Outcomes of Micro Pulse Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma

Doi: 10.36351/pjo.v39i2.1574

Abstract

Purpose:  To evaluate the outcomes of Micro Pulse Transscleral Diode Laser cyclophotocoagulation (MP – TSCPC) in terms of surgical success and safety in various types of refractory glaucoma.

Study Design:  Interventional case series.

Place and Duration of Study:  Ophthalmology department of Rawalpindi Medical University and Allied hospitals from June 2021 to December 2022.

Methods:  Sixty eyes of 59 patients with refractory glaucoma underwent MP – TSCPC with A.R.C Fox portable diode laser. Fox Micro cyclo probe delivered 2000 mW for 80-84 seconds for each 180 – degree arc 3 mm from the limbus. The duty cycle was 31.3% with 0. 5 ms on time and 1.1 ms off time. Best-corrected visual acuity and intraocular pressure were documented pre-laser as a baseline and post-laser at one week and then at 1, 3, and 6 months. Intraoperative and post-laser complications were also noted.

Results:  A significant reduction in IOP from baseline was seen at each follow-up. The mean pre-laser and post-laser Best corrected visual acuity was 0.06 ± 0.17 Snellen decimal. Nine eyes had early mild post-laser inflammation, 3 eyes had early hypotony and tonic pupil, and 2 eyes had IOP spike while corneal edema and hyphaema were seen in 1 eye each. Treatment success was seen in 51 (85%) patients at 3 months and 48 (80%) patients at 6 months. Use of antiglaucoma medications decreased from 3.85 ± 0.10 to 1.07 ± 0.16 which was statistically significant (p = 0.000).

Conclusion:  MP – TSCPC is a safe, effective, and noninvasive method of treatment for refractory glaucoma leading to both persistent reductions of intraocular pressure and decreased need for topical anti-glaucoma medications without significant intraoperative and post-laser complications.