48-Month Outcomes Following The Femtosecond Laser Image Guided High-Precision Trabeculotomy (Flight) Procedure

To evaluate the long-term safety and intraocular pressure (IOP) lowering efficacy of a non-incisional femtosecond laser, image-guided, high-precision trabeculotomy (FLigHT) at 48 months following first-in-human treatment in eyes with open-angle glaucoma.

Prospective, single-center clinical study conducted in Budapest, Hungary.

Eighteen eyes of twelve patients with mild to advanced open-angle glaucoma underwent creation of a single non-incisional trabeculotomy aperture (200 μm × 500 μm × 400 μm) in the nasal quadrant using a femtosecond laser platform (ViaLase, Aliso Viejo, CA). All subjects were on topical hypotensive therapy with no prior glaucoma procedures. Assessments over the 48 months included; Goldmann applanation tonometry, medication use, slit-lamp biomicroscopy, gonioscopy, visual fields, best-corrected visual acuity, and adverse event monitoring.

Mean age was 72.2 ± 9.7 years; 92% were female, all Caucasian, and 89% pseudophakic. Disease severity was 33% mild, 28% moderate, and 39% severe. Baseline mean IOP was 21.4 ± 4.6 mmHg on 2.1 ± 1.0 medications. Fifteen eyes completed 48-month follow-up. Mean IOP decreased to 14.9 ± 2.6 mmHg (p < 0.001 vs baseline), with medications 1.8 ± 1.1 (p = 0.24). All apertures remained patent on gonioscopy and anterior segment OCT, with no peripheral anterior synechiae. No serious procedure-related adverse events or secondary incisional surgeries occurred.

The first-in-human FLigHT procedure demonstrates sustained IOP reduction through 48 months with a favorable safety profile. Trabeculotomy channels remained patent across multiple imaging modalities, supporting procedural durability. Given ongoing challenges with medication adherence in glaucoma care, this non-incisional approach may offer a viable alternative or adjunct to topical therapy. Larger studies are required to confirm outcomes and refine patient selection.