Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients

Abstract

This study aims at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma. Patients with moderate to advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable anti-glaucoma medications were selected to undergo MP-TSCPC, using the MP3 handpiece with the Iridex IQ810 (IRIDEX Laser Systems, Mountain View, CA). Follow-up examinations took place on a regular basis until 15 months postoperatively. Seventy-five eyes of 69 patients (53.6% males) were included. Mean age was 55.5±22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity (CDVA) at baseline ranged between 0 and 2.1 logMAR. Mean pre-laser IOP was 26.0±7.91▒mm Hg. This was reduced significantly to 13.8±5.6▒mm Hg (44.0% reduction; P<0.001) at week 1, and to 18.0±7.7, 18.4±7.1, 16.7±6.2, 15.1±4.1, 15.7±5.32 and 14.8±5.50▒mm Hg at months 1, 3, 6, 9, 12 and 15, respectively. The mean number of anti-glaucoma drops decreased significantly up to 12 months of follow-up (P=0.008) and that of oral acetazolamide tablets decreased significantly up to 15 months (P<0.001). The success rate decreased progressively with time reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered and no eyes lost vision completely. MP-TSCPC is an efficient non-invasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.