Cyclodiode vs micropulse transscleral laser treatment

AbstractPurpose: Continuous wave transscleral cyclophotocoagulation (CW‐TSCPC), is reserved for refractory glaucoma with poor visual potential due to its complication rate, attributed to continuous energy damaging adjacent tissues. Micropulse (MP‐TSCPC), however, utilizes short energy pulses separated by ‘off’ periods, and is associated with a lower complication rate. The National Institute for Health and Care Excellence has deemed evidence surrounding MP‐TSCPC as inadequate, limiting its use to research purposes. This study aims to evaluate the efficacy and safety of MP‐TSCPC compared to CW‐TSCPC. It also aims to investigate whether glaucoma type affects treatment outcomes.Methods: This retrospective study included 86 CW‐TSCPC eyes and 188 MP‐TSCPC eyes at a London tertiary centre. Follow‐up was conducted for 24‐months. Primary outcome was overall treatment success defined as success at the last available follow‐up. Success required at least 20% IOP reduction, with the same or fewer medications, and IOP between 6–18 mmHg (complete success)/19–21 mmHg (qualified success). Secondary outcomes were retinal nerve fibre layer (RNFL) thickness progression, and visual field (VF) change. Safety outcomes were visual acuity (VA) and complication rate.Results: 24‐months success rate was 27.6% for CW‐TSCPC and 30.1% for MP‐TSCPC, p = 0.96. Average IOP was reduced by 44.8% (CW‐TSCPC) and 26.5% (MP‐TSCPC) from baseline 19.0 ± 3.0 mmHg and 19.1 ± 2.2 mmHg, respectively. Both interventions significantly reduced glaucoma medications at 24‐months (p ≤ 0.05). The proportion of patients experiencing complication(s) was significantly higher after CW‐TSCPC (32.9%) vs MP‐TSCPC (16.2%, p = 0.002). Both procedures displayed VA worsening. RNFL thickening rate was greater following CW‐TSCPC (p = 0.31). MP‐TSCPC reduced VF loss rate significantly among severe disease (p = 0.04).Conclusions: Both interventions demonstrated similar success rates, and reduced IOP and glaucoma medications. MP‐TSCPC displayed minimal complications. There was no clear association between glaucoma type and treatment outcomes. Further prospective studies, with measures of medication compliance, are required to further evaluate MP‐TSCPC efficacy and safety compared to CW‐TSCPC.