High-Precision Trabeculotomy Procedure Lowers IOP

A high-precision trabeculotomy procedure can provide a clinically meaningful reduction of intraocular pressure (IOP) in patients with open angle glaucoma, according to research presented at the American Society of Cataract and Refractive Surgery (ASCRS) 2023 Annual Meeting, held in San Diego, California from May 5 to May 8, 2023. 

Investigator Richard A. Lewis, MD, and colleagues included 18 eyes from 12 patients with open angle glaucoma in the 2-year prospective, single center, interventional, nonrandomized clinical trial. Study participants underwent femtosecond laser image guided high-precision trabeculotomy (FLigHT) — a procedure that uses a patient interface and gonioscopic camera for identifying the preferred treatment location and a femotosecond laser to create a 500×200 μm channel via the trabecular meshwork into Schlemm canal. 

At 2 years post treatment, 17 eyes of 11 patients were evaluable. The mean medicated IOP was reduced from 21.4±4.6 mm Hg at baseline to 14.5±2.9 mm Hg (P <.001), and mean hypotensive medication use was reduced from 2.1±1.0 at baseline to 1.8±1.1 (P =.3). 

The average IOP reduction at 2 years was 28.5±0.1% and 14 out of 17 eyes (82%) treated with femtosecond laser image guided high-precision trabeculotomy achieved ≥ 20% reduction in IOP, the report shows. Presenters noted no adverse events related to the laser treatment. 

“Well defined channels were clearly visible at 2 years under gonioscopy and AS-OCT with no visible evidence of healing or scarring,” according to the investigators. “At 2 years, all evaluable subjects experienced a clinically meaningful reduction in IOP with no reports of device related serious adverse events. Measured IOP, AS-OCT and gonioscopy demonstrate the channels are patent at 24 months.”

The presenters suggest this means the femtosecond laser image guided high-precision trabeculotomy has medium term durability, with no indication of diminishing treatment effect to date.

Study limitations include the small sample size of patients and the single center design. 

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.