Clinical Outcomes Of An Excimer Laser Trabecular Bypass Minimally Invasive Glaucoma Surgery Combined With Cataract Surgery In Patients With Ocular Hypertension

This study aims to describe clinical outcomes of patients (pt) with ocular hypertension (OHT) receiving IOP-lowering treatment with the first clinically validated, excimer laser trabecular bypass minimally invasive glaucoma surgery (MIGS; ELIOS, Bausch + Lomb).

The MIGS procedures were conducted by a group of US physicians receiving training on the procedure between January 2024 and August 2024 at a single site in Panama.

The MIGS procedures were performed in combination with cataract surgery in pts with OHT The device used (ELIOS) has received the CE-mark in Europe and is currently undergoing investigational trials in the United States. The procedure uses a 308-nm XeCL excimer laser to create ten 210-µm diameter microchannels in the trabecular meshwork within a 90–110° treatment area, to facilitate aqueous outflow, without leaving a retained implant. No antimetabolites were used. Intraocular pressure (IOP), number of topical IOP-lowering medications, and best-corrected visual acuity (BCVA) were recorded pre- and 1-month post-procedure. Intra- and post-operative interventions and adverse events (AEs) were also recorded.

The study included 47 patients (72 eyes). The procedure was performed bilaterally in 25 pts and unilaterally in 22 pts (OD=13; OS=9). Pts had a mean ± SD age of 71 ± 9 years and 51% were female. All pts were with OHT and no previous history of ocular surgeries or laser treatment. Mean ± SD pre-operative IOP was 22.2 ± 3.2 mmHg, with a mean ± SD of 0.1 ± 0.3 IOP-lowering medications, and a mean ± SD pre-operative BCVA of +1.0 ± 0.6 logMAR (N=72). At 1-month post-procedure, mean ± SD IOP was 19.0 ± 4.0 mmHg, with no recorded IOP-lowering medications (N=71). Mean ± SD BCVA was +0.3 ± 0.2 logMAR (N=72). One pt required post-operative intervention for IOP control and hyphema; no other interventions or AEs were recorded.   

In this study of pts with OHT and cataract, excimer laser trabecular bypass MIGS was successfully combined with cataract surgery to achieve mean IOP-lowering below the for early glaucoma (<20 mmHg) with no topical IOP-lowering medications, and with a low occurrence of intra- or post-operative interventions and AEs.