Efficacy and safety of micropulse versus continuous wave transscleral diode cyclophotocoagulation in treating...

The goal of this study was to compare the efficacy and tolerability of conventional transscleral cyclophotocoagulation (CW-TSCP) versus micropulsed diode laser (MPTLT) in the treatment of glaucoma.

In this single-center retrospective study, all patients treated with CW-TSCP or MPTLT between January 2018 and December 2020 at Nantes University Hospital with at least one month of follow-up were included. Intraocular pressure (IOP), glaucoma medications, use of new laser treatment and complications were recorded at 1, 3, 6, 12 and 24 months. Success was defined as an IOP of 6-21mmHg or a ≥20% IOP reduction from the preoperative measurement, with the same or fewer glaucoma medications and no alternative glaucoma surgery.

Thirty-seven eyes treated with MPTLT and 26 eyes treated with CW-TSCP were included. At the last visit (median=16 months), 69% of eyes treated with CW-TSCP and 54% treated with MPTLT met the success criterion (P=0.720). The mean reduction in IOP from baseline was 8.0mmHg in the CW-TSCP group and 2.1mmHg in the MPTLT group (P=0.030). The mean reduction in medications was 1.24 in the CW-TSCP group and 0.6 in the MPTLT group. Among patients treated with oral acetazolamide, 9 patients (69%) in the CW-TSCP group and 3 patients (33%) in the MPTLT group had discontinued the acetazolamide. Persistent hypotony was a significantly more frequent complication in the CW-TSCP group (n=3; 8%) than in the MPTLT group (n=1; 2%).

While both CW-TSCP and MPTLT are effective treatments for lowering IOP over an extended period, CW-TSCP resulted in a more substantial reduction in IOP and greater decreases in the need for glaucoma eye drops and oral acetazolamide, albeit at the cost of a higher incidence of persistent hypotony. Further prospective randomized studies are needed to confirm the superior efficacy of CW-TSCP over MPTLT and to better assess its tolerability.