Micropulse Transscleral Laser Treatment Versus Continuous Wave Transscleral Cyclophotocoagulation for the Treatment of Glaucoma or Ocular Hypertension: A Meta-Analysis.

Précis: Micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation demonstrated comparable intraocular pressure across all follow-ups. MP-TLT was associated with significantly lower risks of ocular complications, such as hypotony, prolonged inflammation, and phthisis bulbi.

Purpose

To compare the efficacy and safety of micropulse transscleral laser treatment (MP-TLT) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) for the treatment of glaucoma or ocular hypertension.

Methods

A systematic search was conducted in PubMed, Cochrane Library, Embase, and ClinicalTrials.gov. Randomized controlled trials (RCTs) or cohort studies comparing MP-TLT and CW-TSCPC were included. Weighted mean differences (MDs) were computed for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% CIs. Heterogeneity was assessed with I2 statistics. Software R, version 4.4.0, was used for statistical analyses. Subgroup analyses were conducted on glaucoma types.

Results

Eleven studies encompassing 1054 eyes from 986 patients were included, with 47.4% receiving MP-TLT. There were no significant differences in IOP between CW-TSCPC and MP-TLT at 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months of follow-up. The MP-TLT group required a significantly higher number of hypotensive medications but displayed significantly reduced risks of overall complications, ocular hypotony, prolonged inflammation, and phthisis bulbi compared with CW-TSCPC.

Conclusion

MP-TLT and CW-TSCPC showed similar efficacy in IOP control. However, MP-TLT demonstrated a greater safety profile, suggesting its potential suitability for patients requiring repeat interventions or those with lower tolerance for ocular complications.