Grippo Tomas M, de Crom Ronald M P C, Giovingo Michael, Töteberg-Harms Marc, Francis Brian A, Jerkins Brian, Brubaker Jacob W, Radcliffe Nathan, An Jella, Noecker Robert
Department of Ophthalmology, Hospital Aleman, Buenos Aires, Argentina.
University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands.
Clin Ophthalmol. 2022 Jun 7;16:1837-1846. doi: 10.2147/OPTH.S365647. eCollection 2022.
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.
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.
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.
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.
基于文献综述和德尔菲法，提供关于微脉冲经巩膜激光治疗（TLT）最佳剂量测定和患者选择的基于共识的现行指南。
对PubMed进行全面检索，从而识别和分析61项关于微脉冲TLT的研究，这些研究包含激光设置和患者选择方面的信息。为了在现有文献不足的领域确定共识，采用了三轮德尔菲法。
德尔菲技术第一轮的回复率为90%，第二轮为90%，第三轮为80%。汇总所有回复后，召开了一次出席率为80%的现场会议，并就本手稿详细阐述的各项研究结果达成了共识。
微脉冲TLT是青光眼治疗手段中的一项有益补充。当按照本手稿所述的能量设置，采用适当的手术技术使用时，微脉冲TLT对多种类型和阶段的青光眼是一种安全有效的治疗方法。基于当前的知识和经验，该专家小组的共识性建议是，使用改良型微脉冲P3探头的标准微脉冲TLT设置应为2500毫瓦、31.3%的占空比，每侧半球以每秒20秒的扫描速度进行4次扫描。应治疗双侧半球，避开3点和9点时钟方位。该小组还就微脉冲TLT的患者选择达成了共识，为该手术的应用提供了指导。
