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. 2022 Jun 7:16:1837-1846.
doi: 10.2147/OPTH.S365647. eCollection 2022.

Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy: Dosimetry and Patient Selection

Tomas M Grippo  1 , Ronald M P C de Crom  2 , Michael Giovingo  3 , Marc Töteberg-Harms  4 , Brian A Francis  5 , Brian Jerkins  6 , Jacob W Brubaker  7 , Nathan Radcliffe  8 , Jella An  9 , Robert Noecker  10
Affiliations

Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy: Dosimetry and Patient Selection

Tomas M Grippo et al. Clin Ophthalmol. .

Abstract

Purpose: To provide consensus-based current guidelines on optimal dosimetry and patient selection for MicroPulse Transscleral Laser Therapy (TLT) based on a review of the literature and a Delphi method.

Methods: A comprehensive search of Pub Med led to the identification and analysis of 61 studies on MicroPulse TLT that contained information on laser settings and patient selection. To determine consensus in areas where there was not enough available literature, a three-round Delphi method was conducted.

Results: The response rate was 90% in the first round, 90% in the second round, and 80% in the third round of the Delphi technique. Once all responses were aggregated, a live meeting was held with 80% attendance, and consensus was achieved on each of the findings detailed in this manuscript.

Conclusion: Micropulse TLT is a useful addition to the glaucoma armamentarium. When used with proper surgical technique at energy settings within the boundaries described in this manuscript, MicroPulse TLT is a safe and effective treatment for many types and stages of glaucoma. Based on current knowledge and experience, the consensus recommendation of this expert panel is that the standard MicroPulse TLT settings using the revised MicroPulse P3 Probe should be 2500 mW, 31.3% duty cycle, and 4 sweeps at a sweep velocity of 20 seconds each per hemisphere. Both hemispheres avoiding the 3 and 9 clock hours should be treated. The panel also reached consensus on patient selection for MicroPulse TLT providing guidance for the use of the procedure.

Keywords: MicroPulse; glaucoma; transscleral laser therapy.

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Conflict of interest statement

Iridex was not privy to questionnaires, responses or data collection during the Delphi Consensus process, nor were they privy to the manuscript during its preparation, writing and submission. Dr Tomas M Grippo received personal fees from Iridex, MST, Alcon, during the conduct of the study. Dr Ronald MPC de Crom reports personal fees from Iridex, during the conduct of the study. Dr Michael Giovingo reports personal fees, non-financial support from Iridex Corporation, during the conduct of the study; grants from Santen, outside the submitted work. Dr Marc Töteberg-Harms reports grants, personal fees from Iridex, during the conduct of the study; personal fees from Allergan, personal fees from ELT Sight, personal fees from MLase AG, personal fees from Novartis/Alcon, personal fees from Reichert, grants, personal fees from Santen, personal fees from Heidelberg Engineering, personal fees from Glaukos, outside the submitted work. Dr Brian A Francis reports grants from Iridex, outside the submitted work. Dr Brian Jerkins reports personal fees from Iridex, during the conduct of the study. Dr Jacob Brubaker reports personal fees from Iridex, during the conduct of the study. Dr Nathan Radcliffe reports personal fees from Iridex, during the conduct of the study. Dr Jella An reports personal fees from Iridex, during the conduct of the study. Dr Robert Noecker reports personal fees from Iridex, during the conduct of the study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Original MicroPulse P3 Delivery Device.
Figure 2
Figure 2
Revised MicroPulse P3 Delivery Device.
See this image and copyright information in PMC

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