Micropulse Cyclophotocoagulation Outcomes in Primary Open Angle Glaucoma

Main Article Content

D. Dansdill
K. Pikey
R. Krishna


Background: Micropulse cyclophotocoagulation (MPCPC) uses a pulsed application of laser energy to produce a more mild and predictable lowering of intraocular pressure (IOP) compared to traditional CPC with fewer adverse events. It is unclear if particular types of glaucoma are better suited for treatment with MPCPC. Primary open angle glaucoma (POAG) is a leading cause of visual disability in the world and is the most common form of glaucoma in the United States.  A retrospective, observational clinical study was done in order to determine the efficacy and safety of MPCPC specifically for patients with POAG in an urban patient population at a tertiary referral academic medical center.

Methods: Patients with primary open angle glaucoma who underwent an MPCPC procedure and had never undergone previous cyclodestructive procedures were considered.  Patients were followed for 6 consecutive months.  IOP, number of topical glaucoma medications, and best corrected visual acuity (BCVA) were recorded prior to the laser procedure, and at follow-up intervals of 1, 3, and 6 months after the procedure. Procedural success was defined as a 20% reduction in IOP, with IOP between 6-21, and no need for subsequent glaucoma filtering surgery. A Wilxocon signed rank test was used to determine statistical significance.

Results: A total of 39 eyes in patients aged 28-82 with POAG that underwent MPCPC were included in the study. Mean baseline IOP was 22.9 mmHg, mean baseline number of drops was 3.1, and mean baseline BCVA in LogMAR notation was 1.0.  The MPCPC procedure produced a statistically significant decrease in IOP of 42.1% (p<0.001), 31.0% (p<0.001), and 34.0% (p<0.001) at 1, 3, and 6 months respectively. The number of required topical glaucoma drops was not significantly reduced at any of the three follow-up time points, but there was a modest trend towards requiring fewer drops. Patients met the criteria for procedural success at a rate of 74.4%.  

Conclusions: Our results are consistent with the hypothesis that the MPCPC is safe and effective in lowering IOP in patients with POAG.  Further research is needed to determine if MPCPC is equally safe and effective in other forms of glaucoma.

Micropulse cyclophotocoagulation, primary open angle glaucoma, intraocular pressure

Article Details

How to Cite
Dansdill, D., Pikey, K., & Krishna, R. (2021). Micropulse Cyclophotocoagulation Outcomes in Primary Open Angle Glaucoma. Asian Journal of Research and Reports in Ophthalmology, 4(1), 1-9. Retrieved from http://journalajrrop.com/index.php/AJRROP/article/view/30124
Original Research Article


Flaxman SR, Bourne RA, Resnikoff S, Ackland P et al. Global causes of blindness and distance vision impairment 1990–2020: A systematic review and meta-analysis. Lancet Glob Health. 2017; 12:1221–1234.

World Health Organization. Blindness and vision impairment; 2019.


Quigley HA, Broman AT. The number of people with glaucoma world wide in 2010 and 2020. Br J Ophthalmol. 2006;3:262–7.

Turano KA, Rubin GS, Quigley HA. Mobility performance in glaucoma. Invest Ophthalmol Vis Sci. 1999;40:2803–2809.

Ramrattan RS, Wolfs RC, Panda-Jonas S et al. Prevalence and causes of visual field loss in the elderly and associations with impairment in daily functioning: the Rotterdam Study. Arch Ophthalmol. 2001; 119:1788–1794.

Friedman DS, Wolfs RC, O'colmain BJ et al. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol. 2004;122(4):532-8.

Vajaranant TS, Wu S, Torres M, Varma R. The changing face of primary open-angle glaucoma in the United States: Demographic and geographic changes from 2011 to 2050. Am J Ophthalmol. 2012;154(2):303-314.e3.

Kumar H, Mansoori T, Warjri GB, Somarajan BI, Bandil S, Gupta V. Lasers in glaucoma. Indian J Ophthalmol. 2018; 66(11):1539-1553.

Kerr NM, Kumar HK, Crowston JG, Walland MJ. Glaucoma laser and surgical procedure rates in Australia. Br J Ophthalmol. 2016;100(12):1686-1691.

Nouri-Mahdavi K, Brigatti L, Weitzman M, Caprioli J Outcomes of trabeculectomy for primary open-angle glaucoma. Ophthal mology. 1995;102:1760–9.

Nguyen QH. Primary surgical management of refractory glaucoma: tubes as initial surgery. Curr Opin Ophthalmol 2009; 20:122–5.

Nguyen AH, Fatehi N, Romero P et al. Observational outcomes of initial trabeculectomy with mitomycin C in patients of African descent vs patients of European Descent: Five-year results. JAMA Ophthalmol. 2018;136(10):1106-1113.

Noecker RJ, Kelly T, Patterson E, Herrygers LA. Diode laser contact trans-scleral cyclophotocoagulation: getting the most from the G–probe. Ophthalmic SurgLasers Imaging 2004;35:124–30.

Benson MT, Nelson ME. Cyclocryotherapy: A review of cases over a 10 year period. Br J Ophthalmol 1990;7:103–5.

Caprioli J, Strang SL, Speath GL, Poryzees EH. Cyclocryotherapy in the treatment of advanced glaucoma. Ophthalmology. 1985;92:947–54.

Dastiridou AI, Katsanos A, Denis P et al. Cyclodestructive procedures in glaucoma: A review of current and emerging options. Adv Ther. 2018;35(12):2103-2127

Liu GJ, Mizukawa A, Okisaka S. Mechanism of intraocular pressure decrease after contact trans-scleral continuous-wave Nd: YAG laser cyclo photocoagulation. Ophthalmic Res. 1994; 26:65–79.

Kosoko O, Gaasterland DE, Pollack IP, Enger CL. Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophthalmology. 1996;103(8):1294-302.

Beardsley R, Law SK, Caprioli J et al. Comparison of Outcomes between Endoscopic and Transcleral Cyclo photo coagulation. Vision (Basel). 2017;1(4).

Moorman CM, Hamilton AM. Clinical applications of the micropulse diode laser. Eye. 1999;13:145–50.

Tan A, Chockalingam M, Aquino M, Chew P. Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma. Clinical and Experimental Ophthalmology. 2010;38: 266–272.

Kuchar S, Moster M, Reamer C, Waisbourd M. Treatment outcomes of micropulse trans- scleralcyclo photocoagulation in advanced glaucoma. Lasers Med Sci. 2016;31:393–396.

Garcia GA, Nguyen CV, Yelenskiy A et al. Micropulse transscleral diode laser cyclophotocoagulation in refractory glaucoma: Short-term efficacy, safety and impact of surgical history on outcomes. Ophthalmol Glaucoma. 2019;2(6):402-412.

Gorsler I, Thieme H, Meltendorf C. Cyclophotocoagulation and cyclocryocoagulation as primary surgical procedures for open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2015; 253(12):2273-7.

Moussa K, Feinstein M, Pekmezci M et al. Histologic changes following continuous wave and micropulse transscleral cyclophotocoagulation: A Randomized Comparative Study. Transl Vis Sci Technol. 2020;9(5):22.

Tekeli O, Köse HC. Outcomes of micropulse transscleral cyclophotocoagulation in primary open-angle glaucoma, pseudoex foliation glaucoma and secondary glaucoma. Eur J Ophthalmol. 2020;1120672120914231.

Zaarour K, Abdelmassih Y, Arej N, Cherfan G, Tomey KF, Khoueir Z. Outcomes of micropulse transscleral cyclo photocoagulation in uncontrolled glaucoma patients. J Glaucoma. 2019;28(3):270-275.

Ma A, SWY Yu, Wong JKW. Micropulse laser for the treatment of glaucoma: A literature review. Surv Ophthalmol. 2019; 64(4):486-497.