Comparison of micropulse and continuous-wave transscleral cyclophotocoagulation: a tertiary center experience

OBJECTIVE: To compare the effectiveness and safety of micropulse (MP-CPC) and continuous-wave cyclophotocoagulation (CW-CPC). DESIGN: A retrospective, comparative cohort study. PATIENTS: Patients with all types of glaucoma and severity having received MP-CPC or CW-CPC between 2017 and 2021 followed for 2 years. METHODS: Complete success is defined as intraocular pressure (IOP) of 6-21 mm Hg and IOP reduction from baseline of 30% or higher with no additional glaucoma medications. Qualified success includes those with additional glaucoma medications. Safety outcomes include vision loss, visual field (VF), optical coherence tomography (OCT), CPC retreatment, additional glaucoma surgeries, and adverse events. RESULTS: 118 eyes and 114 eyes underwent CW-CPC and MP-CPC, respectively. There was a trend toward better survival in CW-CPC throughout the 24 months, notably at 6 and 18 months (p < 0.04). CW-CPC required significantly less glaucoma medication throughout the follow-up than MP-CPC (p = 0.049). Safety outcomes showed no difference in significant vision loss or change in VF and OCT. Ocular inflammation was more common in the CW-CPC group (33.1% vs 18.4%; p = 0.01), but similar rates of hypotony were observed in both groups (12% vs 9.6%; p = 0.73). The MP-CPC group needed additional incisional glaucoma surgeries sooner than the CW-CPC group (6.7 months vs 10.8 months; p = 0.002). CONCLUSION: CW-CPC demonstrated better IOP control with less use of glaucoma drops than MP-CPC. Early retreatment was more common and occurred sooner in the MP-CPC group. Ocular inflammation was more common with CW-CPC, but overall safety parameters were comparable between the 2 groups.