Real-World Excimer Laser Trabeculostomy Combined With Cataract Surgery In Patients With Primary Open Angle Glaucoma Or Ocular Hypertension: Safety And Effectiveness At 1 Month

Excimer laser trabeculostomy is a form of minimally invasive glaucoma surgery (MIGS) that enables precise creation of microchannels in the trabecular meshwork (TM) to facilitate aqueous outflow, reducing intraocular pressure (IOP) whilst preserving the integrity, structure, and function of the TM. The ELIOS device is a clinically validated excimer laser trabeculostomy MIGS, with CE-marking (Bausch + Lomb). The aim of this study was to assess clinical outcomes of Elios in combination with cataract surgery in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT) at 1 month postoperatively.

This was a retrospective, single-arm study conducted by a group of US physicians receiving training at a single site in Panama between January 2024 and August 2025.

The ELIOS procedure uses a 308-nm XeCL excimer laser to create ten 210-µm diameter microchannels in the TM within a 90–110° treatment area, facilitating aqueous outflow without a retained implant. No antimetabolites were used. Patients had POAG (n=25, 41 eyes) or OHT (n=84, 117 eyes), and no history of ocular surgeries or laser treatment. ELIOS was performed in 158 eyes of 109 patients, bilaterally (n=48) and unliterally (n=61; OD=35, OS=26). IOP, number of topical IOP-lowering medications, and best-corrected visual acuity (BCVA) were recorded pre- and 1-month post-operatively. Intra- and post-operative interventions and adverse events (AEs) were also recorded. Further follow-up is ongoing.

Mean±SD age was 71.4±8.8 years; 53% were female. For POAG and OHT groups, respectively, mean±SD medicated preoperative IOP was 19.6±6.5 and 21.7±2.7, number of IOP-lowering medications per patient was 0.36±0.76 and 0.04±0.19, and BCVA was 0.89±0.60 (n=37) and 0.98±0.53 logMAR (n=108). At 1-month postoperative, for POAG and OHT groups, respectively, mean±SD medicated IOP was 16.3±5.0 (n=39, Δ16.8%) and 18.2±3.6 (n=107, Δ16.4%), number of IOP-lowering medications was 0.20±0.50 (n=25, Δ44.4%) and 0.00±0.00 (n=84, Δ100%), and BCVA was 0.35±0.25 (n=39, Δ60.6%) and 0.36±0.22 logMAR (n=113, Δ63.7%). One patient required postoperative intervention for IOP control and hyphaema. No other interventions or AEs were reported.

In this study of patients with POAG and OHT undergoing Elios MIGS with cataract surgery, mean IOP was reduced to below the European Glaucoma Society target range for early glaucoma (<20 mmHg) and approaching that for mild-to-moderate (<17 mmHg and 25% reduction) with few topical IOP-lowering medications, and with a low occurrence of intra- or post-operative interventions and AEs. Further data with a longer follow up are required to demonstrate the durability of this intervention.