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Aim: To investigate the efficacy and safety of micropulse laser trabeculoplasty (MLT) using a 577 nm yellow wavelength laser randomly assigned to either 1500 or 1000 mW in patients with primary open-angle glaucoma (POAG). Methods: A prospective, double-blinded study of POAG patients was performed in a single center. MLT treatment included a 577 nm micropulse laser (IRIDEX IQ 577TM, IRIDEX, Mountain View, CA, USA) to 360° of the trabecular meshwork at randomly assigned varying powers: 1500 mW in one eye (MLT 1500 group) and 1000 mW in the other (MLT 1000 group). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal central thickness (CCT), and endothelial cell count (ECC) were evaluated at baseline (T0), post-operative 1 h (T1), 24 h (T2), 1 month (T3), 3 months (T4), and 6 months (T5) after laser treatment. Topical medications were assessed pre-treatment and at T4. Results: Among the 18 eyes included, we achieved a success rate (IOP reduced > 20%) in 77% of sampled eyes. In particular, IOP reduced at T2 and T3 with both MLT 1500 and 1000 without any significant differences (IOP reduction 22.9% vs. 17.3%, respectively, MLT1500 vs. MLT1000 at T2). The IOP returned to baseline values at T4 and T5 in both groups, with a reduction in topical medications administered from 2.5 ± 1.1 to 2.0 ± 1.2 to the 1500 mW group and from 2.4 ± 1.0 to 1.9 ± 1.0 to the 1000 mW group. At 1 h post-laser treatment, a transient IOP spike was registered among the MLT1500 group. There were no differences in CCT and ECC at any timepoint according to the laser powers. Conclusions: Over a 6-month follow-up period, 577 nm MLT at either 1500 or 1000 mW reduces IOP, enabling a stable reduction in the number of topical medications required for patients treated for POAG without any significant difference in terms of effectiveness and safety.

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AIM: To examine the efficacy and safety of micropulse laser trabeculoplasty (MLT) versus selective laser trabeculoplasty (SLT) in a large cohort of primarily African American and Hispanic patients. METHODS: A single center retrospective comparative cohort review conducted at Cook County Health facilities that included patients with a diagnosis of open angle glaucoma or ocular hypertension who received an SLT or MLT procedure between January 2017 and May 2021. RESULTS: Totally 131 eyes of 99 patients were analyzed. The 77 eyes received SLT and 54 received MLT. Seven out of 77 eyes in the SLT group (9.1%) and 1 out of 54 eyes in the MLT group (1.9%) had an IOP spike (defined as > 5 mm Hg) at either 1h or 1wk after procedure (P=0.05, Chi-squared test with Haldane-Anscombe correction). The procedure failure rate at one year was 50% for SLT and 48% for MLT (P=0.31). CONCLUSION: MLT has a significantly lower incidence of pressure spikes and a similar treatment failure rate at 1-year post-procedure, demonstrating that it is a reasonable alternative compared to SLT.

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BACKGROUND: Glaucoma is a group of eye diseases that can damage the optic nerve and cause vision loss. A novel technology micropulse laser trabeculoplasty (MLT) can use duty-circle subvisible laser pulses to treat glaucoma. The aim of this study is to evaluate the efficacy of 360° MLT to alleviate intraocular pressure (IOP) in patients with glaucoma. METHODS: This was a single-center prospective study on patients treated with 360° MLT using a Diode True-Yellow 577-nm Laser with MicroPulse technology. All the patients were recruited from the Department of Ophthalmology. Follow-up visits were carried out at 1 day, 1 week, 1 month, 3 months, 6 months, 18 months, and 36 months after the procedure. Best-corrected visual acuity (BCVA), Intraocular pressure (IOP), and vertical cup-to-disc ratio (C/D ratio) were measured during the follow-up. Repeated-measures analysis of variance (ANOVA) and Kaplan-Meier analysis were performed to evaluate the outcomes. RESULTS: A total of 39 eyes from 25 patients were included in this study (10 men/15 women). The average age of patients was 41.47 ± 14.39 years old, and the baseline IOP was 21.13 ± 7.75 mmHg. MLT significantly reduced the IOP at 1 day (range 15.61-19.01, P = 0.0218), 3 months (range 16.47-19.22, P = 0.0390), and 6 months (range 15.38-18.56, P = 0.0332) compared with the baseline. However, by the end of the study, only 21.88% of patients demonstrated a ≥ 20% IOP reduction, while seven eyes needed further laser or surgical treatment. The IOP of glaucoma patients was significantly lower than the ocular hypertension patients at 1 month (P = 0.0124), 3 months (P = 0.0004), 18 months (P = 0.0061) and 36 months (P = 0.0119). CONCLUSIONS: Micropulse laser trabeculoplasty reduce IOP in patients with glaucoma or ocular hypertension for a short period, but its lowering efficiency is limited up to 6 months of the follow-up period.

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Our aim was to evaluate the long-term results of micropulse laser trabeculoplasty (MLT) with 577-nm yellow wavelength in the treatment of glaucoma. We reviewed the medical records of 51 patients (51 eyes) with uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma who underwent 180° MLT for the first time. The success of MLT was defined as an IOP reduction of ≥ 20% and IOP < 21 mmHg after treatment. If the number of medications was increased or further laser trabeculoplasty or glaucoma surgery was required after treatment, the case was considered unsuccessful. The mean duration of patient follow-up was 18.39 ± 12.17 months (range 3-52 months). Patients included in the study used 2-4 types of antiglaucoma eye drops (mean 3.43 ± 0.7). The mean number of MLT spots was 65.54 ± 6.19, and the mean energy level was 750.98 ± 101.73 mJ. The decrease in intraocular pressure compared to baseline measurements was: 16.72 ± 11.87%, 15.07 ± 13.76%, 12.63 ± 14.29%, 16.66 ± 19.32%, and 16.75 ± 19.78% during follow-up at 3, 6, 12, 24, and 36-48 months. Successful response was achieved in 35.41%, 36.95%, 34.21%, 40%, 41.17%, and 42.85% of patients during 3, 6, 12, 18, 24, and 36-48 months of follow-ups, respectively. Of the 51 eyes studied, 12 patients (23.5%) underwent post-MLT glaucoma surgery, and 7 patients (13.7%) had cataract surgery, whose follow-up data were subsequently censored. The reduction of intraocular pressure showed a significant correlation with baseline intraocular pressure, while age and laser power showed no correlation (p > 0.05). MLT is a novel treatment option for patients with glaucoma with favorable long-term outcomes and a good safety profile.

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AIM: To evaluate the effectiveness of micropulse laser trabeculoplasty (MLT) for eyes with open angle glaucoma (OAG) under maximal tolerable glaucoma eyedrops and to assess the effect of expertise performing MLT on its clinical effectiveness. METHODS: Medical records of 42 consecutive eyes of 34 patients diagnosed with OAG who underwent MLT were retrospectively reviewed. The effectiveness was determined using the Kaplan-Meier survival analysis. Failure was defined as an intraocular pressure (IOP) reduction of <20% from baseline, an IOP >21 mm Hg during two consecutive follow-up visits, or surgical intervention for OAG. To determine the impact of MLT surgical expertise on clinical effectiveness, the eyes were divided into two groups according to whether the procedure was conducted by an experienced specialist (defined as a glaucoma specialist who had conducted at least ten MLT procedures) or a less experienced glaucoma specialist. The difference in expertise was determined using a log-rank test. RESULTS: MLT was conducted by three glaucoma specialists. The overall survival rates were 0.76, 0.48, and 0.44 at 1, 3, and 6mo, respectively. The survival rates for MLT performed by a less experienced glaucoma specialist were 0.62, 0.31, and 0.25 (n=21 eyes) at 1, 3, and 6mo, respectively, whereas the survival rates for MLT performed by an experienced glaucoma specialist were 0.90, 0.64, and 0.64 (n=21 eyes) at 1, 3, and 6mo, respectively. The log-rank test showed a significant difference in the survival curves of the two groups (P=0.0061). CONCLUSION: The 6-month effectiveness of MLT for controlling IOP is relatively limited in eyes with OAG using maximal tolerable glaucoma eyedrops. However, its effectiveness may be improved if performed by a glaucoma specialist with sufficient MLT experience.

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BACKGROUND: There is limited long-term data comparing selective laser trabeculoplasty (SLT) to the newer micropulse laser trabeculoplasty (MLT) using a laser emitting at 532 nm. In this study, we determine the effectiveness and safety of MLT compared to SLT. DESIGN: Retrospective comparative cohort study. PARTICIPANTS: A total of 85 consecutive eyes received SLT and 43 consecutive eyes received MLT. METHODS: Patients with open-angle glaucoma receiving their first treatment of laser trabeculoplasty were included. Exclusion criteria are prior laser trabeculoplasty, laser cyclophotocoagulation or glaucoma surgery, and follow-up of less than 1 year. MAIN OUTCOME MEASURES: The primary outcome was success at 1 year, defined as a reduction in intraocular eye pressure (IOP) by ≥20% from baseline or met prespecified target IOP with no additional glaucoma medication or subsequent glaucoma intervention. RESULTS: Baseline IOP was 18.0 mmHg (95% CI=16.4-19.5) in the MLT group on an average of 1.8 (95% CI=1.4-2.2) glaucoma medications compared to 18.2 mmHg (95% CI=17.2-19.3) for the SLT group on an average of 2.0 (95% CI=1.6-2.3) medications. At 1-hour post-laser, the SLT group had more transient IOP spikes (MLT 5% vs SLT 16%, P=0.10). There was a trend toward increased success in the SLT group compared to MLT at 1 year (relative risk=1.4, 95% CI=0.8-2.5, P=0.30). CONCLUSION AND RELEVANCE: Eyes had similar success after MLT compared to SLT at 1 year. Laser trabeculoplasty with either method could be offered as treatment with consideration of MLT in those eyes where IOP spikes should be avoided.

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BACKGROUND: To evaluate the effect of a single session of micropulse laser trabeculoplasty on the cornea in eyes with primary open-angle glaucoma and pseudoexfoliation glaucoma. METHODS: This single-centre, prospective, case series enrolled patients with primary open-angle and pseudoexfoliation glaucoma under treatment with glaucoma agents that required additional intraocular pressure reduction. Eyes underwent 360 degrees treatment with 532 nm micropulse laser trabeculoplasty. Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-efficient of variation of endothelial cells were measured before micropulse laser trabeculoplasty and at one, three and six months after treatment. RESULTS: Twenty eyes of 20 patients (mean age 67.6 ± 8.0 years) with primary open-angle glaucoma and 18 eyes of 18 patients (mean age 71.44 ± 6.43 years) with pseudoexfoliation glaucoma were included in the study. Treatment with micropulse laser trabeculoplasty resulted in statistically significantly lower intraocular pressure compared to baseline in both primary open-angle and pseudoexfoliation glaucoma eyes (p < 0.0001 at both comparisons). Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-efficient of variation of the endothelial cell size showed no significant change between baseline and six months after micropulse laser trabeculoplasty in both primary open-angle and pseudoexfoliation glaucoma eyes. CONCLUSION: A single session of micropulse laser trabeculoplasty did not affect central corneal thickness and corneal endothelium parameters in eyes with primary open-angle and pseudoexfoliation glaucoma.

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PURPOSE: To evaluate the immediate 24-hour effect on intraocular pressure (IOP) of a single session of micropulse laser trabeculoplasty (MLT) in patients with pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS: In this single-center, one-arm, prospective study, patients with PEXG on prostaglandin analogue monotherapy with inadequate IOP control were treated with 360-degree 532nm MLT. Intraocular pressure was evaluated at 1, 4, 8, 12 and 24hours after MLT. Twenty-three eyes of eighteen patients (10 male, 8 female) were enrolled in the study. RESULTS: The mean age of the patients was 71.83±6.51 years, and the mean IOP prior to MLT was 20.61±1.8mmHg. The mean IOP was reduced by 2.17±3.31mmHg, 2.69±3.85mmHg, 0.87±3.02mmHg, 2.13±2.8mmHg and -0.87±3mmHg at 1, 4, 8 and 24hours after MLT, respectively. At 4 and 12hours after MLT, the mean IOP was statistically significantly lower compared to the pre-MLT IOP (P=0.043 and P=0.021 respectively). No eye experienced an IOP spike≥5mmHg during the first 24hours after MLT. CONCUSION: Treatment with MLT in PEXG eyes did not result in any significant, potentially dangerous IOP spikes during the first 24hours after MLT.

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AIM: To evaluate the efficiency and safety of micropulse laser trabeculoplasty (MLT) for primary open angle glaucoma (POAG) patients. METHODS: Retrospective study. POAG patients undergoing MLT in Peking University Third Hospital from June 2016 to November 2017. Seventy-two eyes of 72 POAG patients were enrolled. Only one eye of each patient was treated by MLT. The intraocular pressure (IOP) before MLT and at 1d, 1, 4, 12 and 24wk and glaucoma medication before and after treatment were compared. RESULTS: The IOP was 20.6±5.9 mm Hg before MLT and 20.8±6.8 mm Hg at 2h after MTL. The IOP at 1d, 1, 4, 12 and 24wk was 17.9±4.4, 18.0±4.3, 17.5±3.4, 17.0±2.7, and 16.5±2.9 mm Hg, respectively. The IOP before and after MLT demonstrated a statistically significant difference by ANOVA analyses (F=5.797, P<0.001). Least significant difference t-tests showed there was no statistically significant difference between pre-MLT IOP within 2h after MLT (P=0.207). The statistically significant difference was confirmed between the pre-MLT IOP at 1d, 1, 4, 12 and 24wk after MLT (P=0.006, 0.009, 0.001, <0.001, <0.001, respectively). The number of glaucoma medications before MLT was 1.7±1.4 and 1.5±1.4 24wk after MLT with a significantly statistical difference (t=2.219, P=0.031). CONCLUSION: MLT is effective and safe for POAG patients. No patient experienced IOP spikes after MLT. The IOP 6mo after treatment decreased significantly with less glaucoma medication.

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Objective To evaluate the efficiency and safety of micropulse laser trabeculoplasty (MLT) for open angle glaucoma ( OAG) patients and ocular hypertension ( OHT) patients. Methods A prospective self-controlled study was designed. Fifty-six eyes of 56 OAG and OHT patients in Peking University Third Hospital were recruited from June 2016 to June 2017,including 32 males and 24 females with the age of (50. 4±19. 0) years old. The diagnosis included 48 eyes of primary open angle glaucoma (POAG),3 eyes of normal tension glaucoma and 5 eyes of OHT. The best corrected vision acuity ( BCVA) was 0. 7 ±0. 3 before treatment. The intraocular pressure (IOP) before MLT was (20.4±5.8) mmHg,the average types of antiglaucoma medications was 1.7,including systemic medication and local drug use. The general information, BCVA, IOP and antiglaucoma medication were recorded. Only one eye of each patient was treated by MLT. The IOP at different follow-up time points (2 hours, 1 day,1 week, 1 month, 3 months post-treatment) and the number of antiglaucoma medication before and after treatment were compared. This study protocol was approved by Ethic Committee of Peking University Third Hospital (No. 2014166). Written informed consent was obtained from each subject prior to any medical examination. Results The IOP after MLT was (20. 2±6. 7),(17. 6±4. 4),(18. 1±4. 5),(17. 4±3. 4) and (17. 0±2. 1)mmHg at 2 hours, 1 day,1 week,1 month and 3 months,respectively,with significant difference among the different time points ( F=7. 320,P<0. 001). Compared with the IOP before treatment,the IOP at 1 day,1 week,1 month and 3 months after treatment were significantly decerased,with significant differences between them (all at P<0. 05). Three months after treatment,the average number of glaucoma medications used was 1. 5, and only local administration was used. Infection,hyphema,cornea injury,burns and other complications were not seen in all the patients. Conclusions MLT is effective and safety for OAG and OHT patients,and reduce the use of glaucoma drugs.