Efficacy And Safety Of Excimer Laser Trabeculostomy (Elt), A Laser-Based Trabecular Minimally Invasive Glaucoma Surgery (Migs) Combined With Phacoemulsification (Phaco) Surgery.

To evaluate the efficacy and safety of excimer laser trabeculostomy (ELT), a laser-based trabecular minimally invasive glaucoma surgery (MIGS) combined with phacoemulsification (PHACO) surgery, in terms of intraocular pressure (IOP) reduction and endothelial cell loss after a three-year follow-up.

Real-world data of a novel Laser-based MIGS three years follow-up. First report of safety for corneal endothelial cells.

We present a retrospective, single-site, case series of patients with cataract and open angle glaucoma who underwent combined PHACO-ELT surgery in the last three years. Data were recorded preoperative, 1, 3, 6 months, and annually. Mean outcomes were IOP, number of IOP lowering medications and endothelial cell counting (ECC), using specular microscopy. Data from 128 eyes (96 patients; 51 women and 45 men; mean age of 73 years) was gathered.

 Baseline IOP was 26.14 mmHg and preoperative medicated IOP was 21 mmHg. Mean IOP after combined surgery decreased to 16.8, 17.6, and 17.6 mmHg at one, two, and three years, respectively. The number of ocular antihypertensive medications was reduced from 1.6 medications preoperative to 0.33,  0.39, and 0,53 at one, two, and three years after surgery. In those patients who achieve 3 years follow-up, 66% were free of any IOP lowering medication. Only 5 patients required filtering surgery (Deep sclerectomy). Concerning ECC, there was a significant reduction from 2246.5 to 2124.3  cells/mm3 one month after surgery related to PHACO. After that, ECC remained stable at 2055.1, 2112.7, and 2109.7 cells /mm3 at one, two, and three years follow-up.

The hypotensive effect of PHACO-ELT was maintained three years after surgery. This implant-free MIGS technique seems to be respectful with endothelial corneal cells in the long term.