Clinical Ophthalmology (Aug 2024)

Outcomes of Micropulse Laser Trabeculoplasty Compared to Selective Laser Trabeculoplasty: A Systematic Review and Meta-Analysis

  • Zhu D,
  • Shah PP,
  • Zhang C,
  • Wong A,
  • Bouaziz M,
  • Barmas-Alamdari D,
  • Mootz J,
  • Yu A,
  • Tirsi A,
  • Tello C

Journal volume & issue
Vol. Volume 18
pp. 2205 – 2215

Abstract

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Daniel Zhu,1,2,* Paras P Shah,1,2,* Charles Zhang,3 Amanda Wong,4 Michael Bouaziz,1,2 Daniel Barmas-Alamdari,1,2 Joseph Mootz,1,2 Austin Yu,5 Andrew Tirsi,1,2 Celso Tello1,2 1Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA; 2Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA; 3Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY, 14203, USA; 4Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York, 10003, USA; 5Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA*These authors contributed equally to this workCorrespondence: Daniel Zhu, Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 600 Northern Blvd., Suite 214, Great Neck, NY, 11021, USA, Email [email protected]: To perform a meta-analysis and systematic review to compare the efficacy and complications of micropulse laser trabeculoplasty (MLT) and selective laser trabeculoplasty (SLT) in adult patients with open-angle glaucoma (OAG) and ocular hypertension (OHT).Methods: We performed a systematic review utilizing PubMed, Embase, and Scopus, on April 8, 2024. Meta-analyses were performed for the mean change in intraocular pressure (IOP) at one-month, six-month, and one-year follow-up visits, rate of IOP spikes (> 5 mmHg increase from the pre-procedure baseline IOP), rate of treatment failure (< 20% or < 3 mmHg reduction in IOP or requiring additional medications or procedures), and mean change in number of medications.Results: Six studies, with a total of 593 eyes, were included: 283 underwent MLT, while 310 underwent SLT. A statistically significant difference in the efficacy of MLT versus SLT at one-month and six-month follow-ups was present, with SLT reducing IOP by 0.83 mmHg (95% CI: 0.20, 1.47; P = 0.01) more and 0.55 mmHg (95% CI: 0.02, 1.08; P = 0.04) more than MLT, respectively. At the one-year follow-up, there was no significant disparity in IOP reduction between SLT and MLT (WMD = 0.16; 95% CI: − 0.40, 0.71; P = 0.58). There was a significantly lower rate of IOP spikes in the MLT treatment group (RR = 0.37; 95% CI: 0.16, 0.89; P = 0.03). There was no statistically significant difference in the rate of treatment failures (RR = 1.05; 95% CI: 0.68, 1.62; P = 0.84) or number of topical medications reduced (WMD = 0.06; 95% CI: − 0.13, 0.26; P = 0.53).Conclusion: While SLT may offer greater short-term reductions in IOP, it may be associated with more postoperative IOP spikes when compared to MLT. At one-year follow-up, there were no significant differences in IOP reduction or failure rates between the MLT and SLT groups.Keywords: trabeculoplasty, micropulse, SLT, selective laser trabeculoplasty, glaucoma

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