Clinical Outcomes Of An Excimer Laser Trabecular Bypass Minimally Invasive Glaucoma Surgery Combined With Cataract Surgery In Patients With Primary Open Angle Glaucoma

This study aims to describe clinical outcomes of patients with primary-open angle glaucoma (POAG) 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 June 2024 at a single site in Panama.

The MIGS procedures were performed in combination with cataract surgery in patients with POAG. 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. 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.

Twelve patients(18 eyes) were included in the study. The procedure was performed bilaterally in 6 patients and unilaterally in six patients (OD=2;OS=4). Patients had a mean ± SE age of 69 ± 3 years and 58% were female. All patients were phakic with POAG and no previous history of ocular surgeries or laser treatment. Mean ± SE pre-operative IOP was 20.0 ± 1.0 mmHg, with a mean ± SE of 0.5 ± 0.2 IOP-lowering medications, and a mean ± SE pre-operative BCVA of +1.2 ± 0.1 logMAR (N=18). At 1-month post-procedure, patients had a mean ± SE IOP of 15.0 ± 1.1 mmHg, with a mean ± SE of 0.3 ± 0.1 IOP-lowering medications (N=18). Mean ± SE BCVA of +0.3 ± 0.1 logMAR was recorded (N=18). No intra- or post-operative interventions or AEs were reported.   

In this study, excimer laser trabecular bypass MIGS was successfully combined with cataract surgery to achieve mean IOP-lowering below the target range for early (<20 mmHg) and moderate glaucoma (<17 mmHg) in patients with POAG and cataract, without the occurrence of intra- or post-operative interventions or adverse events.