Efficacy of slow-coagulation cyclophotocoagulation after failed MicroPulse cyclophotocoagulation in refractory glaucoma

Slow-coagulation continuous wave cyclophotocoagulation (SC-CWCPC) is a promising treatment option for refractory glaucoma. However, its efficacy following a failed MicroPulse transscleral cyclophotocoagulation (MP-TSCPC) procedure remains unexplored. This study evaluates the efficacy of SC-CWCPC in patients with uncontrolled intraocular pressure (IOP) after undergoing MP-TSCPC. A retrospective case series of patients with uncontrolled glaucoma who underwent SC-CWCPC following MP-TSCPC failure was conducted. All procedures were performed by a single glaucoma surgeon between January 2022 And October 2024. Patients with < 3 months follow-up were excluded. SC-CWCPC was performed using 1250-milliwatt power and 4-second applications. Surgical success was defined as IOP between 6 and 21 mmHg with a ≥ 20% reduction from baseline on topical medication, no incisional reoperation for glaucoma, and no loss of light perception vision. Eight patients (10 eyes) with a mean age of 43.75 ± 24.59 years were included. 90% (9/10) had prior Tube/Trabeculectomy procedures. Mean preoperative IOP was 26.10 ± 15.80 mmHg on 3.1 ± 1.20 antiglaucoma medications (AGM). At a mean follow up time of 10.97 ± 3.42 months, IOP decreased to 15.80 ± 5.31 mmHg (p = 0.002) with 2.30 ± 1.49 AGM (p = 0.070) with an overall success rate of 80%. One eye required Ahmed Glaucoma Valve implantation one year postoperatively while another had prolonged inflammation that resolved medically. No cases of persistent hypotony or significant visual acuity loss occurred. SC-CWCPC is an effective and safe surgical intervention in patients with refractory glaucoma following failed MP-TSCPC. The results of our study are helpful in expanding the role of the SC-CWCPC technique in the management of glaucomatous patients.