Noninferiority of selective and micropulse laser trabeculoplasties: a meta-analysis and systematic review

Chronic open-angle glaucoma (COAG) affecting over 70 million people globally, is one of the leading causes of irreversible blindness. To lower intraocular pressure (IOP) in COAG, common treatments include Selective Laser Trabeculoplasty (SLT) and Micropulse Laser Trabeculoplasty (MLT). This systematic review and meta-analysis evaluates the efficacy, safety, and clinical outcomes of both treatments in managing open-angle glaucoma. A systematic review and meta-analysis following PRISMA guidelines, with searches across MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to July 2024. Five studies, including 462 eyes from COAG patients, met the inclusion criteria. Primary outcomes were the success rate (defined as ≥ 20% IOP reduction) and mean IOP reduction. Secondary outcomes included adverse events, medication use, and requirement for glaucoma surgery. No significant difference was observed between both treatments in success rates (OR = 0.91, 95% CI: 0.61-1.36, P = 0.64). Mean IOP reduction at 3-6 months (MD = 0.46 mmHg, 95% CI: -0.43-1.36, P = 0.31) and 6-12 months (MD = 0.72 mmHg, 95% CI: -0.22-1.65, P = 0.13) showed no significant differences. Medication requirements, post-laser IOP spikes, and requirement for further surgery were similar between both treatments (OR = 2.31, 95% CI: 0.75-7.15, P = 0.15). SLT and MLT are both effective and safe for COAG, showing no significant differences in efficacy or safety over one year. MLT's cooling cycles may reduce IOP spikes, but further studies are needed to confirm long-term outcomes. Clinicians can choose between treatments based on patient-specific preferences and needs.