Efficiency of micropulse transscleral cyclophotocoagulation in patients with refractory, operated open-angle glaucoma and preserved visual functions

Introduction . Glaucoma is one of the most common visual pathologies leading to blindness and low vision worldwide. Refractory glaucoma is characterized by a severe course and resistance to traditional treatment methods. One of the promising treatments for such patients is micropulse transscleral cyclophotocoagulation (mCPC), which allows laser energy to be delivered to a localized area in doses without causing thermal damage to the structures of the ciliary body. With the advent of this method, new opportunities have emerged in the treatment of patients not only in the terminal stages of glaucoma with residual visual functions but also in the earlier stages of the disease with preserved and even high vision. Purpose : to evaluate the effectiveness of mCPC in patients with refractory, operated glaucoma with preserved visual functions using ultrasound biomicroscopy (UBM). Materials and methods . From April 2023 to January 2024, 80 patients aged 68,3 ± 5,6 years with refractory, operated open-angle glaucoma were examined and prescribed mCPC using the Quantel Medical device (Supra 810, France). The patients were divided into 2 groups: Group I consisted of 32 patients (32 eyes) with advanced glaucoma, while Group II included 48 patients (48 eyes) with far-advanced glaucoma. All patients were on the maximum antihypertensive regimen and had a history of repeated laser and surgical interventions. The procedure was carried out using standardized technology. Results . In the early postoperative period, a hypothensive effect was achieved in all cases, with an average intraocular pressure (IOP) decreased by 38%. The antihypertensive regimen was discontinued in 37% of patients. By the 9 th month, 55% of patients had reduced the number of medications used, and 45% of patients in the second group underwent repeated mCPC, after which the IOP decreased to 16,7 ± 0,06 mm Hg in this group. Conclusion . mCPC is an effective and safe method for treating refractory, operated glaucoma, leading to a persistent decrease in IOP without affecting visual functions and the structure of ciliary body. It also reduces the number of used antihyperthensive drugs used.