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Patient Outcomes Following Micropulse Transscleral Cyclophotocoagulation: Intermediate-term Results

Yelenskiy, Aleksandr, MD*; Gillette, Thomas B., MD*; Arosemena, Analisa, MD; Stern, Augustus G., MD; Garris, Winston J., MD§; Young, Curt T., MD; Hoyt, Michelle, OD; Worley, Nancy, BS*; Zurakowski, David, MS, PhD; Ayyala, Ramesh S., MD, FRCS#

doi: 10.1097/IJG.0000000000001023
Case Report/Small Case Series

Purpose: To report the safety and efficacy outcomes following micropulse transscleral cyclophotocoagulation (MPTSCPC) procedure in patients with uncontrolled glaucoma.

Materials and Methods: Longitudinal retrospective cohort, multicenter study. Patients with different types of glaucoma who underwent MPTSCPC with P3 probe between July 2015 and May 2017. Patients were treated by different glaucoma specialists from 5 different locations (Tulane Study Group). Data on preoperative characteristics, surgical procedure(s) performed, and postoperative outcomes were collected and analyzed. Statistical analysis using logistic regression and Kaplan-Meier analysis was performed with Stata software. Intraoperative and postoperative complications, intraocular pressure, visual acuity, need for incisional glaucoma surgery, need for repeat micropulse, and number of topical medications were studied.

Results: One hundred ninety-seven eyes from 161 patients were included. Median follow-up was 12 months [interquartile range (IQR), 6 to 14]. Glaucoma diagnosis included 141 primary open-angle glaucoma (POAG), 8 neovascular glaucoma, and 12 others. The total success rate was 71%. Two percent (4 patients) developed postoperative cystoid macular edema. Preoperative mean intraocular pressure (SD) was 22±9 and 16±6 mm Hg at last follow-up (P<0.001). Median preoperative logMAR visual acuity (IQR) was 0.4 (0.2 to 1.0) and 0.3 (0.2 to 1.0) at last follow-up (P=0.65, Wilcoxon signed-rank test). Median number (IQR) of topical medications was 3 (1 to 4) preoperative and 2 (1 to 3) at last follow-up (P<0.001). Kaplan-Meier analysis indicated 90% of patients free from repeat MPTSCPC at 12 months. Multivariable logistic regression identified 3 significant independent predictors of total success: diagnosis (P=0.011) (POAG), previous glaucoma surgery (P=0.003), and other concurrent procedures (P=0.013).

Conclusions: Our large longitudinal cohort study has provided evidence that MPTSCPC is a safe and generally effective option in the treatment of POAG up to 12 months.

*Department of Ophthalmology, Tulane University School of Medicine, Tulane University, New Orleans, LA

Aran Eye Associates, Miami

#Department of Ophthalmology, Marsoni School of Medicine, Tampa, FL

Maryland Vision Institute, Hagerstown, MD

§Carolina Eye Associates, Southern Pines, NC

Vision Care of Maine, Bangor, ME

Department of Anesthesia and Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA

Supported by Tulane Glaucoma Research Fund.

Poster abstract presented at the American Academy of Ophthalmology Annual Meeting, 2017.

Disclosure: The authors declare no conflict of interest.

Reprints: Ramesh S. Ayyala, MD, FRCS, Department of Ophthalmology, Marsoni School of Medicine, 13330 USF Laurel Dr 4th floor, Tampa, FL 33613 (e-mail: rayyala@health.usf.edu).

Received January 15, 2018

Accepted June 25, 2018

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