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Slow-coagulation transscleral cyclophotocoagulation provides greater IOP reduction than micropulse transscleral cyclophotocoagulation in glaucomaSlow-coagulation Treatment Shows More IOP Reduction for Glaucoma

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Key Takeaway
Note that SC-TSCPC provides greater IOP reduction than MP-TSCPC but comparable results to CW-TSCPC in glaucoma.

This systematic review and meta-analysis evaluated three transscleral cyclophotocoagulation modalities for glaucoma: slow-coagulation (SC-TSCPC), micropulse (MP-TSCPC), and conventional continuous-wave (CW-TSCPC). The analysis included data from 992 patients to compare intraocular pressure (IOP) reduction, medication burden, best-corrected visual acuity (BCVA), treatment success, and complication rates.

The meta-analysis found that SC-TSCPC resulted in a greater IOP reduction compared to MP-TSCPC (MD 1.29 mm Hg; 95% CI 0.26-2.32, P = 0.01). In contrast, SC-TSCPC and CW-TSCPC showed comparable IOP reduction (MD -1.00 mm Hg; 95% CI -3.14 to 1.13, P = 0.36). Secondary outcomes including medication burden, BCVA, treatment success, and total complication rates were reported as similar across all three modalities. Safety profiles were also noted as similar across the groups.

The authors note that the evidence is of low-to-very low quality due to significant heterogeneity among studies and overall study quality. While SC-TSCPC may be a viable nonincisional treatment option for glaucoma, its clinical superiority over CW-TSCPC should not be overstated given the data limitations. Clinical application should be weighed against the observed association between procedure type and IOP reduction.

How this fits prior evidence

This meta-analysis addresses a gap in comparative evidence for cyclophotocoagulation modalities in glaucoma management. It builds upon previous reports where certain glaucoma management reviews lacked specific intervention details or outcomes. While this study identifies SC-TSCPC as having greater IOP reduction than MP-TSCPC, the low quality of evidence and heterogeneity mean these findings should be interpreted with caution when compared to other established treatments like Netarsudil or standard prostaglandin analogues.

Researchers analyzed data from 992 patients with glaucoma to compare three different types of laser treatments. They looked at how well these procedures lowered intraocular pressure (IOP), which is a key factor in managing the condition. The three methods compared were slow-coagulation, micropulse, and conventional continuous-wave treatments.

The findings showed that the slow-coagulation method resulted in greater pressure reduction than the micropulse method. However, it performed similarly to the traditional continuous-wave method. Other factors, such as the number of medications needed, vision clarity, and overall success rates, were similar across all three treatment types. No significant differences in safety or complications were reported between the methods.

It is important to note that the evidence for these findings is currently of low to very low quality due to inconsistencies among the studies included. Because the data is limited, these results should not be seen as a definitive proof of superiority. Patients should discuss these specific treatment options with their eye specialist to determine the best plan based on their individual needs.

What this means for you:
Slow-coagulation may lower eye pressure more than micropulse methods, but evidence quality is currently low.

Common questions

How does the slow-coagulation method compare to other treatments?

The study found that slow-coagulation resulted in greater intraocular pressure (IOP) reduction compared to micropulse treatment. However, it showed similar results to conventional continuous-wave treatment. Other factors like medication burden and vision clarity were similar across all three methods.

Is the slow-coagulation procedure safe for glaucoma patients?

The study reported a similar safety profile across all three types of laser treatments. No specific differences in complications or serious adverse events were noted between the slow-coagulation, micropulse, and continuous-wave methods.

Can I rely on these results to choose my treatment?

The evidence for these findings is currently of low to very low quality because the studies included were inconsistent. You should talk to your doctor to decide which treatment is best for your specific eye health needs.

Study Details

Study typeMeta analysis
Sample sizen = 992
EvidenceLevel 1
PublishedJul 2026
View Original 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 nonincisional 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 with those of 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% CIs. RESULTS: Thirteen studies comprising 992 patients were included. SC-TSCPC achieved greater IOP reduction from baseline compared with MP-TSCPC ( MD 1.29 mm Hg, 95% CI 0.26-2.32, P =0.01, I2 =0%) but was comparable to conventional CW-TSCPC ( MD -1.00 mm Hg, 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 for SC-TSCPC were similar to those for 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 nonincisional 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.
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