Participants underwent MicroPulse transscleral laser therapy, followed by conjunctival biopsies for the analysis of inflammation and fibrosis.

During MicroPulse TLT, all patients received periocular anesthesia, with an injection of 5 to 10 ml of Lidocaine (Xylocaine 5mg/ml ®) to achieve complete anesthesia.

The investigators employed the 810 nm Cyclo G6® Laser in its MicroPulse® mode (Iridex Corporation, Mountain View, CA, USA) and delivered laser energy to the eye using the second-generation MicroPulse P3® probe (Iridex Corporation, Mountain View, CA, USA). The laser was calibrated to generate a power output of 2500 mW, and a MicroPulse duty cycle of 31.3%. The curved end of the probe's footplate (bunny ears) was positioned 0.5 to 1 mm away from the corneoscleral limbus, maintaining a perpendicular orientation to the eyeball.

Following the laser therapy, an immediate conjunctival biopsy measuring 2 * 2 mm and avoiding the laser-treated region was performed.

histological changes of the conjunctiva according to a scale ranging from 0 to 3, with the following interpretation:

• Grade 0: no difference between the two samples
• Grade 1: increase in inflammation / fibrosis < 33%
• Grade 2: increase in inflammation / fibrosis from 33% to 66%
• Grade 3: increase in inflammation / fibrosis > 66%

change in intraocular pression

This score is calculated and ranges from 0 to 100 with the following interpretation:

• 0 to 12 = Normal
• 13 to 22 = Mild ocular surface disease
• 23 to 32 = Moderate ocular surface disease
• 33 to 100 = Severe ocular surface disease