Efficacy of a Novel Zigzag Application Pattern for Micropulse Transscleral Cyclophotocoagulation for the Management of Glaucoma

Précis: A zigzag mode of application effectively lowered IOP in glaucoma patients at 6 months with a low incidence of complications despite the longer application time. Comparative studies to assess the potential advantages of treating a larger area of ciliary body with this approach are needed. Purpose: The purpose of this study is to evaluate the clinical outcome of micropulse transscleral laser cyclophotocoagulation with zigzag mode of application in adult glaucomatous patients. Subjects and Methods: A prospective single-arm clinical trial included a series of 34 eyes of 30 consecutive patients who underwent micropulse transscleral cyclophotocoagulation (MP-TSCPC) with zigzag technique at a private ophthalmology center. The trial was conducted from March 16, 2021 to April 12, 2021. Patients who had at least 6 months of follow-up were included. MP-TSCPC probe was moved for 2 mm perpendicular to a line 3 mm parallel to the cornea. This aims to cover the largest circumference of the area supposed to hinder the cilliary body. The probe is moved over 3 quadrants for 90 seconds for each quadrant (total 270 s). Defined as an intraocular pressure (IOP) of 6 to 21 mm Hg or a reduction of IOP by 30%. Failure was defined as an inability to meet the criteria for success or need for retreatment. Results: The mean age of involved patients was 52.9 (±SD: 3.9) years old. The mean IOP before MP-TSCPC was 37.47 (±SD: 11.08) mm Hg, which was significantly reduced to 17.7 (±SD: 7.4) mm Hg in the last follow-up visit at 6 months. Number of medications showed significant reduction from mean 3.44 (±SD: 0.99) to 1.91 (±SD: 1.26) in the last follow-up. Success rate was found to be 88% (30 out of 34 eyes) at the final follow-up, where 9 cases showed complete success (26.5%), whereas 21 (61.8%) cases showed qualified success. Despite the relatively higher parameters used in our study, no cases reported postoperative complications apart from only 1 case of reduced visual acuity by 1 line. Conclusions: A zigzag mode of application effectively lowered IOP in glaucoma patients at 6 months with a low incidence of complications despite the longer application time. Comparative studies to assess the potential advantages of treating a larger area of ciliary body with this approach are needed.