EXPRESS: Meta-analysis of the clinical efficacy of microcatheter-assisted trabeculotomy in the treatment of glaucoma

This meta-analysis systematically evaluates the clinical efficacy and safety of microcatheter-assisted trabeculotomy in glaucoma treatment. We searched databases including PubMed, Embase, Web of Science, Wiley Library, CNKI, Wanfang, and VIP. Four randomized controlled trials and three case-control studies, totaling 460 patients, were included. Data were analyzed using Stata/MP18 to calculate risk ratio (RR), standardized mean difference (SMD), and 95% confidence interval (CI). It showed a significant short-term (3-6 months) reduction in intraocular pressure (IOP) with microcatheter-assisted trabeculotomy compared to control procedures (SMD = -0.39, 95% CI: -0.72 to -0.05, P=0.01). Subgroup analysis suggested a significant short-term benefit in adults (SMD = -0.71, 95% CI: -1.37 to -0.05, P=0.04), but not in pediatric patients. For long-term IOP (>1 year), the overall reduction was statistically significant (SMD = -0.46, 95% CI: -0.89 to -0.04, P=0.03), with a significant benefit observed in adults (SMD = -1.03, 95% CI: -1.41 to -0.64, P < 0.01) but not in pediatric patients. No significant differences were found in postoperative success rates, number of antiglaucoma medications, or the incidence of ciliary detachment. Current evidence suggests that microcatheter-assisted trabeculotomy provides significant IOP-lowering effects in both the short and long term overall, with a significant benefit in adults, whereas in children remains unclear. Its effects on surgical success rates and medication burden remain inconclusive. These findings support its potential as an effective surgical option, but highlight the need for further high-quality, long-term studies.