Slow-Coagulation Continuous-Wave Cyclophotocoagulation vs. Micropulse Laser Treatment Procedure in Refractory Glaucoma: A Randomized Clinical Trial.

PURPOSE

To evaluate the effectiveness of transscleral diode laser cyclophotocoagulation in a population of patients with refractory glaucoma, comparing the results between the slow-coagulation continuous-wave cyclophotocoagulation (SC-CPC) and micropulse laser treatment (MP-LT) techniques.

DESIGN

Prospective 2-center randomized clinical trial.

SUBJECTS

Sixty eyes from 60 patients with medically uncontrolled glaucoma under maximum therapy and no prior cyclodestructive procedures.

METHODS

Patients were enrolled at 2 centers and randomly assigned to laser treatment with SC-CPC or MP-LT. The technique was standardized (1250 mW, 4 s/spot, 20 spots for SC-CPC; 2000 mW, 90 s/quadrant, 31.3% duty-cycle for MP-LT; the 3- and 9-o'clock meridians were spared in both groups). Success was defined as postoperative intraocular pressure (IOP) between 6 and 18 mmHg and ≥20% reduction, without the need for additional glaucoma surgery or clinically significant visual acuity loss, including loss of light perception.

MAIN OUTCOME MEASURES

Treatment success over 18 months. The secondary outcome measures included postoperative IOP, number of IOP-lowering medications, need for retreatments, postoperative complications, and visual acuity throughout follow-up.

RESULTS

Treatment success was achieved in 70.0% of SC-CPC eyes and 30.0% of MP-LT eyes (log-rank test, P = 0.001), with a lower cumulative failure probability in the SC-CPC group (33.4% vs. 70.4%). At the last visit, the mean IOP was significantly lower in the SC-CPC group compared to the MP-LT group (18.4 ± 12.9 mmHg vs. 22.5 ± 9.3 mmHg; P = 0.005), with a greater percentage reduction from baseline (23.1% vs. 11.5%; P = 0.020). The SC-CPC group required fewer IOP-lowering medications at final follow-up (2.1 ± 1.1 vs. 2.7 ± 1.1; P = 0.020). Repeated treatments and additional surgeries were more frequent in the MP-LT group.

CONCLUSIONS

Slow-coagulation continuous-wave cyclophotocoagulation demonstrated superior IOP control and lower surgical failure rates compared to MP-LT. These findings support SC-CPC as a more effective option for refractory glaucoma. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.