Efficacy, Repeatability, and Safety of Retreatment with Micropulse Cyclophotocoagulation in the Management of...

This study investigated the effectiveness, repeatability, and safety of retreatments with micropulse transscleral cyclophotocoagulation (MP-TSCPC).

A retrospective cohort study was conducted on 76 eyes of patients with glaucoma who underwent standardized MP-TSCPC at the University Eye Clinic Maastricht between November 2016 and February 2019. Patients with at least one retreatment and a follow-up of 6 months or more were included and divided into four groups on the basis of their response to the primary treatment: nonresponder (NR), early attrition (EA), late attrition (LA), and enhancement (EH). Intraocular pressure (IOP) and IOP lowering medication use were recorded, and complications were assessed. Treatment success was defined as an IOP reduction of ≥ 20% compared with baseline or a decrease in the number of IOP-lowering medications with stable target IOP.

Three months after retreatment, the NR, EA, LA, and EH groups experienced significant IOP reductions of 24.7%, 35.3%, 24.7%, and 28.2%, respectively. Significant medication reduction was observed only in the EH group. At the last follow-up, treatment success was achieved in 39.4% (NR), 33.3% (EA), 41.7% (LA), and 60.0% (EH) of the patients. Among patients receiving a second retreatment, the EH group demonstrated the most favorable and sustained outcomes. Early postoperative complications after retreatment (5.26%) were mild and reversible. A late complication of persistent hypotony developed in one patient (1.3%). Additional glaucoma surgery was required in 28.9% of the eyes.

Retreatment with micropulse TSCPC is a safe and effective option for (further) lowering IOP in patients with glaucoma. Especially patients who responded well to the primary treatment and patients who initially showed a good response but in whom the effect of the primary treatment has worn off have shown to be good candidates for retreatment. Repeatability and treatment success are most evident in initial responders and the primary benefit of retreatment is IOP reduction, with a less consistent effect on reducing IOP lowering medications.