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Inflammation and patient satisfaction in micropulse versus continuous wave transscleral cyclophotocoagulation
Leonie Franziska Keidel1, Franziska Eckardt2, Matthias Nobl2
1Department of Ophthalmology, Ludwig Maximilian University of Munich, Munchen, Germany leonie.keidel@med.uni-muenchen.de.
Background/Aims:
This work aims to clarify whether micropulse transscleral cyclophotocoagulation (MPCPC) is gentler in terms of postoperative inflammation and is better tolerated compared with continuous wave cyclophotocoagulation (CWCPC).
Methods:
Prospective, randomised controlled, interventional, single-centre trial performed at the Ludwig Maximilians University Munich from January 2020 to July 2023. In all patients, a laser flare meter was used to measure anterior chamber flare (ACF). Central macular thickness (CMT) was assessed using optical coherence tomography. To quantify pain perception and quality of life (QoL), patients completed the Visual Analogue Scale (VAS) and the Glaucoma Activity Limitation 9 questionnaire.
Results:
60 eyes of 60 patients were included, with 30 eyes in the MPCPC group and 30 eyes in the CWCPC group. A significantly higher increase in ACF was found after CWCPC as compared with MPCPC at 1 day (p=0.004) and 1 week after surgery (p=0). ACF values equalised at week 6 (p=0.270) and month 3 (p=0.610). The increase in ACF at week 1 did not show a significant correlation with the final decrease in intraocular pressure (IOP, p=0.465). Moreover, the CWCPC group showed a markedly higher increase in CMT (165.5 (15-354) µm vs 55.8 (24-141) µm). VAS and QoL scores did not show to be significantly different.
Conclusions:
Compared with MPCPC, patients treated with CWCPC presented with more marked ACF only in the early postoperative period. ACF did not correlate with final IOP. CWCPC and MPCPC are equally well tolerated in terms of pain perception and QoL, but CWCPC may cause more severe inflammatory macular oedema.
Insights
Micropulse transscleral cyclophotocoagulation (MPCPC) causes less postoperative inflammation than continuous wave cyclophotocoagulation (CWCPC). Both MPCPC and CWCPC are equally tolerated, but CWCPC may lead to more severe macular edema.
Area of Science:
- Ophthalmology
- Glaucoma Treatment
- Laser Therapy
Background:
- Glaucoma management often requires procedures to reduce intraocular pressure (IOP).
- Transscleral cyclophotocoagulation is a surgical option for glaucoma.
- Continuous wave cyclophotocoagulation (CWCPC) and micropulse cyclophotocoagulation (MPCPC) are two types of this laser treatment.
Purpose of the Study:
- To compare the postoperative inflammatory response and patient tolerance between MPCPC and CWCPC.
- To evaluate if MPCPC is a gentler alternative to CWCPC regarding inflammation and tolerability.
Main Methods:
- A prospective, randomized controlled trial involving 60 patients (60 eyes).
- Measurements included anterior chamber flare (ACF) using a laser flare meter and central macular thickness (CMT) via OCT.
- Pain and quality of life were assessed using the Visual Analogue Scale (VAS) and Glaucoma Activity Limitation 9 questionnaire.
Main Results:
- CWCPC resulted in significantly higher ACF at 1 day and 1 week post-surgery compared to MPCPC (p<0.05).
- ACF levels normalized by 6 weeks and 3 months.
- The CWCPC group showed a greater increase in CMT, indicating more macular edema.
- No significant differences in VAS or quality of life scores were observed between the groups.
Conclusions:
- CWCPC induces more pronounced early postoperative inflammation (ACF) and macular edema compared to MPCPC.
- Both MPCPC and CWCPC demonstrate similar patient-reported outcomes in terms of pain and quality of life.
- MPCPC may be preferable to CWCPC to minimize early postoperative inflammation and macular edema.
