Micropulsed diode laser transscleral cyclophotocoagulation: An effective technique whose role remains to be defined

Micropulse Transscleral Cyclophotocoagulation (MP-TSCP) is a recently developed cyclodestructive procedure less aggressive than conventional TSCP. In this study, we aimed to evaluate the safety and efficacy of MP-TSCP in a real-life setting. Material and methods: We retrospectively included all MP-TSCP cases performed in the Bicêtre Hospital Ophthalmology department between January 2017 and September 2019. Intraocular pressure (IOP) and hypotensive medications were recorded preoperatively, at month 1, 3, 6 and at the conclusion of follow-up, as well as postoperative adverse events. Success was defined as an IOP between 6 and 21 mmHg with a decrease of at least one medication or an IOP reduction > 20%. Results: Thirty eyes (28 patients) were included. Preoperative IOP was 27.2 ± 10.6 mmHg, with 3.5 ± 0.6 hypotensive medications, the mean deviation on the Humphrey 24-2 visual field was −21.9 ± 6.9 dB, and 43% of eyes had a past history of filtering surgery. The mean follow-up was 13.5 ± 8.1 months. Eleven patients (37%) had to be retreated with MP-TSCP during follow-up. At 3 and 6 months and at the conclusion of follow-up, the IOP was 18.3 ± 7.3 mmHg (−33%; P < 0.0001), 22.5 ± 11.8 mmHg, (−17%; P = 0.052), 22.7 ± 12.0 mmHg (−16,5%; P < 0.050), respectively. The success rates were 57%, 50% et 53% at 3 months, 6 months and at the conclusion of follow-up, respectively. Severe adverse events included 3 cases of corneal ulcers and 2 cases of severe but transient ocular hypotony without visual impairment. Conclusion: MP-TSCP is an effective procedure for severe and/or refractory glaucoma, but retreatments are required in more than one-third of cases. Further studies are warranted to define factors predictive of success and indications for retreatment.