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.