Transscleral Micropulse Cyclophotocoagulation for the Treatment of Refractory Primary Congenital Glaucoma: A Case Series

Primary congenital glaucoma is a rare but vision-threatening disease. Transscleral micropulse cyclophotocoagulation (MPCPC) delivers diode laser energy in short pulses with intervening off periods, allowing tissue cooling and potentially reducing adjacent thermal damage. However, evidence on MPCPC for childhood glaucoma among Japanese patients remains limited. In this series, we describe our experience with MPCPC in refractory cases of primary congenital glaucoma. All procedures were performed under general anesthesia. All four patients had primary congenital glaucoma that had remained uncontrolled despite multiple previous surgeries. Case 1 was a 12-year-old female who had undergone three trabeculotomies in the right eye. Her intraocular pressure (IOP) decreased transiently after MPCPC but rose again within three months. Case 2 was an 11-year-old male who had undergone three trabeculotomies in the right eye. Although the right eye showed an initial reduction in IOP after MPCPC, the effect was not sustained. Case 3 was a 10-year-old male who had previously undergone two trabeculotomies and Ahmed glaucoma valve implantation in the right eye. His IOP remained inadequately controlled after MPCPC. Case 4 was a three-year-old male who had undergone two trabeculotomies in the right eye. His IOP decreased for several months after MPCPC but rose again at nine months. No vision-threatening complications were observed. MPCPC for primary congenital glaucoma in eyes with multiple prior glaucoma surgeries may offer a favorable safety profile but limited and short-lived efficacy.