Patient Outcomes Following Micropulse Transscleral Cyclophotocoagulation: Intermediate-term Results

Abstract

To report the safety and efficacy outcomes following micropulse transscleral cyclophotocoagulation (MPTSCPC) procedure in patients with uncontrolled glaucoma. Longitudinal retrospective cohort, multicenter study. Patients with different types of glaucoma who underwent MPTSCPC with P3 probe between July 2015 and May 2017. Patients were treated by different glaucoma specialists from 5 different locations (Tulane Study Group). Data on preoperative characteristics, surgical procedure(s) performed and postoperative outcomes were collected and analyzed. Statistical analysis using logistic regression and Kaplan-Meier analysis was performed with Stata software. Intraoperative and postoperative complications, IOP, visual acuity, need for incisional glaucoma surgery, need for repeat micropulse, and number of topical medications were studied. 197 eyes from 161 patients were included. Median follow-up was 12 months (IQR 6-14). Glaucoma diagnosis included 141 POAG, 8 NVG, and 12 others. The total success rate was 71%. 2% (4 patients) developed postop CME (cystoid macular edema). Preoperative mean IOP (SD) was 22±9▒mmHg and 16±6▒mmHg at last follow-up (P<0.001). Median preop logMAR VA (IQR) was 0.4 (0.2-1.0) and 0.3 (0.2-1.0) at last follow-up (P=0.65, Wilcoxon signed-ranks test). Median number (IQR) of topical medications was 3 (1-4) preop and 2 (1-3) at last follow-up (P<0.001). Kaplan-Meier analysis indicated 90% of patients free from repeat MPTSCPS at 12 months. Multivariable logistic regression identified three significant independent predictors of total success: diagnosis (P=0.011) (POAG), previous glaucoma surgery (P=0.003) and other concurrent procedures (P=0.013). Our large longitudinal cohort study has provided evidence that MP-TSCPC is a safe and generally effective option in the treatment of POAG up to 12 months.