# Outcomes and success predictors of micropulse transscleral cyclophotocoagulation in patients with refractory glaucoma

## TL;DR

This study shows that micropulse transscleral cyclophotocoagulation can effectively lower eye pressure in patients with hard-to-treat glaucoma.

## Contribution

The study identifies early intraocular pressure reduction as a predictor of long-term success in this glaucoma treatment.

## Key findings

- Micropulse transscleral cyclophotocoagulation reduced intraocular pressure significantly in refractory glaucoma patients.
- Success rates at 12 months were 54.9% and 49.7% for two defined criteria.
- Early intraocular pressure reduction at 1 month predicted 1-year success.

## Abstract

This study aimed to report the surgical outcomes and success predictors of
micropulse transscleral cyclophotocoagulation in eyes with refractory
glaucoma.

This was a noncomparative, interventional case series. Patients with
refractory glaucomas, defined as eyes with prior incisional glaucoma surgery
failure and uncontrolled intraocular pressure, who underwent micropulse
transscleral cyclophotocoagulation between March 2017 and June 2021 were
enrolled. A minimum follow-up period of 6 months was required. Preoperative
and postoperative intraocular pressure, number of hypotensive medications,
surgical complications, and any subsequent related events were recorded.
Success criteria were as follows: 1) intraocular pressure reduction
≥20% and intraocular pressure ≤18 mmHg; 2) intraocular
pressure reduction ≥30% and intraocular pressure ≤15 mmHg. The
need for topical hypotensive medications was not considered a failure.

Seventy-nine (79) eyes (79 patients; mean age, 57.5 ± 20.6 years) were
included. Overall, the median follow-up duration was 12.0 (interquartile
interval, 6–24) months, and the mean intraocular pressure was reduced from
22.8 ± 6.8 mmHg to 15.5 ± 5.6 mmHg at the last follow-up visit
(p<0.001). The mean number of medications was reduced from 2.8 ±
0.7 to 2.0 ± 1.0 (p<0.01). At 12 months postoperatively, the
success rates for criteria 1 and 2 were 54.9% and 49.7%, respectively. Aside
from one case of corneal ulcer, which fully resolved with clinical
treatment, and two cases of persistent hypotony (with no visual acuity loss
during follow-up), no other vision-threatening complications were observed
during the postoperative period. The magnitude of intraocular pressure
reduction at 1 month (adjusted to preoperative intraocular pressure;
HR=1.01; p=0.002).

Our findings suggest that micropulse transscleral cyclophotocoagulation is a
relatively effective alternative for managing refractory glaucomas, with
minor postoperative complications. In addition, the initial intraocular
pressure reduction was a statistically significant predictor of 1-year
success in patients undergoing micropulse transscleral
cyclophotocoagulation.