Treatment Outcomes of Micropulse Transscleral Laser Therapy as an Adjunctive Therapy in African American Individuals with Prior Procedural Interventions.

Abstract

Prcis: Micropulse transscleral laser therapy is a clinically beneficial adjunctive treatment option for African American individuals with severe-stage primary open-angle glaucoma who have undergone prior glaucoma procedural interventions.

Purpose: To assess the safety and efficacy of micropulse transscleral laser therapy as an adjunctive treatment in reducing intraocular pressure and ocular hypotensive medications in African American patients.

Methods: We analyzed forty-four eyes of 44 African American individuals with severe-stage primary open-angle glaucoma which underwent prior procedural interventions and received a subsequent micropulse treatment. Mean intraocular pressure and ocular hypotensive medications were evaluated at all postoperative visits through 12 months. Main outcome measures included within-group reductions in intraocular pressure and ocular hypotensive medications at 12 months compared to baseline. Univariate and multivariable logistic regression models were used to calculate odds ratios to evaluate characteristics associated with the likelihood of success at 12 months. Success was defined as achieving a target intraocular pressure of ≤12 mmHg without additional medications and no secondary surgical interventions.

Results: Mean intraocular pressure was significantly reduced from 22.9±6.2 mmHg at baseline to 13.8±4.8 at 12 months following micropulse, a 40% reduction (P<0.001). The majority of patients were on 4-6 ocular hypotensive medications at baseline. By 12 months, the proportion of patients requiring ≥3 ocular hypotensive medications was significantly reduced compared to baseline (P=0.03). Univariate analysis revealed that a history of trabeculectomy before micropulse treatment increased the likelihood of successful surgery at 12 months by nearly 5-fold (OR, 4.67; P=0.03).

Conclusion: Micropulse is an effective adjunctive treatment in African Americans with severe-stage primary open-angle glaucoma and a history of prior glaucoma procedures.