Comparative Efficacy and Safety of Micropulse Versus Continuous-Wave Transscleral Cyclophotocoagulation in the Management of Refractory Glaucoma: A Prospective Cohort Study

PRCIS: Micropulse transscleral cyclophotocoagulation (MP-TSCPC) has gained considerable acceptance as a preferred cyclodestructive intervention for refractory glaucoma, offering significantly enhanced safety profiles through precisely controlled pulse energy delivery while maintaining equivalent therapeutic outcomes compared with traditional modalities. OBJECTIVE: To compare the efficacy and safety profiles of MP-TSCPC versus continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in patients with refractory glaucoma. MATERIALS AND METHODS: This prospective, randomized, single-blind study included 52 patients (52 eyes) with refractory glaucoma assigned to either MP-TSCPC or CW-TSCPC. Patients were followed for 18 months. Secondary outcomes included absolute IOP values, medication reduction, preservation of visual acuity, visual function parameters, quality of life, and complication rates. Success was defined as IOP between 6-21 mm Hg without medications (complete success), with medications (qualified success), or either (cumulative success). Patients were followed for 18 months. RESULTS: At 18 months, 47 eyes completed follow-up (24 in MP-TSCPC and 23 in CW-TSCPC). The MP-TSCPC group (n=24) achieved a 34.43% IOP reduction from baseline, compared with 42.86% in the CW-TSCPC group (n=23), P=0.052. Complete success rates were 25.00% (6/24) for MP-TSCPC and 21.74% (5/23) for CW-TSCPC (P=0.999), while qualified success rates were 29.16% (7/24) and 39.13% (9/23), respectively (P=0.550). The cumulative success rates were 54.17% for MP-TSCPC and 60.87% for CW-TSCPC (P=0.706). The CW-TSCPC group experienced significantly higher rates of postoperative pain (56.52% vs. 20.83%, P=0.012) and prolonged inflammation (34.78% vs. 8.33%, P=0.039). Visual function parameters remained stable in both groups throughout the study period. Quality of life improved significantly in the MP-TSCPC group but not in the CW-TSCPC group, although between-group differences were not statistically significant. CONCLUSION: MP-TSCPC demonstrated comparable efficacy to CW-TSCPC in IOP reduction and success rates for refractory glaucoma management, while offering a significantly improved safety profile with less postoperative pain and inflammation. These findings suggest that MP-TSCPC may be considered as a preferred initial cyclodestructive option when balancing efficacy and safety, though larger studies are needed to confirm these findings.