Results of Using a Combination of Micropulse Transscleral Cyclophotocoagulation and Transscleral Focal Full-pulse Cyclophotocoagulation in Patients with Refractory Glaucoma

Objective: to analyze the effectiveness of micropulse transscleral cyclophotocoagulation (MPTC) in combination with focal applications of full-pulse transscleral cyclophotocoagulation (FPTC) of the ciliary body in patients with refractory glaucoma.

Patients and methods. A total of 36 patients (36 eyes), 16 women and 20 men, with a history of refractory terminal glaucoma participated in this openlabel, prospective study. They ranged in age from 37 to 91 years and had a hypotensive medication use ratio of 3.0. Inclusion criteria included refractory glaucoma, primary open-angle terminal glaucoma, and subjective complaints of eye and temporal pain. All patients were divided into two groups based on surgical treatment strategy. The main group (16 patients, 16 eyes — 2 patients with IOL subluxation, 3 patients with operated pseudoexfoliative glaucoma, 3 patients with silicone tamponade, 5 patients with iridocorneal adhesion, 3 patients with neovascular glaucoma) received combined MCFC with TCFC, with an average IOP before surgery of 48.1 mm Hg. The control group (20 patients, 20 eyes — 3 patients with IOL subluxation, 4 patients with operated pseudoexfoliative glaucoma, 3 patients with silicone tamponade, 6 patients with neovascular glaucoma) received only MCFC with an average IOP before surgery of 46.3 mm Hg. Comparative evaluation of effectiveness was carried out based on the average intraocular pressure (IOP) in the early (1 day) and late (1 and 6 months) periods. postoperative period.

Results. The average IOP in the study group in the early postoperative period (1 day — 28.6 mm Hg) was lower than that in the control group (1 day — 29.8 mm Hg). In the late postoperative period, between 1 month and 6 months, the average IOP in the study group also decreased more effectively (1 month — 23.8 mm Hg, 6 months — 17.0 mm Hg) than in the control group (1 month — 27.4 mm Hg, 6 months — 23.6 mm Hg). After 6 months, the average IOP in the study group was 28% lower than in the control group. The rate of antihypertensive drug use after 6 months was 2.4 in the study group, while it remained 3.0 in the control group. The average IOP of the main group was lower than similar indicators in the control group at all stages of postoperative observation.

Conclusion. This study presents the comparative effectiveness of using MCFC in combination with focal TCFC of the ciliary body in patients with refractory glaucoma in terms of the hypotensive effect, reduced use of antihypertensive medications, and the absence of postoperative complications.

1. Kang JM, Tanna AP. Glaucoma. Med Clin North Am. 2021 May;105(3):493–510. doi: 10.1016/j.mcna.2021.01.004.

2. Dietze J, Blair K, Zeppieri M, Havens SJ. Glaucoma. 2024 Mar 16. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.

3. Egorov AE, Movsisyan AB, Shastina VR, Gorin SG. Managing Patients with Decompensed Advanced and Terminal Stage Glaucoma: Ophthalmogerontological Aspects. Problems of Geroscience. 2023;4:209–211 (In Russ.).

4. Kuroyedov AV, Zavadski PC., Zakhidov AB, Chernyakova TV, Zvereva OG, Basinskii AS, Bakunina NA, Brezhnev AYu, Seleznev AV, Gorodnichii VV. Characteristics of predictors for the development of end-stage primary open-angle glaucoma. National Journal glaucoma. 2024;23(3):3–13 (InRuss.). doi: 10.53432/2078-4104-2024-23-3-3-13.

5. Movsisyan AB, Egorov AE, Kuroyedov AV. Effectiveness of minimally invasive glaucoma surgery (review of international experience). National Journal glaucoma. 2022;21(4):56–63 (In Russ.). doi: 10.53432/2078-4104-2022-21-4-56-63.

6. Egorov VV, Postupaev AV, Postupaeva NV. Results of using micropulse cyclophotocoagulation in the treatment of patients with primary open-angle glaucoma. Clinical ophthalmology. 2022;22(4):204–209 (In Russ.). doi: 10.32364/23117729-2022-22-4-204-209.

7. Salazar-Quiñones L, Fernández-Vigo JI, Pérez-Quiñones Y, Montolío-Marzo E, García-Bella J, Morales-Fernandez L, Sánchez-Del-Hoyo R, García-Feijóo J, Martínezde-la-Casa JM. Comparison of intraocular pressure measurements between Easyton transpalpebral tonometry and Perkins, iCare iC100 and Corvis ST, and the influence of corneal and anteriorscleral thickness. Int Ophthalmol. 2023 Nov;43(11):4121–4129. doi: 10.1007/s10792-023-02814-y.

8. Gómez-Gómez A, Talens-Estarelles C, Alcocer-Yuste P, Nieto JC. Reliability of iCare ic100 Rebound Tonometry and Agreement With Goldmann Applanation Tonometry in Healthy and Post-myopic LASIK Patients. J Glaucoma. 2021 Aug 1; 30(8):634–642. doi: 10.1097/IJG.0000000000001878.

9. Tukhtaev BU, Yusupov AA, Yangieva NR, Saidov TT. Our experience in comparative analysis of laser interventions in complex therapy of primary open-angle glaucoma. Advanced Ophthalmology. 2023;4(4):51–55 (In Russ.). doi: 10.57231/j.ao.2023.4.4.008.

10. Ioshin IE. Micropulse transscleral laser cycloplasty (mTLC) — a new name for micropulse cyclophotocoagulation (mCPC). Russian Ophthalmological Journal. 2024;17(3):85–89 (In Russ.). doi: 10.21516/2072-0076-2024-17-3-85-89.

11. Ioshin IE, Tolchinskaya AI, Maksimov IV. Criteria for choosing the energy of micropulse transscleral cyclophotocoagulation. Russian Ophthalmological Journal. 2023;16(4):18–23 (In Russ.). doi: 10.21516/2072-0076-2023-16-4-18-23.

12. Valle IT, Bazarra SP, Taboas MF, Cid SR, Diaz MDA. Medium-term Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma. J Curr Glaucoma Pract. 2022 May-Aug;16(2):91–95. doi: 10.5005/jp-journals10078-1370.

13. Ioshin IE, Tolchinskaya AI, Maximov IV. Comparative Analysis of Treatment of Patients with Refractory Glaucoma of Various Stages by Microimpulse Transscleral Cyclophotocoagulation. Ophthalmology in Russia. 2022;19(2):318–324 (In Russ.). doi: 10.18008/1816-5095-2022-2-318-324.

14. ChuprovAD, FomenkoAV. Long-term results of cyclodestructive surgery forrefractory glaucoma. Vyatka Medical Bulletin. 2023;80(4):54–56 (In Russ.). doi: 10.24412/22207880-2023-4-54-56.