PRéCIS:: In advanced refractory glaucoma which has failed prior MP3 laser, MP3 Plus is effective in reducing intraocular pressure without significant complications. It is also useful as a temporising procedure prior to incisional surgery.
To evaluate the efficacy and safety of MP3 Plus, a novel technique using modified micropulse trans-scleral cyclophototherapy (MPTCP) in eyes with refractory glaucoma or failed MPTCP treatment.
This is a retrospective interventional case series. Thirty-two consecutive eyes from 29 patients with uncontrolled intraocular pressures (IOP) who had previous MPTCP or refractory glaucoma underwent MP3 Plus, a modified MPTCP where additional discrete pulses are applied. Main outcome measurement was IOP at 1, 3, 6 and 12 months post-procedure, with success defined as a 20% reduction in baseline IOP, an IOP of 25▒mmHg or less and no need for further re-operation. We collected and analysed visual acuity, number of glaucoma medications and complications.
The patients had an average of 1.4±0.9 glaucoma procedures prior to treatment, where 87.5% underwent one or more previous MPTCP with suboptimal response. Of the eyes presenting for follow-up, 51.6% (n=31), 37.0% (n=27), 35.7% (n=28) and 25.9% (n=27) achieved the primary outcome at 1,3, 6 and 12 months respectively. Baseline IOP was 33.7±11.6▒mmHg (n=32 eyes) and post-treatment IOP at 1,3, 6 and 12 months were 21.0±9.0▒mmHg (n=31; P<0.0001), 26.2±10.8▒mmHg (n=25; P<0.0001), 23.2±9.4▒mmHg (n=20; P<0.05) and 24.6±9.8▒mmHg (n=16; P<0.001) respectively. There was a reduction in glaucoma medications from 3.4±0.8 pre-operatively to 2.8±1.2 (n=16; P<0.05) at 12 months. There were no cases of prolonged inflammation or hypotony.
MP3 Plus is effective and safe in lowering IOP in eyes with refractory glaucoma after previous failed MPTCP.