Micropulse Versus Continuous Wave Transscleral Cyclophotocoagulation in Refractory Pediatric Glaucoma.

PURPOSE

The aim of this study was to compare the safety and efficacy of micropulse cyclophotocoagulation (MP-CPC) and transscleral continuous wave cyclophotocoagulation (CW-CPC) for the treatment of refractory glaucoma in the pediatric age group.

METHODS

This prospective study included 45 eyes of 36 children requiring transscleral cyclophotocoagulation, in the period spanning from September 2016 to August 2017, using micropulse (MP-CPC) or continuous wave (CW-CPC) modes. The intraocular pressure (IOP) reduction, success rates, and complications were compared for both groups. Success was defined as an IOP of 5 to 21 mm Hg, in the absence of vision-threatening complications at 6 months.

RESULTS

The MP-CPC group included 17 eyes, in patients aged 67.8±48 months, and the CW-CPC group included 28 eyes, in patients aged 61.3±38.3 months. There was a tendency toward lower IOP in the MP-CPC group at all follow-ups, almost reaching statistical significance at 2 weeks and 3 months (P=0.05). IOP reduction was 63% in the MP-CPC group and 67% in the CW-CPC group (P=0.6). The success rate was higher in the MP-CPC group (71% vs. 46% in the CW-CPC group), but the difference was not significant (P=0.1). No significant complications were noted in the MP-CPC group whereas, in the CW-CPC group, 1 eye developed phthisis bulbi, and 2 eyes had severe pain and uveitis (P=0.3).

CONCLUSIONS

Both the MP-CPC and CW-CPC are effective in lowering the IOP in children with refractory glaucoma. However, the rate of complications, pain, and inflammation seem to be lower with the micropulse mode, making it a safer alternative for cyclophotocoagulation, especially since retreatments are often needed.