Corneal Endothelial Safety and Intraocular Pressure Outcomes of MicroPulse Laser Trabeculoplasty in Treatment-Naïve Glaucoma: A Six-Month Retrospective Study

MicroPulse laser trabeculoplasty (MLT) lowers intraocular pressure (IOP) with subthreshold pulses that spare the surrounding tissue, yet its effect on the corneal endothelium is far less studied than that of selective laser trabeculoplasty, and almost unstudied in treatment-naïve eyes. We retrospectively reviewed 70 treatment-naïve glaucoma patients (one eye each) treated with a 577 nm yellow laser (Easyret®) in micropulse mode (300 µm, 300 ms, 1000 mW, 360°). Endothelial cell density, mean cell area, hexagonality, the coefficient of variation in cell size, and central corneal thickness were recorded by specular microscopy (SP-1P, Topcon), and IOP by Goldmann applanation, at baseline and 1, 3, and 6 months. Linear mixed-effects models used every available observation, so no patient was excluded for a missed visit. IOP fell from 25.9 ± 2.5 mmHg to 20.6 and 21.0 mmHg at one and three months (−5.32 and −5.00 mmHg, roughly 20%; both p < 0.001), then returned to 24.8 mmHg by six months, and the proportion reaching a 20% reduction fell from 62.5% to 4.6%. Endothelial cell density, mean cell area, and central corneal thickness held steady, and every morphological change stayed within the device’s repeatability limits on equivalence testing. MLT lowered IOP early but transiently; over six months no clinically meaningful change in corneal endothelial morphology was detected.