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Comparative Study
. 2024 Jun;38(8):1477-1484.
doi: 10.1038/s41433-024-02929-1. Epub 2024 Jan 30.

Cyclodiode vs micropulse transscleral laser treatment

Monica Kelada  1 , Eduardo M Normando  2   3   4 , Francesca M Cordeiro  3   4   5 , Laura Crawley  3   4 , Faisal Ahmed  3   4 , Sally Ameen  4 , Niten Vig  4   6 , Philip Bloom  3   4
Affiliations
Comparative Study

Cyclodiode vs micropulse transscleral laser treatment

Monica Kelada et al. Eye (Lond). 2024 Jun.

Abstract

Background: Continuous-wave transscleral cyclophotocoagulation (CW-TSCP) is usually reserved for advanced/refractory glaucoma. Micropulse transscleral laser therapy (MPTLT) utilises short energy pulses separated by 'off'-periods. MPTLT is postulated to have fewer complications, but its relative efficacy is not known. The National Institute for Health and Care Excellence (NICE) has deemed the evidence supporting MPTLT use of inadequate quality, limiting its use to research. This study aims to evaluate MPTLT efficacy and safety compared to CW-TSCP.

Methods: This 24-month follow-up retrospective audit included 85 CW-TSCP and 173 MPTLT eyes at a London tertiary referral centre. Primary outcome was success rate at the last follow-up; defined as at least 20% intraocular pressure (IOP) reduction with the same/fewer medications, and IOP between 6 and 18 mmHg. Secondary outcomes were acetazolamide use and success rates per glaucoma type. Safety outcomes were reported as complication rates.

Results: By 24-months, mean IOP reduced from 34.6[±1.4]mmHg to 19.0[ ± 3.0]mmHg post-CW-TSCP (p < 0.0001); and from 26.1[±0.8]mmHg to 19.1[±2.2]mmHg post-MPTLT (p < 0.0001). Average IOP decreased by 45.1% post-CW-TSCP, and 26.8% post-MPTLT. Both interventions reduced medication requirements (p ≤ 0.05). More CW-TSCP patients discontinued acetazolamide (p = 0.047). Overall success rate was 26.6% for CW-TSCP and 30.6% for MPTLT (p = 0.83). Only primary closed-angle glaucoma saw a significantly higher success rate following CW-TSCP (p = 0.014). CW-TSCP complication rate was significantly higher than MPTLT (p = 0.0048).

Conclusion: Both treatments significantly reduced IOP and medication load. CW-TSCP had a greater absolute/proportionate IOP-lowering effect, but it carried a significantly greater risk of sight-threatening complications. Further prospective studies are required to evaluate MPTLT compared to CW-TSCP.

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Conflict of interest statement

PB received consultancy fees from BVI and travelling expenses and honoraria from Iridex. EMN has received travelling expenses from Iridex. MK, FMC, LC, FA, SA, NV declare no potential conflict of interest.

Figures

Fig. 1
Fig. 1. IOP and average number of glaucoma medications after CW-TSCP and MPTLT.
A The effect of CW-TSCP (white circle) and MPTLT (black circle) on IOP. B The effect of CW-TSCP (white bar) and MPTLT (black bar) on the average number of glaucoma medications required. Vertical error bars represent SEM. *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001, ****p ≤ 0.0001—Wilcoxon matched pairs signed-rank test comparing pre-operative vs follow-up IOP after CW-TSCP (grey asterisks)/MPTLT (black asterisks). Paired t-test used for day-1, 3-months, 6-months MPTLT (parametric). Mann-Whitney U test comparing pre-operative and follow-up average number of medications after CW-TSCP (grey asterisks)/MPTLT (black asterisks). CW-TSCP continuous wave transscleral cyclophotocoagulation, MPTLT micropulse transscleral laser therapy, IOP intraocular pressure, n number of eyes at follow-up.
Fig. 2
Fig. 2. Kaplan-Meier analysis using cumulative probability of overall treatment success.
Overall success: success at the last available follow-up. Success at follow-up: ≥ 20% IOP reduction AND IOP 6–18 mmHg, with the same or fewer glaucoma medications. Failure: an inability to reach either success criteria at 2 successive visits/an increased number of glaucoma medications/a need for an additional laser treatment/a need for alternative glaucoma surgery. 85 eyes underwent CW-TSCP, 173 eyes underwent MPTLT. Vertical bars represent SEM. Mantel-Cox test was used to test for significance between two curves (p = 0.94). CW-TSCP continuous wave transscleral cyclophotocoagulation, MPTLT micropulse transscleral laser therapy, IOP intraocular pressure.
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