One-Year Outcomes Of Excimer Laser Trabeculostomy (Elios) Compared With Hydrus Microstent And Istent: A Retrospective Comparative Study

To compare 12-month efficacy and safety of excimer laser trabeculostomy (ELIOS), Hydrus Microstent, and iStent in eyes undergoing trabecular outflow–based microinvasive glaucoma surgery (MIGS).

Department of Ophthalmology, Centre Hospitalier Sud-Francilien, Paris, France

Retrospective comparative study of consecutive eyes operated at Centre Hospitalier Sud-Francilien between March, 2025 and March, 2026. Intraocular pressure (IOP) and number of glaucoma medications were collected preoperatively and postoperatively. The primary endpoint was complete success at month 12, defined as IOP < 18 mmHg without glaucoma medications.

A total of 83 eyes were included (ELIOS n=26, Hydrus n=20, iStent n=37). At month 12, mean IOP was 13.62 ± 2.45 mmHg (ELIOS), 15.63 ± 2.59 mmHg (Hydrus), and 15.33 ± 2.74 mmHg (iStent) (between-group p=0.016). Mean medication burden at month 12 was 0.96 ± 1.25 (ELIOS), 0.17 ± 0.38 (Hydrus), and 1.11 ± 1.18 (iStent) (p=0.011). Complete success occurred in 14/26 (53.8%) ELIOS eyes, 13/18 (72.2%) Hydrus eyes, and 9/35 (25.7%) iStent eyes (p=0.005). Hyphema was uncommon (11.5%, 5.0%, and 2.7% in ELIOS, Hydrus, and iStent, respectively; p=0.369), with no sight-threatening complications reported in the dataset.

In this real-world retrospective cohort, all three trabecular outflow–based MIGS approaches reduced IOP at 12 months. Hydrus was associated with the greatest medication reduction and the highest rate of medication-free IOP < 18 mmHg at month 12, while iStent showed more modest medication reduction. Excimer laser trabeculostomy (ELIOS) provided intermediate outcomes with a favorable safety profile.