2026-01-28
Laser and glaucoma: a high-pressure duel
Ophthalmology
By Ana Espino | Published on January 28, 2026 | 3 min read
Glaucoma is a chronic, progressive optic neuropathy, most often associated with elevated intraocular pressure (IOP), leading to irreversible visual field loss. It represents the second leading cause of blindness worldwide, with an increasing burden related to population aging.
When medical treatments are insufficient or poorly tolerated, and surgery is not indicated, transscleral cyclophotocoagulation (TSCP) techniques may be proposed to partially destroy the ciliary body and reduce aqueous humor production. Continuous-wave TSCP (CW-TSCP), historically used, is effective but associated with significant adverse effects, particularly severe and sometimes irreversible ocular hypotony.
In response to these limitations, an alternative has emerged: micropulse transscleral laser therapy (MPTLT), which delivers energy in intermittent pulses, allowing for better tissue preservation and potentially improved tolerability. However, questions remain regarding its long-term efficacy, especially when compared with continuous-wave laser treatment.
In this context, this study was initiated to compare the efficacy and safety of CW-TSCP and MPTLT and to evaluate the relevance of MPTLT as a therapeutic alternative in the management of refractory glaucoma.
In this study, 63 patients undergoing ocular laser treatment were included. Twenty-six were treated with CW-TSCP and thirty-seven with MPTLT, with no exclusion based on glaucoma type or stage. Patients were followed for up to 24 months. The primary endpoint was treatment success, defined as an IOP between 6 and 21 mmHg or a ≥20% reduction, without escalation of medical therapy or additional surgery. Secondary outcomes included IOP reduction, decrease in glaucoma medications, use of acetazolamide, and adverse events.
At the final visit (median 16 months), 69% of eyes treated with CW-TSCP and 54% treated with MPTLT met the success criteria. CW-TSCP achieved a mean IOP reduction of 8 mmHg, compared with only 2.1 mmHg with MPTLT. The reduction in the number of medications was greater in the CW-TSCP group (1.24 vs 0.6 agents).
Among patients receiving acetazolamide, 69% in the CW-TSCP group were able to discontinue treatment, compared with 33% in the MPTLT group. The laser retreatment rate at 24 months was 38% with CW-TSCP versus 55% with MPTLT. In terms of safety, persistent hypotony was more frequent with CW-TSCP (8% vs 2%), while other complications were comparable between groups.
Glaucoma is a vision-threatening chronic disease, whose management becomes particularly challenging in advanced or treatment-resistant forms. One of the main challenges is to achieve sustained IOP reduction while minimizing adverse effects. This study aimed to compare the efficacy and tolerability of two transscleral cyclophotocoagulation techniques, CW-TSCP and MPTLT, in a real-world clinical setting.
The results confirm the superior efficacy of continuous-wave laser, at the cost of greater toxicity, whereas micropulse therapy offers a more favorable safety profile, albeit with more modest efficacy.
However, limitations of this study remain, justifying further research. Future investigations will include larger prospective randomized trials, stratification by glaucoma type and stage, and the integration of quality-of-life and patient-reported outcome measures. The goal will be to better define the patient profiles for whom MPTLT represents a relevant alternative, and to optimize the use of CW-TSCP in the most severe cases.
Glaucoma is a chronic, progressive optic neuropathy, most often associated with elevated intraocular pressure (IOP), leading to irreversible visual field loss. It represents the second leading cause of blindness worldwide, with an increasing burden related to population aging.
When medical treatments are insufficient or poorly tolerated, and surgery is not indicated, transscleral cyclophotocoagulation (TSCP) techniques may be proposed to partially destroy the ciliary body and reduce aqueous humor production. Continuous-wave TSCP (CW-TSCP), historically used, is effective but associated with significant adverse effects, particularly severe and sometimes irreversible ocular hypotony.
In response to these limitations, an alternative has emerged: micropulse transscleral laser therapy (MPTLT), which delivers energy in intermittent pulses, allowing for better tissue preservation and potentially improved tolerability. However, questions remain regarding its long-term efficacy, especially when compared with continuous-wave laser treatment.
In this context, this study was initiated to compare the efficacy and safety of CW-TSCP and MPTLT and to evaluate the relevance of MPTLT as a therapeutic alternative in the management of refractory glaucoma.
Is micropulse up to the task?
In this study, 63 patients undergoing ocular laser treatment were included. Twenty-six were treated with CW-TSCP and thirty-seven with MPTLT, with no exclusion based on glaucoma type or stage. Patients were followed for up to 24 months. The primary endpoint was treatment success, defined as an IOP between 6 and 21 mmHg or a ≥20% reduction, without escalation of medical therapy or additional surgery. Secondary outcomes included IOP reduction, decrease in glaucoma medications, use of acetazolamide, and adverse events.
At the final visit (median 16 months), 69% of eyes treated with CW-TSCP and 54% treated with MPTLT met the success criteria. CW-TSCP achieved a mean IOP reduction of 8 mmHg, compared with only 2.1 mmHg with MPTLT. The reduction in the number of medications was greater in the CW-TSCP group (1.24 vs 0.6 agents).
Among patients receiving acetazolamide, 69% in the CW-TSCP group were able to discontinue treatment, compared with 33% in the MPTLT group. The laser retreatment rate at 24 months was 38% with CW-TSCP versus 55% with MPTLT. In terms of safety, persistent hypotony was more frequent with CW-TSCP (8% vs 2%), while other complications were comparable between groups.
The right laser for the right patient
Glaucoma is a vision-threatening chronic disease, whose management becomes particularly challenging in advanced or treatment-resistant forms. One of the main challenges is to achieve sustained IOP reduction while minimizing adverse effects. This study aimed to compare the efficacy and tolerability of two transscleral cyclophotocoagulation techniques, CW-TSCP and MPTLT, in a real-world clinical setting.
The results confirm the superior efficacy of continuous-wave laser, at the cost of greater toxicity, whereas micropulse therapy offers a more favorable safety profile, albeit with more modest efficacy.
However, limitations of this study remain, justifying further research. Future investigations will include larger prospective randomized trials, stratification by glaucoma type and stage, and the integration of quality-of-life and patient-reported outcome measures. The goal will be to better define the patient profiles for whom MPTLT represents a relevant alternative, and to optimize the use of CW-TSCP in the most severe cases.
Read next: An immunological link between the eye and the brain
About the author – Ana Espino
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
PhD in Immunology, specialized in Virology
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