Slow-Coagulation Cyclophotocoagulation Versus Conventional Continuous Wave Cyclophotocoagulation and Micropulse Cyclophotocoagulation for the Treatment of Glaucoma: A Systematic Review and Meta-Analysis.

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.