关键词: 微脉冲经巩膜睫状体光凝术, 难治性青光眼, 眼压

Abstract:  Objective To assess the short-term efficacy and safety of micro-pulse transscleral cyclophotocoagulation (MP-TSCPC) in refractory glaucoma. Design Retrospective case series. Participants  Twenty-nine patients (31 eyes) with refractory glaucoma whose intraocular pressure (IOP) was uncontrolled despite prior medical or surgical treatment, treated at Baotou Chaoju Eye Hospital between August 2023 and January 2025. Methods The MP-TSCPC procedure was performed using a Cyclo G6 laser system with a MicroPulse P3 probe. The fiberoptic probe was positioned approximately 1 mm posterior to the limbus, maintaining gentle contact with the conjunctiva, and swept continuously for 45~60 seconds in each quadrant at a power setting of 2000 mW. IOP, best-corrected visual acuity (BCVA), number of glaucoma medications, NEI-VFQ-25 quality-of-life score, and visual analog scale (VAS) pain score were assessed preoperatively and at 3 months postoperatively. Main Outcome Measures IOP, number of glaucoma medications, BCVA, score of VAS and NEI-VFQ-25. Results The mean IOP at 1 day, 1 week, 1 month, and 3 months postoperatively was (18.61±7.97) mmHg, (14.16±3.86) mmHg, (18.90±7.84) mmHg, and (20.97±9.00) mmHg, respectively, all significantly lower than the preoperative value of (46.35±15.02) mmHg (F=57.302, P<0.001). The median number of glaucoma medications decreased from 3 preoperatively to 2 postoperatively (Z=-3.973, P<0.001). BCVA showed no significant change (Z=-0.618, P=0.536). The preoperative VAS score was (1.74±3.15), while it decreased significantly to (0.58±1.45) on postoperative day 1 and to (0.10±0.53) on postoperative week 1, with statistical significance (P=0.025, 0.002). By postoperative month 1, all ocular pain had completely resolved. NEI-VFQ-25 scores improved significantly in the domains of general health, overall vision, and ocular pain. Preoperatively, 11 eyes experienced pain; this decreased to 5 eyes at postoperative day 1 and to 1 eye (mild) at postoperative week 1. The proportion of pain-free eyes increased from 64.5% preoperatively to 99.6% at 1 week postoperatively. All eyes were pain-free at 1 month and 3 months postoperatively. Within 3 months, 3 eyes developed complications: 2 eyes of choroidal detachment and 1 case of corneal epithelial injury, all of which resolved with medical treatment. No other complications were observed. Conclusions MP-TSCPC effectively lowers IOP and reduces medication burden within 3 months postoperatively, while improving quality of life and alleviating ocular pain in patients with refractory glaucoma, with a favorable safety profile.

Key words:  Micro-pulse transscleral cyclophotocoagulation, Refractory glaucoma, Intraocular pressure