Micropulse Cyclophotocoagulation (MP-CPC)

If your eye pressure readings remain above your target range at multiple visits, that is a clear signal that your current treatment may not be enough. You might also notice that you are using three or four different glaucoma drops each day, which can become difficult to manage. Some people experience side effects from their medications that make it hard to continue using them long term.

• Pressure readings consistently above your personalized target
• Progressive damage to the optic nerve seen on imaging tests
• Worsening visual field loss despite medication use
• Difficulty affording or remembering multiple daily eye drops

MP-CPC can be used for several forms of glaucoma, including primary open-angle glaucoma, which is the most common type. We also use it to treat angle-closure glaucoma, secondary glaucoma caused by other eye conditions, and neovascular glaucoma, which involves abnormal blood vessel growth. Each of these conditions can lead to dangerously high pressure that threatens your vision.

In angle-closure glaucoma, treating the mechanism of angle closure such as laser peripheral iridotomy or lens-based treatment may be prioritized. In neovascular glaucoma, managing the underlying retinal ischemia and using anti-VEGF treatments are often required alongside eye pressure lowering. In some cases, we may recommend MP-CPC for glaucoma that developed after cataract surgery or eye trauma. The versatility of this treatment makes it useful across a wide range of glaucoma types.

Beyond glaucoma, MP-CPC may help people with other causes of elevated eye pressure. Scleral buckles, which are used to repair retinal detachments, can sometimes lead to increased pressure over time. Patients with uveitis, an inflammatory condition, may develop pressure problems that respond well to MP-CPC when medications are not enough. In uveitic glaucoma, we weigh the risk of triggering inflammation and may require inflammation control before and after treatment.

We evaluate each situation individually to determine whether this laser treatment is likely to be safe and effective for your particular eye condition.

MP-CPC may not be appropriate for everyone with high eye pressure. We carefully evaluate your individual situation to determine whether this treatment is right for you or whether extra precautions are needed.

• Active eye inflammation or uveitis flare that is not controlled
• Very low baseline eye pressure or risk of hypotony
• Thin sclera or prior scleral disease in the treatment areas
• Significant macular disease where inflammation after the procedure could threaten vision
• Certain medical conditions that make anesthesia or sedation higher risk

Traditional glaucoma surgeries, such as trabeculectomy or tube shunt procedures, involve creating a new drainage pathway by cutting into the eye. These operations can be very effective, but they also carry risks like infection, bleeding, or excessive pressure drop. MP-CPC offers a less invasive alternative that does not require an incision through the wall of your eye.

• You have significant medical conditions that make incisional surgery riskier
• You want to avoid the longer recovery time of traditional operations
• Your glaucoma is moderate and may respond well to a gentler approach
• You have already had incisional surgery that did not provide lasting control

Mild redness, tearing, and a gritty feeling are common in the first day or two after MP-CPC. Your vision may remain slightly hazy as your eye heals, but this usually improves within a few days. Some people notice fluctuations in their vision during the first week, which is a normal part of the healing process.

Serious pain is not typical, so contact us right away if you develop severe discomfort, because that could signal a complication that needs prompt attention.

We typically prescribe anti-inflammatory eye drops to control swelling inside your eye after treatment. Using these drops exactly as directed helps you heal more comfortably and can improve your final results. Over-the-counter pain relievers like acetaminophen can help with any mild achiness, though most people find they need very little pain medication.

• Apply a cool, clean compress for 10 minutes several times a day
• Avoid rubbing or pressing on your treated eye
• Use artificial tears if your eye feels dry, unless we advise otherwise
• Wear sunglasses outdoors if you are sensitive to bright light

In addition to anti-inflammatory drops, we usually ask you to continue your regular glaucoma medications for a while after MP-CPC. It can take several weeks for the full pressure-lowering effect to develop, so stopping your drops too soon might allow pressure to spike. We will let you know at your follow-up visits when it is safe to reduce or stop certain medications.

Your regimen often includes a topical steroid to control inflammation. Some clinicians also add a cycloplegic drop for comfort, and antibiotics may be used in select cases. Because steroids can raise eye pressure in some patients, we monitor closely and adjust as needed.

Make sure you understand the schedule for each type of drop, since you may be using several different bottles at various times of day. Setting phone reminders or keeping a written chart can help you stay on track.

Most people can return to light activities within a day or two, but we recommend avoiding heavy lifting, strenuous exercise, and bending over for several days or as directed. These actions can increase pressure inside your eye and interfere with healing. You should also avoid swimming, hot tubs, and getting water directly in your eye until we clear you at a follow-up visit.

Many patients feel well enough to go back to desk work or other non-strenuous jobs within a few days, though you should arrange time off if your work involves physical labor or environments with dust and debris. We will give you individualized instructions based on your specific situation and recovery.

We will want to see you soon after your procedure to check your pressure and make sure your eye is healing properly. The first check-up often occurs within a few days to one week, with timing individualized based on starting eye pressure, glaucoma severity, and symptoms. Additional visits are typically scheduled over the next few months so we can track how well the treatment is working.

During these appointments, we measure your pressure, look for any signs of inflammation or other complications, and adjust your medications as needed.

• First check-up timing is tailored to your risk level and baseline pressure
• Additional visits at one month, three months, and six months are common
• We compare your new pressure readings to your baseline levels
• Ongoing monitoring helps us decide if you need any additional treatments

While serious complications from MP-CPC are rare, you should contact us immediately if you notice sudden vision loss, severe eye pain that does not improve with over-the-counter pain relievers, or a significant increase in redness or discharge. Severe headache, nausea, vomiting, halos around lights, or rapidly worsening blurry vision may signal a dangerous rise in eye pressure.

Disproportionate pain combined with worsening light sensitivity can be a red flag for significant inflammation. Flashes of light, new floaters, or a curtain-like shadow over your vision could indicate a problem that needs urgent evaluation, though these are less commonly related to MP-CPC itself.

We would rather have you call and find out everything is fine than delay getting help when something truly needs attention. Always err on the side of caution when it comes to changes in your vision or eye comfort.