Transscleral Micropulse Cyclophotocoagulation: Our Experience

Abstract

Introduction
Traditionally, ciliary body destruction has been used to treat uncontrolled intraocular pressure (IOP) following maximally tolerable
medical therapy. This is due to the large number of complications seen with this procedure. However, recently a new technique
of sub-threshold laser or micropulse laser, is able to provide selective destruction of the ciliary body in a controlled manner. This
avoids most of the complications seen with other modalities. We have performed a small case descriptive pilot study to assess the
effectiveness of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in lowering IOP.
Methods
This pilot study was conducted on four patients in the age range 55-70-years with intractable glaucoma. Two patients had primary angle closure glaucoma, one-each had steroid-induced glaucoma and neovascular glaucoma. Mean baseline IOP was 32±2.4
mmHg. Mean number of glaucoma medications were 2.5±1.5. All patients underwent 180° MP-TSCPC. Absolute success was
defined as IOP<20 mmHg without acetazolamide.
Results
Following the procedure the patients were followed-up at days 1,7,30 and 90. At the last follow-up of the study, mean IOP was
18.2±1.2 mmHg in all four patients. Mild anterior chamber inflammation was the only complication noted. Mean number of
glaucoma medications reduced to 1.5±1.0 following the procedure. Thus, absolute success was achieved in all patients.
Conclusion
This small pilot study validates other studies which show effectiveness of MP-TSCPC as an efficient and safe procedure to lower
IOP. This procedure can be used over a wide variety of cases, though the indications for such procedures are still evolving. More
extensive and long-term studies will clarify the position of this procedure in our glaucoma management practices.