Safety and efficacy of micropulse transscleral cyclophotocoagulation: 2-year follow-up in a tertiary Canadian centre

Objective To describe the long-term results of patients undergoing micropulse cyclophotocoagulation (MPCPC). Methods Retrospective review of patients undergoing MPCPC with 1 surgeon between July 2016 and January 2017. Data collected included preoperative intraocular pressure (IOP), number of medications, daily acetazolamide use, and whether inferior, superior, or circumferential MPCPC was performed. This was assessed at postoperative week 1 and postoperative months 1, 3, 6, 12, 18, and 24. Results A total of 49 patients undergoing MPCPC with 2-year follow-up data was included. Ages ranged from 20 to 91 years (mean age, 69 years; 50% female). Following MPCPC, IOP was significantly lower at all points of follow-up (p < 0.05). At 2-year follow-up, the average IOP was 15 mm Hg (35% reduction). Six patients remained on acetazolamide (average daily dose, 333 mg). Average number of medications had decreased to 2.6 (p > 0.05). No significant structural complications occurred, but 53% required repeat MPCPC applications. The most common complication was failure requiring a secondary IOP-lowering surgical procedure. This occurred in 33% of patients. Subsequent glaucoma surgeries included gonioscopy-assisted transluminal trabeculotomy, iStent, Xen glaucoma implant, and Ahmed glaucoma valve. Conclusions MPCPC was successful in reducing IOP in conjunction with a nonsignificant reduction in topical glaucoma medications. However, a large proportion of patients required repeat micropulse applications or invasive glaucoma surgery to achieve IOP control. These results suggest that the clinical efficacy of MPCPC may be lower than that reported in the literature.