Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study.

BACKGROUND The aim of this study was to compare the efficacy and safety of micropulse and continuous wave diode transscleral cyclophotocoagulation in refractory glaucoma. DESIGN Randomized, comparative, exploratory study in a tertiary hospital setting. PARTICIPANTS Patients with refractory, end-stage glaucoma. METHODS Forty-eight patients were randomized to either treatment. The intraocular pressure, visual acuity, number of medicines and repeat treatment were monitored for 18 months. Complications that include visual acuity decline, prolonged anterior chamber inflammation, phthisis bulbi, scleral thinning and ocular pain were noted. MAIN OUTCOME MEASURE Intraocular pressure between 6 and 21 mmHg and at least a 30% reduction with or without anti-glaucoma medications after 18 months. RESULTS A successful primary outcome was achieved in 75% of patients who underwent micropulse cyclophotocoagulation and 29% of patients who received continuous wave cyclophotocoagulation after 12 months (P < 0.01). At 18 months, successful outcome was 52% and 30% (P = 0.13), respectively. The mean intraocular pressure was reduced by 45% in both groups (P = 0.70) from a baseline of 36.5 mmHg and 35.0 mmHg (P = 0.50) after 17.5 ± 1.6 months (range 16-19) follow up. No significant difference in retreatment rates or number of intraocular pressure lowering medications was noted. The ocular complication rate was higher in continuous wave treated eyes (P = 0.01). CONCLUSION Diode transscleral cyclophotocoagulation in both micropulse and continuous modes was effective in lowering intraocular pressure. The micropulse mode provided a more consistent and predictable effect in lowering intraocular pressure with minimal ocular complications.