Optimization of ciliary body cyclophotocoagulation settings: a randomized and controlled pilot study.

Objective: To compare the efficacy of different settings in continuous-wave transscleral cyclophotocoagulation (CW-TSCPC).

Design: Prospective, randomized, triple-blind clinical trial in a single tertiary center.

Participants: Adult glaucoma patients who need continuous wave-transscleral cyclophotocoagulation to control intraocular pressure (IOP) or prevent or treat ocular pain/discomfort secondary to increased IOP.

Methods: Group A uses 1 250 mW for 4 seconds. Group B uses 2 000 mW for 2 seconds.

Main Outcome Measures: IOP, best-corrected visual acuity, glaucoma medication, complications, and the need to retreat.

Results: Eighteen and 19 eyes in group A and group B, respectively, were included. Groups were comparable at baseline (p > 0.1) for mean age (76.9, 73.5 years), mean IOP (29.1, 29.8 mm Hg), mean logMAR visual acuity (1.6, 1.7), and mean number of glaucoma agents (3.4, 3.4). IOP was comparable between groups at 1 (15.6, 13.7 mm Hg), 4-6 (14.6, 14.8 mm Hg) and 12 months (10.3, 17.3 mm Hg; p = 0.07). There was a trend toward more medication reduction earlier in group B at 1 and 4-6 months (p = 0.11). Complication rates were similar between groups (group A: n = 6; group B: n = 9), with more serious complications in group B. Reintervention was required in 5 patients in group A, and 3 patients in group B after a mean of 4.7 and 6.7 months, respectively.

Conclusions: Both techniques are efficient and comparable in reducing IOP. Our study favours the 1 250 mW for 4 seconds group, with its possibly better safety profile.