Double-Session Micropulse Transscleral Laser (CYCLO G6) As a Primary Surgical Procedure for Glaucoma

Purpose: To evaluate the safety and effectiveness of double-session micropulse transscleral laser (MP3) as a primary treatment modality for glaucoma.

Materials And Methods: Patients who underwent MP3 therapy with double sessions in each hemifield, with a follow-up period of at least 6 months, were retrospectively considered. Patients were categorized into 2 groups: GI (no previous glaucoma surgery) and GII (with previous glaucoma surgery). Success was defined by either achieving a final intraocular pressure (IOP) between 6 and 18 mm Hg and an IOP reduction of >20%, or a minimum 50% reduction in the number of glaucoma medications, at the last visit, without any serious complications.

Results: Eighty-four eyes were included in the GI group and 101 in the GII group, with the latter demonstrating relatively higher preoperative IOP (31.1±5.4 vs. 26.2±6.9 mm Hg, P<0.001). Final IOP (14.9±5.2 vs. 13.6±4.1 mm Hg, P=0.06), average MP3 treatment time (358.0±50.7 vs. 362.7±67.8 s, P=0.5), and follow-up duration (10.8±5.1 vs. 12.3±5.4 mo, P=0.06) were similar between the groups. The percentage reduction with regard to glaucoma medication was higher in GI than in GII (49.1±28.8 vs. 38.8±30.1%, P=0.02). GI underwent fewer MP3 procedures than GII (1.2±0.5 vs. 1.5±0.8, P=0.002). No hypotony or phthisis bulbi was observed in GI (1 and 2 in GII, respectively). Procedural success was noted in 92.9% of the cases in GI and 87.1% in GII.

Conclusions: Double-session MP3 therapy could be considered as a safe and effective procedure to treat glaucoma in eyes that have not undergone any previous glaucoma surgery. Primary eyes achieved a success-rate similar to those with refractory glaucoma with fewer MP3 procedures and fewer glaucoma medications.