Combined Phaco-Elios: First Experience In France

To evaluate the effectiveness and safety of combined Excimer laser trabeculostomies with phacoemulsification (Phaco-ELIOS) in the management of patients with glaucoma.

Minimally invasive glaucoma surgeries are popular for treating mild-to-moderate glaucoma due to their ability to be combined with cataract surgery to lower IOP and decrease medications with a favorable safety profile. Excimer Laser IntraOcular Surgery (ELIOS) uses 308-nm Excimer laser to perform microchannels to decrease resistance to outflow and IOP. The photoablative tissue interaction is non-thermal, with scant damage to the tissue, minimum inflammation and less scar tissue formation.

Prospective, single-center study of patients undergoing combined Phaco-ELIOS surgical procedure since January 2023. To this day patients continue to be included. The main main outcome measures is the reduction in postoperative intraocular pressure (IOP) and number of postoperative hypotensive medications. Clinical data was collected on day 1, month 1 and every 3 months thereafter in the postoperative period. Intra- and postoperative events were also recorded.

On the day of submission, 45 eyes of  24 patients were included for the analysis, with a mean age of 67.44 ± 9.19 years. The preoperative IOP was 16.35 ± 3.23 mmHg with an mean number of 1.81 hypotensive medications. Postoperatively, IOP was reduced to 18.73±7.4 mmHg at D7, 13.61±2.3 at M1, 13.50±1.1 at M3 and 15.63±2.8 at M6 (p<0.01). The number of hypotonsive medications increased to 1.50±1.0 at D7, 1.86±1.1 at M1, 0.83±0.9 at M3, and 0.63±0.8 at M6 (p<0.01). IOP and medication burden had a statistically significant reduction from baseline to 6 months. No serious intra- or postoperative events were reported during this study. The results at M12 and M18 will be known during the presentation in September 2024.

Minimally invasive glaucoma techniques continue to grow, meeting a need for reliable and consistent therapeutic options in the management of glaucoma without the significant and, sometimes severe, complications associated with more invasive surgeries such as filtering procedures or valves. Combined phaco-ELIOS procedure showed a significant reduction in IOP and number of hypotensive medications at 6 months of follow up.