Clinical outcomes of slow-coagulation continuous wave diode transscleral cyclophotocoagulation laser for treatment of refractory glaucoma

Purpose: To evaluate the short-term safety and efficacy of slow-coagulation trans-scleral cyclophotocoagulation (SC-TSCPC) in patients with refractory glaucoma. Methods: A retrospective study was done on 140 patients (144 eyes) with a diagnosis of refractory glaucoma and vision more than 2/60 with a minimum follow-up of 6 months. All patients underwent SC-TSCPC (800-milliwatt power and 4 seconds duration). The primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21 mmHg or ≥20% IOP reduction from the baseline value, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures include percentage of IOP reduction, glaucoma medications, visual acuity, and complications. Results: Mean IOP decreased from 40.97 ± 12.00 mmHg preoperatively to 19.31 ± 9.91 mmHg (mean percentage IOP reduction = 52.9%) at 6 months postoperatively ( P < 0.0001). The number of glaucoma medications also dropped from 3.0 ± 0.89 at baseline to 2.0 ± 1.4 at 6 months ( P = 0.0003). No significant deterioration in visual acuity was observed during 6 months follow-up ( P < 0.0001). The cumulative probabilities of success at 1, 3, and 6 months were 86.1%, 77.4%, and 66.64%, respectively. Eyes with baseline IOP >30 mmHg demonstrated lower success rates, higher postoperative complications, and greater need for additional glaucoma interventions compared with eyes having baseline IOP <30 mmHg. The most common complications observed were uncontrolled IOP and anterior chamber inflammation. Endophthalmitis and retinal detachment were seen in one patient at 6-month follow-up. Conclusion: SC-TSCPC may serve as a useful adjunct or temporizing procedure in selected refractory glaucoma patients who are at high risk for invasive glaucoma surgery. Patients with high preoperative IOP required more surgical interventions and also had more complications warranting individualized laser energy settings.