Micropulse trans-scleral diode laser cyclophotocoagulation in refractory glaucoma: an initial experience in Indian eyes

Purpose To evaluate the efficacy and safety of micro-pulse trans-scleral diode laser cyclophotocoagulation (MP-TSCPC) in Indian eyes with refractory glaucoma. Methods A prospective interventional short-term study was carried out with relatively small sample size of 55 eyes with refractory glaucoma. All eyes had visual acuity (VA) and intraocular pressure (IOP) measurements at baseline, 1 week (1w), 1 month (1 m) and 3 months (3 m). A single surgeon treated all eyes with recommended MP-TSCPC treatment settings. Surgical success was defined as achieving an IOP between 8-21 mmHg or achieving > 20% IOP reduction. Results The age of participants was 56.98 +/- 15.74 years. Our study had more number of males. VA (in logMAR) at baseline was 1.38 +/- 0.99. VA was 1.43 +/- 0.93 at 1w, 1.47 +/- 0.94 at 1 m and 1.47 +/- 0.96 at 3 m (p > 0.05 for all). IOP (in mmHg) at baseline was 30.38 +/- 10.70. IOP was 15.72 +/- 6.85 at 1w, 16.98 +/- 8.72 at 1 m and 17.60 +/- 8.40 at 3 m (p < 0.001 for all). At 3 m, 49 (89.1%) eyes had surgical success. Surgical success was lesser in primary open angle glaucoma (p = 0.03). IOP at baseline showed significant correlation with percentage reduction in IOP at each review (p < 0.05). Use of glaucoma medication reduced from 2.94 +/- 0.98 to 2.01 +/- 1.16 at 3 m (p < 0.001). At 3 m, hypotony was noted in 4 (7.3%) eyes and reduction in visual acuity was seen in 15 (27.3%) eyes. Conclusion Initial experience in Indian eyes has shown that MP-TSCPC is safe and effective for refractory glaucoma. Patients can expect significant IOP lowering along with reduction in number of topical medications required for control of IOP.