2023循证共识指南：微脉冲经巩膜激光治疗—手术技术、术后护理、预期结果以及再治疗／强化

Clinical OphthalmologyDovepressopen access to scientific and medical researchORIGINAL RESEARCHEvidence-Based Consensus Guidelines Series forMicroPulse Transscleral Laser Therapy SurgicalTechnique,Post-Operative Care,ExpectedOutcomes and Retreatment/EnhancementsTomas M Grippo D',Marc Toteberg-Harms2,Michael Giovingo3,Brian A Francis,Ronald RMPC de Crom5,Brian Jerkins5,Jacob W Brubaker,Jella An8,Nathan Radcliffe,Robert Noecker10Grippo Glaucoma and Cataract Center.Buenos Aires,Argentina;2Department of Ophthalmology.Medical College of Georgia,Augusta University.Augusta,GA USA;3Cook County Health,Chicago,IL USA:Department of Ophthalmology,Doheny and Stein Eye Institutes,David Geffen School ofMedicine.University of California Los Angeles (UCLA).Los Angeles.CA.USA;5University Eye Clinic.Maastricht University Medical CentreMaastricht the Netherlands;Department of Ophthalmology.Hamilton Eye Institute,University of Tennessee Health Science Center.Memphis,TN.USA;7Sacramento Eye Consultants,Sacramento,CA USA;Department of Ophthalmology.Wilmer Eye Institute.ohn Hopkins School of MedicineBethesda,MD,USA;Glaucoma Department.New York Eye and Ear Infirmary.New York,NY.USA:Ophthalmic Consultants of Connecticut.Fairfield,CT.USACorrespondence:Tomas M Grippo.Grippo Glaucoma and Cataract Center,250 Luis Maria Campos,Ist Floor.Suite Capital Federal.1426.Argentina.Tel +54-11-4-774-2930,Email tomasgrippo@yahoo.comPurpose:To provide expert consensus and evidence-based current guidelines on treatment technique,postoperative care,expectedoutcomes and retreatment for MicroPulse Transscleral Laser Treatment(TLT).Methods:A comprehensive search of PubMed led to the identification and analysis of 61 studies on MicroPulse TLT.To provideguidance in areas where there was not enough available literature,a three-round Delphi method was conducted involving 10international experts in MicroPulse TLT.Results:The response rate was 70%in the first round,70%in the second round,and 80%in the third round of the Delphi method.Once all responses were aggregated,a live meeting was held with 90%attendance,and consensus was achieved on each of the findingsdetailed in this manuscript.Conclusion:Used within appropriate treatment parameters,with proper technique and patient selection,Micro Pulse TLT is a safe andeffective treatment for many types and severities of glaucoma.MicroPulse TLT represents a useful addition to the glaucomaarmamentarium.Keywords:glaucoma,MicroPulse,transscleral laser treatmentIntroductionMicroPulse Transscleral Laser Therapy (TLT)is a non-incisional laser treatment for glaucoma.The Cyclo G6 Laser(Iridex,Mountain View,CA,USA)and the MicroPulse P3 Delivery Device (Iridex,Mountain View,CA,USA)use aninfrared diode laser at a wavelength of 810nm in which the continuous energy wave is divided into a series of pulses,minimizing tissue temperature elevation and coagulative damage.The laser is"ON"31.3%of the time (the duty cycle)and "OFF"68.7%of the time.The MicroPulse technology resu