Slow-Coagulation Cyclophotocoagulation versus Conventional Continuous Wave Cyclophotocoagulation and Micropulse Cyclophotocoagulation for the Treatment of Glaucoma: A Systematic Review and Meta-analysis.
Neeran Narainswami, Matheus Pedrotti Chavez, Pedro Henrique Ferrazza Sperotto, Nuno Rodrigues Alves, Guilherme Melchior Maia Lopes, Eduardo de Carvalho Mazzocato, Carolina Carvalho Soares Valentim, Toit Nagib du, Mohamed Khodeiry
Summary
Slow-coagulation cyclophotocoagulation effectively lowers intraocular pressure, outperforming micropulse and matching conventional methods, with similar safety. This offers a viable non-incisional glaucoma treatment option, even for patients with visual potential.
Abstract
PRCIS
SC-TSCPC significantly lowers intraocular pressure more effectively than MP-TSCPC and performs similarly to CW-TSCPC. Safety and visual outcomes are comparable, supporting its use as a non-incisional treatment option for various glaucoma patients.
INTRODUCTION
Slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) is an emerging laser modality for glaucoma management designed to lower intraocular pressure (IOP) with possible fewer complications than conventional continuous-wave (CW-TSCPC) and micropulse (MP-TSCPC) approaches. We conducted a systematic review and meta-analysis to compare the efficacy and safety of SC-TSCPC to MP-TSCPC and CW-TSCPC.
METHODS
PubMed, Embase, and Cochrane Library were searched from inception through December 2025 for studies comparing SC-TSCPC with MP-TSCPC or "conventional" CW-TSCPC. Primary outcomes were IOP reduction from baseline and IOP at last follow-up. Secondary outcomes included medication burden, best-corrected visual acuity (BCVA), treatment success, and complications. We computed mean differences (MDs) for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs).
RESULTS
Thirteen studies comprising 992 patients were included. SC-TSCPC achieved greater IOP reduction from baseline compared to MP-TSCPC (MD 1.29 mmHg, 95% CI 0.26 to 2.32, P=0.01, I2=0%) but was comparable to conventional CW-TSCPC (MD -1.00 mmHg, 95% CI -3.14 to 1.13, P=0.36). IOP at last follow-up, number of medications, BCVA, treatment success, and total complication rates of SC-TSCPC were similar to MP-TSCPC or CW-TSCPC.
CONCLUSION
SC-TSCPC may provide comparable IOP control to CW-TSCPC and appears more effective than MP-TSCPC in lowering IOP, with a similar safety profile. It may represent a viable non-incisional treatment option for glaucoma, including patients who retain visual potential. These results require cautious interpretation due to the overall low-to-very low quality of evidence and significant heterogeneity among studies. Larger randomized studies are needed to validate these findings.
Keywords
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Discussion
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