Five-year Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma: Intraocular Pressure Reduction, Surgical Success, and Safety

Background: Long-term real-world evidence regarding the efficacy and safety of micropulse transscleral cyclophotocoagulation (MPCPC) remains limited. Aim: To evaluate the 5-year efficacy and safety of MPCPC in refractory glaucoma. Methods: This single-center retrospective study evaluated 42 eyes of 30 patients who underwent MPCPC between January 1, 2019, and May 31, 2020. All procedures followed a standardized protocol using a 2.0 W power setting for 180 s. The primary outcome was surgical success, defined as an intraocular pressure (IOP) reduction of ≥20% from baseline. Secondary outcomes included changes in visual acuity, antiglaucoma medication burden, and the incidence of ocular adverse events. Results: Mean IOP significantly decreased from 28.9 ± 11.6 mm Hg at baseline to 24.4 ± 10.4 mm Hg at 12 months and 21.5 ± 11.5 mm Hg at 60 months (all P < 0.05). Success rates were 54.3% at 1 year and 51.7% at 5 years. In the multivariable Firth regression model, each 1 mm Hg increase in baseline IOP was associated with a 16% increase in the probability of 1-year success (odds ratio: 1.16; 95% confidence interval: 1.05–1.29; P = 0.0048). While the topical medication burden remained unchanged, oral acetazolamide use significantly decreased at 1 month ( P = 0.039). Visual acuity declined in 58.1% of eyes at 5 years, largely attributable to disease progression in this refractory cohort. No severe complications, such as hypotony or phthisis bulbi, were observed. Conclusion: MPCPC provides a sustained, long-term IOP-lowering effect with a favorable safety profile in a real-world refractory population. This study addresses a critical evidence gap by demonstrating treatment durability up to 5 years and identifying preoperative IOP as a key predictor of success in an ethnically Chinese cohort.