ABSTRACT Background Childhood glaucoma is considered one of the main causes of irreversible blindness. Primary congenital glaucoma (PCG) is a rare disease; however, in Middle East countries such as Saudi Arabia, the incidence is high. Research design and methods A retrospective study was conducted at Dhahran Eye Specialist Hospital from September 2016 to March 2020 to evaluate the efficacy and safety of transscleral micropulse cyclophotocoagulation (TS-MPCPC) as a primary procedure in congenital glaucoma and as an adjuvant to prepare the patient for ultimate surgical intervention. Emergent ophthalmic examination under sedation or general anesthesia was done to evaluate the presence of PCG features, measure the intraocular pressure (IOP), horizontal corneal diameter (HCD), and to evaluate the optic disc. Results Twenty-one eyes were included in the study. Cup to disc ratio (CDR) was not decreased postoperatively, and it was found statistically non-significant. There was statistically significant decrease in IOP and horizontal corneal diameter (HCD) (p < 0.001, 0.014), respectively. The mean reduction in IOP was 36%. The final IOP was between 5 and 21 mmHg in all cases. Qualified success was achieved in 17 (81%) eyes and 4 (19%) eyes had surgical failure. Conclusion TS-MPCPC might have effective and safe implications for congenital glaucoma patients.