Journal of Current Glaucoma Practice

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VOLUME 16 , ISSUE 2 ( May-August, 2022 ) > List of Articles


Medium-term Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma

Inigo Tejada Valle, Sara Pose Bazarra, Miguel Ferreira Taboas, Sara Rubio Cid, Maria Dolores Alvarez Diaz

Keywords : Diode laser, Intraocular pressure, Micropulse transscleral cyclophotocoagulation, Pseudoexfoliation, Refractory glaucoma

Citation Information : Valle IT, Bazarra SP, Taboas MF, Cid SR, Diaz MD. Medium-term Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma. J Curr Glaucoma Pract 2022; 16 (2):91-95.

DOI: 10.5005/jp-journals-10078-1370

License: CC BY-NC 4.0

Published Online: 30-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To describe our first experience with the efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) procedure in the treatment of different glaucoma subtypes refractory to topical medication using a standard protocol. Materials and methods: Retrospective, interventional study in a series of 35 eyes of 34 patients with refractory glaucoma who underwent MP-TSCPC. Treatment success was defined as an intraocular pressure (IOP) reduction of at least 20% compared to baseline with or without IOP-lowering medication or eventual retreatment. Results: Mean age was 78.0 years. The glaucoma subtypes included pseudoexfoliative (PSXG) (16), neovascular (NVG) (9), primary open-angle (POAG) (7), congenital (1), aphakic (1), and secondary glaucoma (1). The mean preoperative IOP was 31.8 ± 10.5 mm Hg and at month 12 was 21.9 ± 10.6 mm Hg (p < 0.05). The average baseline number of glaucoma medications pretreatment was 3.0 ± 1.0 and at month 12 was 2.3 ± 1.2 (p = 0.114). At month 12, success was achieved in 15 eyes (42.9%) with an IOP-lowering effect of 31.1%. PSXG was correlated with IOP reduction (p = 0.037) and had a higher likelihood of success (p = 0.031). As complications, there was one case of prolonged hypotony and another case of developed postoperative neurotrophic keratopathy. Conclusion: Using our standardized protocol, MP-TSCPC seems a safe and relatively effective treatment in the medium-term for refractory glaucoma, achieving good results in PSXG. Clinical significance: There are few studies published about MP-TSCPC. The results of our study contribute to expanding on the short evidence reported at present, emphasizing our considerable percentage of PSGX.

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  1. Quigley H, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmology 2006;90(3):262–267. DOI: 10.1136/bjo.2005.081224
  2. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014;121(11):2081–2090. DOI: 10.1016/j.ophtha.2014.05.013
  3. Bloom PA, Tsai JC, Sharma K, et al. “Cyclodiode”. Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma. Ophthalmology 1997;104(9):1508–1519. DOI: 10.1016/s0161-6420(97)30109-2
  4. Kosoko O, Gaasterland DE, Pollack IP, et al. Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophthalmology 1996;103(8):1294–1302. DOI: 10.1016/s0161-6420(96)30508-3
  5. Aquino MC, Barton K, Tan AM, et al. Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Exp Ophthalmol 2015;43(1):40–46. DOI: 10.1111/ceo.12360
  6. Tan AM, Chockalingam M, Aquino MC, et al. Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma. Clin Exp Ophthalmol 2010;38(3):266–272. DOI: 10.1111/j.1442-9071.2010.02238.x
  7. Emanuel ME, Grover DS, Fellman RL, et al. Micropulse cyclophotocoagulation: initial results in refractory glaucoma. J Glaucoma 2017;26(8):726–729. DOI: 10.1097/IJG.0000000000000715
  8. Williams AL, Moster MR, Rahmatnejad K, et al. Clinical efficacy and safety profile of micropulse transscleral cyclophotocoagulation in refractory glaucoma. J Glaucoma 2018;27(5):445–449. DOI: 10.1097/IJG.0000000000000934
  9. Yelenskiy A, Gillette TB, Arosemena A, et al. Patient outcomes following micropulse transscleral cyclophotocoagulation: intermediate-term results. J Glaucoma 2018;27(10):920–925. DOI: 10.1097/IJG.0000000000001023
  10. Sanchez FG, Lerner F, Sampaolesi J, et al. Efficacy and safety of micropulse® transscleral cyclophotocoagulation in glaucoma. Arch Soc Esp Oftalmol (Engl Ed) 2018;93(12):573–579. DOI: 10.1016/j.oftal.2018.08.003
  11. Zaarour K, Abdelmassih Y, Arej N, et al. Outcomes of micropulse transscleral cyclophotocoagulation in uncontrolled glaucoma patients. J Glaucoma 2019;28(3):270–275. DOI: 10.1097/IJG.0000000000001174
  12. Nguyen AT, Maslin J, Noecker RJ. Early results of micropulse transscleral cyclophotocoagulation for the treatment of glaucoma. Eur J Ophthalmol 2020;30(4):700–705. DOI: 10.1177/1120672119839303
  13. Souissi S, Baudouin C, Labbé A, et al. Micropulse transscleral cyclophotocoagulation using a standard protocol in patients with refractory glaucoma naive of cyclodestruction. Eur J Ophthalmol 2021;31(1):112–119. DOI: 10.1177/1120672119877586
  14. Jammal AA, Costa DC, Vasconcellos JPC, et al. Prospective evaluation of micropulse transscleral diode cyclophotocoagulation in refractory glaucoma: 1 year results. Arq Bras Oftalmol 2019;82(5):381–388. DOI: 10.5935/0004-2749.20190076
  15. Tekeli O, Köse HC. Outcomes of micropulse transscleral cyclophotocoagulation in primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma. Eur J Ophthalmol 2021;31(3):1113–1121. DOI: 10.1177/1120672120914231
  16. Sanchez FG, Peirano-Bonomi JC, Grippo TM. Micropulse transscleral cyclophotocoagulation: a hypothesis for the ideal parameters. Med Hypothesis Discov Innov Ophthalmol 2018;7(3):94–100.
  17. Shaarawy TM, Sherwood MB, Grehn F. Guidelines on Design and Reporting of Surgical Trials. World Glaucoma Association; 2009. 90 p.
  18. Kaba Q, Somani S, Tam E, et al. The effectiveness and safety of micropulse cyclophotocoagulation in the treatment of ocular hypertension and glaucoma. Ophthalmol Glaucoma 2020;3(3):181–189. DOI: 10.1016/j.ogla.2020.02.005
  19. de Crom RMPC, Slangen CGMM, Kujovic-Aleksov S, et al. Micropulse trans-scleral cyclophotocoagulation in patients with glaucoma: 1- and 2-year treatment outcomes. J Glaucoma 2020;29(9):794–798. DOI: 10.1097/IJG.0000000000001552
  20. Kuchar S, Moster MR, Reamer CB, et al. Treatment outcomes of micropulse transscleral cyclophotocoagulation in advanced glaucoma. Lasers Med Sci 2016;31(2):393–396. DOI: 10.1007/s10103-015-1856-9
  21. Gavris MM, Olteanu I, Kantor E, et al. IRIDEX MicroPulse P3: innovative cyclophotocoagulation. Rom J Ophthalmol 2017;61(2):107–111. DOI: 10.22336/rjo.2017.20
  22. Radhakrishnan S, Wan J, Tran B, et al. Micropulse cyclophotocoagulation: a multicenter study of efficacy, safety, and factors associated with increased risk of complications. J Glaucoma 2020;29(12):1126–1131. DOI: 10.1097/IJG.0000000000001644
  23. Sarrafpour S, Saleh D, Ayoub S, et al. Micropulse transscleral cyclophotocoagulation: a look at long-term effectiveness and outcomes. Ophthalmol Glaucoma 2019;2(3):167–171. DOI: 10.1016/j.ogla.2019.02.002
  24. Preda MA, Karancsi OL, Munteanu M, et al. Clinical outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma-18 months follow-up. Lasers Med Sci 2020;35(7):1487–1491. DOI: 10.1007/s10103-019-02934-x
  25. Sanchez FG, Peirano-Bonomi JC, Brossard BN, et al. Update on micropulse transscleral cyclophotocoagulation. J Glaucoma 2020;29(7):598–603. DOI: 10.1097/IJG.0000000000001539
  26. Perez CI, Han Y, Rose-Nussbaumer J, et al. Neurotrophic keratitis after micropulse transscleral diode laser cyclophotocoagulation. Am J Ophthalmol Case Rep 2019;15:100469. DOI: 10.1016/j.ajoc.2019.100469
  27. Fernández VGÁ, Barraquer CRI, Cárcamo MAL, et al. Neurotrophic keratitis after transscleral diode laser cyclophotocoagulation. Arch Soc Esp Oftalmol 2016;91(7):320–326. DOI: 10.1016/j.oftal.2015.12.001
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