performance. Numerous reports have documented the reliability of the G-probe’s energy output after multiple uses [29, 30]. Before and after each use, we clean the probe with 70% isopropyl alcohol and visually inspect the tip for abnormalities. Debris caught in the lumen can become charred, which can decrease the energy subsequently delivered. Others clean the tip with mild dish detergent followed by a water rinse and then a 20-min soak in hydrogen peroxide followed by another water rinse and drying. One paper reported no adverse effects to the probe appearance or performance after sterilization with ethylene oxide [31].

Summary for the Clinician

››TCP can be safely and easily performed in a clinical setting, such as the examination room or even a hospital room.

››A retrobulbar block is necessary.

››Treating 360° reduces the number of repeat procedures and has not been associated with increased phthisis in our patients.

››Initial power is set at 1,750–2,000 mW and is adjusted according to the auditory pop which indicates too much power, while 2,000 ms is constant.

››The G-probe of the diode laser unit can be reused several times without sacrificing safety or efficacy.

34.4  How Should One Manage the Postoperative Course? When Can One Expect the Pressure to Drop After TCP? When Can Medications be Tapered off After TCP?

Upon completion of the procedure, a steroid or steroid– antibiotic ointment and 1% atropine drops are applied to the eye, and the eye is patched overnight or at least until the anesthesia has worn off. The patient is seen the following day and started on prednisolone 1% qid and occasionally­ continued on the atropine 1% bid. Most patients continue with their IOP-lowering drops until the IOP-lowering effect of TCP is observed, although pros­ taglandin analogs and cholinergics are usually stopped

after the procedure. The prednisolone and atropine are tapered off as the inflammation and discomfort improve, usually over the course of 1 month.

We expect to see a pressure-lowering effect by 1 week, although it can be appreciated as soon as 1 day. The maximum IOP-lowering effect is usually obtained by 1 month. IOP-lowering medications are tapered off gradually until safe IOPs are attained.

If IOPs are trending downward, we observe the patient until the pressures stabilize at a safe range. If pressures are consistently at an undesired level, we consider repeating the TCP. For persistently high IOPs, we have repeated TCP therapy as early as 1 week, but we prefer to delay retreatment for at least 1 month. Retreatments follow the same protocol as the initial treatment and typically involve 360°.

Summary for the Clinician

››Topical prednisolone 1% qid and occasionally atropine 1% bid are typically sufficient for inflammation management.

››IOP-lowering drops are decreased depending on the pressure-lowering response to TCP.

››One should expect to see a pressure-lowering effect by 1 week. IOP lowering may be appreciated as soon as 1day, but it may take one month or more to see the full benefits.

››Retreatment, if necessary, is ideally delayed for 1 month, but can be performed as early as 1 week after the last TCP.

››Retreatment is performed over 360°.

34.5  What Complications May be Encountered and How Can I Specifically Manage Each One? What is the Long-Term Efficacy and Safety Data on TCP?

The patient will usually experience mild to moderate pain, which is often described as a dull headache, after the anesthesia wears off. However, the pain can typically be controlled by a mild analgesic, such as acetaminophen or ibuprofen, and is usually gone by the next morning.