Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma

Abstract

Transscleral diode laser cyclophotocoagulation (TSCPC) is an established method of treatment for refractory glaucoma, but is associated with significant complications. This study evaluates the efficacy and safety of a new form of TSCPC using micropulse diode laser and trans-pars plana treatment with a novel contact probe. Prospective interventional case series of 40 eyes of 38 consecutive patients with refractory glaucoma treated with micropulse TSCPC with a novel probe. Outcomes measured were success, hypotony and response rates. The mean age of patients was 63.2 +/- 16.0 years. The mean follow-up period was 16.3 +/- 4.5 months. The mean intraocular pressure (IOP) before micropulse TSCPC was 39.3 +/- 12.6 mmHg. Mean IOP decreased to 31.1 +/- 13.4 mmHg at 1 day, 28.0 +/- 12.0 mmHg at 1 week, 27.4 +/- 12.7 mmHg at 1 month, 27.1 +/- 13.6 mmHg at 3 months, 25.8 +/- 14.5 mmHg at 6 months, 26.6 +/- 14.7 mmHg at 12 months and 26.2 +/- 14.3 mmHg at 18 months (P < 0.001 at all time points). No patient had hypotony or loss of best-corrected visual acuity. The overall success rate after a mean of 1.3 treatment sessions was 72.7%. Micropulse TSCPC is a safe and effective method of lowering IOP in cases of refractory glaucoma and is comparable with conventional TSCPC.