Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma


Dr Anna M Tan, Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore. Email: amwttan@yahoo.com


Background:  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.

Methods:  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.

Results:  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 (< 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%.

Conclusion:  Micropulse TSCPC is a safe and effective method of lowering IOP in cases of refractory glaucoma and is comparable with conventional TSCPC.