 5% concentration).
Proparacaine Eye Drops	Alcon	NA	Topical anesthetic for preoperative anesthesia.
Slit Lamp Microscope	KANGHUA	SLM-2ER	Used for preoperative ocular examination.
Specular Microscope	Tomey	EM-3000	Evaluation of corneal endothelial cell density and morphology.
Sterile Cotton Swabs	Medline	SW-8001	Used for disinfection and cleaning.
Sterile Gloves	Halyard Health	GLV-7001	Worn by the surgical team to ensure aseptic technique.
Sterile Surgical Drape	3M	DRN-5001	Maintains a sterile surgical field.
Surgical Tape	3M	TAP-5001	Used to secure the eye drape.
Tobramycin and Dexamethasone Eye Drops	NOVARTIS	NA	Steroid eye drops to reduce postoperative inflammation.
Topcon Non-Mydriatic Retinal Camera	Topcon	NW-400	Laser scanning ophthalmoscope with multi-modal imaging capabilities.
Ultrasound Biomicroscopy (UBM)	Ellex	UBM-5001	Provides detailed imaging of the ciliary body region.
Visual Acuity Chart	Reichert	VT-1001	Used to assess preoperative visual acuity.