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Micropulse transscleral cyclophotocoagulation: initial results using a reduced energy protocol in refractory glaucoma

Abstract

Purpose

This study evaluates the 6-month safety and efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma/ocular hypertension using a reduced energy protocol.

Methods

Retrospective analysis of patients undergoing MP-TSCPC from January–April 2018 was carried out. Patients received up to 90 s of laser with settings of 2000 mW/Cm2 and a duty cycle of 31.3%.

Results

A total of 29 patients were included, with a mean age of 64.7 ± 15.1 years. The most common diagnosis was primary open angle glaucoma (41.4%) with a mean Logmar visual acuity of 1.5 ± 1.2. All subjects had either undergone intraocular surgery (58.6% filtration surgery) or continuous wave diode laser prior to micropulse treatment. Mean pre-laser IOP was 26.2 ± 11.1 mmHg. There was a significant reduction (p < 0.05) in IOP at 1 month to 15.8 ± 5.4 mmHg (39.7% reduction), at 3 months to 15.04 ± 5.25 mmHg (42.6% reduction) and at 6 months to 18.19 ± 7.47 mmHg (30.6% reduction). There was also a corresponding reduction (p < 0.05) in the number of topical agents required to control pressure from a baseline of 3.31 ± 0.97, to 2.72 ± 0.88 at 1 month, 2.76 ± 0.91 at 3 months and 2.90 ± 1.08 at 6 months. Requirements for oral acetazolamide reduced from 41.3% (1/29) at baseline to 3.4% (1/29) at 6 months. Success rates were 75.9% at 1 month, 79.3% at 3 months and 58.6% at 6 months. There was no drop in the visual acuity, no change in central retinal thickness and no cases of intraocular inflammation.

Conclusions

MP-TSCPC at a decreased duration is effective at reducing intraocular pressure in ethnically diverse glaucoma patients refractory to previous glaucoma laser or surgeries at 6 months follow-up, with no significant complications. Further work is needed to confirm efficacy in the long term and to determine optimal settings.

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Author information

Correspondence to Niten Vig.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Western Eye Hospital and carried out in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent is not required for this study.

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Vig, N., Ameen, S., Bloom, P. et al. Micropulse transscleral cyclophotocoagulation: initial results using a reduced energy protocol in refractory glaucoma. Graefes Arch Clin Exp Ophthalmol (2020). https://doi.org/10.1007/s00417-020-04611-0

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Keywords

  • Glaucoma
  • Micropulse laser
  • Cyclophotocoagulation
  • Intraocular pressure