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Published on: January 26, 2018
Clinical Efficacy and Safety Outcomes of Micropulse Transscleral Diode Cyclophotocoagulation in Patients With
Edward J Y Lim1, Aquino M Cecilia2, Dawn K A Lim2
1Yong Loo Lin School of Medicine.
Precis:
Micropulse transscleral cyclophotocoagulation (MPTCP) is only moderately effective in lowering intraocular pressure (IOP) and is useful as an adjunct procedure to other glaucoma surgeries. There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi.
Aim:
The aim of this study was to determine the efficacy and safety of a single MPTCP treatment for an Asian population with advanced glaucoma.
Methods:
This is a retrospective single-center study of 207 eyes (207 patients) with advanced glaucoma which underwent first-time MPTCP between January 1, 2008, and March 31, 2018. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, and without glaucoma reoperation. The IOP, best-corrected visual acuity, and number of glaucoma medications were also analyzed.
Results:
The mean (SD) age was 64.9±16.9 years. The mean follow-up duration was 18.7±16.2 months. The rate of success at postoperative years 1 and 2 follow-up was 44.1% and 32.6%, respectively. The median survival time of MPTCP was 9.0 months and 85 (40.9%) eyes received reoperation. The mean IOP decreased from 31.5±12.0 mm Hg preoperatively to 22.1±10.3 and 23.8±11.8 mm Hg at postoperative years 1 and 2, respectively (P<0.0001). The mean number of glaucoma medications was reduced from 3.3±1.0 preoperatively to 2.6±1.1 and 2.4±1.1 at postoperative years 1 and 2, respectively (P<0.0001). Significant complications included prolonged hypotony [1 eye (0.5%)], phthisis bulbi [7 eyes (3.4%)], and best-corrected visual acuity reduction [29 eyes (13.9%)].
Conclusion:
Single first-time MPTCP for advanced glaucoma eyes was moderately effective in lowering IOP but >50% failed by 1 year.
Insights
Micropulse transscleral cyclophotocoagulation (MPTCP) moderately lowers intraocular pressure in advanced glaucoma patients. However, over half of patients experienced treatment failure within one year, necessitating further interventions.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Medical Technology
Background:
- Micropulse transscleral cyclophotocoagulation (MPTCP) is an established glaucoma treatment.
- Its efficacy as a standalone procedure for advanced glaucoma requires further investigation, particularly in diverse populations.
- MPTCP has shown moderate success but carries risks like vision loss and hypotony.
Purpose of the Study:
- To evaluate the efficacy and safety of a single MPTCP treatment.
- To assess long-term outcomes in an Asian population with advanced glaucoma.
- To determine the success rate and complication profile of MPTCP.
Main Methods:
- Retrospective single-center study of 207 patients with advanced glaucoma.
- First-time MPTCP procedure performed between January 2008 and March 2018.
- Success defined as IOP 6-21 mmHg or ≥20% reduction without increased medication or reoperation.
Main Results:
- Mean IOP decreased from 31.5 mmHg to 22.1 mmHg at year 1 and 23.8 mmHg at year 2 (P<0.0001).
- Success rates were 44.1% at year 1 and 32.6% at year 2; 40.9% required reoperation.
- Complications included phthisis bulbi (3.4%) and visual acuity reduction (13.9%).
Conclusions:
- Single MPTCP is moderately effective for lowering IOP in advanced glaucoma.
- More than 50% of patients failed MPTCP within one year, indicating limited long-term efficacy.
- MPTCP may serve as an adjunct but not a definitive primary treatment for advanced glaucoma.
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