MP3 Plus: A Modified Micropulse Trans-scleral Cyclophototherapy Technique for the Treatment of Refractory Glaucoma.

Precis: In advanced refractory glaucoma which has failed prior MP3 laser, MP3 Plus is effective in reducing intraocular pressure (IOP) without significant complications. It is also useful as a temporizing procedure before incisional surgery. Purpose: To evaluate the efficacy and safety of MP3 Plus, a novel technique using modified micropulse transscleral cyclophototherapy (MPTCP) in eyes with refractory glaucoma or failed MPTCP treatment. Methods: This is a retrospective interventional case series. In total, 32 consecutive eyes from 29 patients with uncontrolled IOPs who had previous MPTCP or refractory glaucoma underwent MP3 Plus, a modified MPTCP where additional discrete pulses are applied. The main outcome measurement was IOP at 1, 3, 6, and 12 months postprocedure, with success defined as a 20% reduction in baseline IOP, an IOP of 25 mmHg or less, and no need for further reoperation. We collected and analyzed visual acuity, number of glaucoma medications, and complications. Results: The patients had an average of 1.4 +/- 0.9 glaucoma procedures before 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 posttreatment 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 preoperatively to 2.8 +/- 1.2 (n=16; P<0.05) at 12 months. There were no cases of prolonged inflammation or hypotony. Conclusions: MP3 Plus is effective and safe in lowering IOP in eyes with refractory glaucoma after previous failed MPTCP.