Excimer Laser Trabeculostomy, Cataract Surgery Lowers IOP in 2 Glaucoma Subtypes

Excimer laser trabeculostomy combined with cataract surgery (phaco-ELT) can significantly lower intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXFG), according to research presented at the American Society of Cataract and Refractive Surgery (ASCRS) 2023 Annual Meeting, held in San Diego, CA, May 5 to 8, 2023. 

“Cataract surgery combined with excimer laser trabeculostomy (phaco-ELT) leads to a significant reduction in IOP by enhancing trabecular outflow,” according to the presentation. “The FDA approval process of this [minimally invasive glaucoma surgery (MIGS)] procedure is underway.”

In this study, researcher Marc Toeteberg-Harms, MD, FEBO, and colleagues conducted a retrospective chart review of 285 eyes with POAG (n=170) or PXFG (n=115) that were treated with the cataract surgery plus excimer laser trabeculostomy procedure between July 17, 2010 and July 17, 2018. The study defined success 1 as IOP less than 21 mm Hg (success 2, IOP ≤18 mm Hg and success 3, IOP ≤16 mm Hg) with no hypotony, no loss of light perception vision, no subsequent incisional glaucoma surgery or cyclodestructive procedure, and a decrease in the number of medications from baseline.

Mean baseline best-corrected visual acuity (BCVA) was 0.39±0.35 logarithm of the minimum angle of resolution (logMAR), IOP was 19.1±6.2 mm Hg, and patients used 2.1±1.2 antiglaucoma medications. At 1 year, BCVA was 0.3±0.3 logMAR, IOP improved to 14.3±3.8 mm Hg, and participants took a total of 1.7±1.4 medications. 

Researchers noted no statistically significant differences between patients with POAG and PXFG who underwent the combined excimer laser trabeculostomy procedure, either at baseline or at their 1-year follow up (P >.05). Both cohorts experienced similar safety-related outcomes.

“This is the first report comparing phaco-ELT between POAG and PXFG. This implant-free MIGS showed similar success rates and safety in both groups,” according to the researchers. “Although the entire trabecular meshwork and the extracellular matrix are compromised especially in PXFG, the creation of ten laser channels can still sufficiently manage glaucoma for up to 12 months.”

This study was limited by its retrospective design.