ESCRS - FP22.01 - Systematic Review And Meta-Analysis Of The Long-Term Efficacy And Safety Of Excimer Laser Trabeculostomy.

Systematic Review And Meta-Analysis Of The Long-Term Efficacy And Safety Of Excimer Laser Trabeculostomy.

Published 2025 - 43rd Congress of the ESCRS

Reference: FP22.01 | Type: Free paper | DOI: 10.82333/v0yd-c950

Authors: Maryam Yadgari 1 , Soheil Adib-Moghaddam 2 , Nader Nassiri* 3 , Kourosh Sheibani 4 , Sara Kavousnezhad 5

1Ophthalmology,Imam Hossein Medical Center,Tehran,Iran, Islamic Republic Of, 2Ophthalmology,Universal Council of Ophthalmology (UCO),Tehran,Iran, Islamic Republic Of, 3Ophthalmology,Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences,Tehran,Iran, Islamic Republic Of, 4Ophthalmology,Basir Eye Health Research Center,Tehran,Iran, Islamic Republic Of;Ophthalmology,Basir Eye Health Research Center,Tehran,Iran, Islamic Republic Of, 5Ophthalmology,Vanak Eye Surgery Center,Tehran,Iran, Islamic Republic Of

Purpose

To conduct a Systematic Review and meta-analysis of the long-term efficacy and safety of Excimer Laser Trabeculostomy (ELT).

Setting

International multi-site collaboration between academic centres, with financial support from Elios Vision, Inc, (Irvine, CA)

Methods

A systematic literature search according to PRISMA guidelines was performed by two independent reviewers using PubMed and EMBASE databases to identify published articles that examined the efficacy and safety of the ELT procedure performed in adult patients with glaucoma. Data was extracted after screening articles using a pre-defined patient, intervention, comparison, and outcome (PICO) process. Meta-analysis of key clinical efficacy endpoints for stand-alone ELT ('ELT') and combined Phaco-ELT (visual acuity, VA; intraocular pressure (IOP); glaucoma medication burden; safety) was performed using R version 4.1.0 with the meta package.

Results

 

  • Phaco-ELT improved VA;  both ELT & Phaco-ELT reduced medication burden and IOP.
  • After Phaco-ELT VA improved -0.23 LogMAR (95%CI: -0.32, -0.14; n=564) at 1-year and -0.12 LogMar (95%CI: -0.20, -0.05; n=70) at 2-yrs.
  • Glaucoma medication reduced 0.37 (95%CI: -0.18, 0.92; n=107) at 1-year & 1.26 (95%CI: 0.74, 1.78; n=95) at 2-yrs for ELT;  0.73 (95%CI: 0.49, 0.97; n=854) at 1-year & 0.58 (95%CI: 0.33, 0.83; n=130) at 2-yrs for Phaco-ELT.
  • IOP reduced 6.18 mmHg (95%CI: 3.69, 8.68; n=127) at 1-year p & 7.10 mmHg (95%CI:6.25, 7.95; n=105) at 2-yrs for ELT; 5.41 mmHg (95%CI: 4.12, 6.70; n=847) at 1-year & 6.72 mmHg (95%CI: 3.01, 10.42; n=130) at 2-yrs after Phaco-ELT.
  • Both ELT & phaco-ELT had low rates of complications or additional surgery.

Conclusions

This meta-analysis concludes that ELT is an efficacious and safe option as both stand-alone and when combined with cataract extraction.  Based upon current reimbursement rates in markets where ELT is available, it is likely that ELT is cost-effective and a potentially cost-saving treatment option for patients with OAG and OHT.  Country specific cost-effectiveness modeling performed by payors and HTA bodies may support future coverage and payment decisions when evaluating ELT in the MIGS category.