Outcomes of initial and repeat micro-pulse transscleral cyclophotocoagulation in adult glaucoma patients

Background: Micro-pulse transscleral cyclophotocoagulation (MP-TSCPC) has continued to gain popularity as a treatment in adult glaucoma patients. Thus far there is limited evidence reporting the efficaciousness and safety of retreatment. Objective: To evaluate safety and efficacy of primary and repeat MP-TSCPC procedures. Methods: Thirty-four of 67 eyes who failed to achieve target IOP from initial MP-TSCPC underwent repeat MP-TSCPC and followed for a minimum of 6 months. All treatments were performed using the laser power of 2000 or 2250 mW, duration of 100-200 s, and a velocity 16-20 s per hemisphere swipe. Success criteria were defined as intraocular pressure (IOP) reduction of greater than 20% from baseline or any medication reduction without additional glaucoma procedures at 6 months after repeat MP-TSCPC. The 6-month success rate after repeat MP-TSCPC was also compared to that of initial MP-TSCPC in the same group of eyes. Results: Mean baseline IOP before the repeat MP-TSCPC was 23.0 +/- 5.3 on 3.0 +/- 1.4 medications. At 6 months, mean post-op IOP was 18.2 +/- 5.4 (21.9% reduction, p < 0.002), with mean medication staying relatively the same (p = .976). Success rate was increased from 23.5% to 44.1% with the repeat procedure compared to that of initial procedure (p = 0.123). Mean IOP reduction was also greater after repeat MP-TSCPC (18.7%, p < 0.002) when compared to initial MP-TSCPC (10.4%). No adverse events occurred. Conclusions: MP-TSCPC is a safe and effective non-invasive means to lower IOP in a variety of glaucoma patients. While over 50% (34/67) of eyes required repeat MP-TSCPC, repeat treatment resulted in greater success rates and IOP reduction without any adverse events when using the total energy between 112 and 150 J.