Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma: Two-year Results of a Prospective Multicenter Study

Purpose: To evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) for refractory glaucoma. Patients and Methods: This prospective multicenter study included 62 eyes of 57 refractory glaucoma patients. MP-TSCPC was performed from August 2022 to May 2023. All patients had a complete ophthalmic examination preoperatively, including medical history, slit-lamp examination, best-corrected visual acuity (BCVA) assessment, and pre- and post-operative intraocular pressure (IOP) measurements. The main outcomes included IOP change, antiglaucoma medication use, the cumulative incidence of treatment success, and the postoperative complications over 24 months. Treatment success was defined as an IOP reduction of more than 20% compared with baseline or a decrease in the number of antiglaucoma medications with stable target IOP. Retreatments were classified as failures. Results: The glaucoma subtypes included primary glaucoma (n=29) and secondary glaucoma (n=33). Prior glaucoma surgery had been performed in 48 of the 62 eyes (77.4%), with 30 of them having multiple types of surgery. Preoperatively, the mean IOP was 38.2± 10.3 mmHg and the median number of antiglaucoma medications used was 3.0 (2.0, 3.0); these values decreased to 20.9± 8.8 mmHg (a reduction of 42.7%; P< 0.001) and 2.0 (0.0, 3.0) (P< 0.001) at month 24, respectively. The treatment success rate was 77.4% at 24 months. Postoperative complications included mydriasis (n=10), conjunctival hemorrhage (n=9), mild anterior chamber inflammation (n=1), hyphema (n=1), mild ciliary body detachment (n=3), and choroidal detachment (n=1), all reversible after treatment. Conclusion: MP-TSCPC appears to be a safe and effective treatment option for refractory glaucoma.