Combined Phaco-Excimer Trabeculostomies: Up To 24 Month Follow-Up

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

Minimally invasive glaucoma surgeries (MIGS) are popular for treating mild-to-moderate glaucoma due to their ability to be combined with cataract surgery to lower intraocular pressure (IOP) and decrease medications with a favorable safety profile. Excimer Laser IntraOcular Surgery (ELIOS), a MIGS, uses 308-nm Excimer laser to perform laser trabeculostomies to decrease resistance to outflow and thus IOP. 

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, 97 eyes of  53 patients were included for the analysis, with a mean age of 63 ± 9.19 years. The preoperative IOP was 17.41 ( ± 4.72)  mmHg with an mean number of 1.63 ± 1.11 hypotensive medications. Postoperatively, IOP was reduced to 20.27 (±8.40) mmHg at D7, 15.23 (±4.42) at M1, 15.23 (±4.42) at M3, 14.95 (±2.78) at M6 (p<0.01), 15.62 (±4.08) at M12 and 14.36 (±3.92) at M24. The number of hypotonsive medications decreased to 1.07 ± 1.1 at D7, 1.43 ± 1.15 at M1, 1.02 ± 1.18 at M3, 1.14 ± 1.20 at M6, 1.12 ± 1.22 at M12 and 0.91 ± 0.94 at M24 (p<0.01). IOP and medication burden had a statistically significant reduction from baseline to up to 24 months. No serious intra- or postoperative events were reported. 

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 24 months of follow up.