Précis: Micropulse cyclophotocoagulation (MPCP) lowered intraocular pressure (IOP) in the short-term but nearly half required additional intervention. Mydriasis was the most common complication (11%); 15% lost ≥3 Snellen lines of acuity; 11% had persistent complications at last follow-up. Purpose: The purpose of this study was to evaluate the efficacy and complications of MPCP in a large series of patients with all stages of glaucoma. Design: Multicenter, retrospective chart review of patients from 3 clinical sites. Participants: One hundred sixty-seven eyes of 143 patients. Methods: MPCP was performed with 2000 mW energy, 31.3% duty cycle and 2 to 4 180-degree applications of 80 seconds duration each per treatment. The procedure was considered a failure if any of the following occurred: additional IOP lowering intervention, <20% IOP reduction from baseline at the last follow-up (with or without medication), or severe complications. Results: Mean age was 71 years, 53% were female, and 53% were Asian. 60% of eyes had POAG, 63% were pseudophakic, 38% had prior glaucoma surgery, and 51% had Snellen visual acuity (VA) of 20/40 or better. Mean follow-up time was 11.9±7.8 months. Mean IOP was 21.9±8.4 mm Hg before intervention, and 17.4±7.2 mm Hg at last follow-up (P<0.0001). There was no change in mean logMAR VA (P=0.0565) but 15% lost ≥3 Snellen lines of VA. The success rate was 36.5% (61/167 eyes) at last follow-up. The probability of survival by Kaplan-Meier analysis was 82%, 71%, and 57% at 3, 6, and 12 months after the procedure, respectively. The reasons for failure were additional intervention in 47%, inadequate IOP reduction in 14%, and severe complication in 1.8%. In a multivariable Cox proportional hazard model, female sex was associated with a 56% decrease in failure rate compared with males (P<0.0001), while a unit increase in baseline IOP corresponded with a 5.7% increase in failure rate (P<0.0001). If repeat MPCP was allowed then success rate increased to 58%. There were no complications in 73% (122/167) but 11% (18/167) had persistent complications at the last follow-up and half of these 18 eyes had decrease in VA of 1 to 6 Snellen lines. Asian race (odds ratio 13.5, P=0.0131) and phakic status (odds ratio 3.1, P=0.0386) were associated with higher odds of developing mydriasis, which was the most common complication. Conclusions: MPCP lowered IOP in the short-term but nearly half required additional IOP lowering intervention. Potential complications should be discussed in detail especially when the procedure is being considered for those with good VA and early stage disease.

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INTRODUCTION: For average risk patients, current guidelines generally recommend either yearly FIT or colonoscopy every ten years. A positive FIT test triggers reflex colonoscopy, which can have higher ADR than screening colonoscopy. FIT tests are also frequently performed following a negative colonoscopy in routine practice for concerning symptoms or desire for “early relook.” A positive FIT test often leads to reflex “relook colonoscopy” despite negative colonoscopy within the past 10 years. It is not clear if relook colonoscopy would be necessary or lead to new findings. As such, we aimed to compare colonoscopy findings including ADR in the “relook FIT-colonoscopy” versus the “standard FIT-colonoscopy” population. METHODS: This is a retrospective study of 1,940 patients age ≥ 18 at a community medical center between December 1, 2002 and June 1, 2018: 51 had relook FIT-colonoscopy and 1,889 patients had standard FIT-colonoscopy. The primary outcome was ADR with secondary outcomes including other colonoscopy findings. RESULTS: The group receiving relook colonoscopy was on average younger than the standard FIT-colonoscopy group (61.8 v 64.5, P = 0.049). The relook colonoscopy group had lower percentage of males (37.3 v 45.6%, p< 0.001) but higher percentage of Asians (90.2 v 76.5%, p< 0.001). While the relook colonoscopy group had fewer days between FIT and colonoscopy, this was not statistically significant (61.1 v 68.9, P = 0.800). For patients receiving relook colonoscopy, 82.4% were asymptomatic at time of FIT, while 5.9% had bowel habit changes, 5.9% anemia, 3.9% abdominal pain, and 3.9% rectal bleeding. FIT occurred on average 4.9 +1.8 years following colonoscopy. Standard FIT-colonoscopy demonstrated ADR of 51.2% with cancer identified in 1.6% of patients. The relook colonoscopy strategy had ADR of 39.2% (N = 20); 49.0% of patients had no abnormal findings: 47.1% had hemorrhoids, 23.5% had diverticulosis, and none had cancer (Figure 1). Of the 20 patients with adenoma in the relook colonoscopy group, 3 patients had adenoma >1 cm and 2 had advanced neoplastic polyps (villous and serrated). CONCLUSION: While significant data has demonstrated that colonoscopy following positive FIT is important, data on relook colonoscopy is less clear. Given ADR of 37.7%, patients with positive FIT should receive repeat colonoscopy despite prior normal colonoscopy. Nevertheless, more data is needed to determine validity and criteria for pursuing repeat FIT following a normal colonoscopy.

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