Posters

Excimer laser trabeculostomy (ELT), a laser-based MIGS procedure with no implants: enables consistent intraocular pressure-lowering in glaucoma patients over 12 years, both stand-alone and combined with phacoemulsification

Poster Details

First Author: M.Berlin USA

Co Author(s):    M. Agam   G. Shan   M. Toeteberg-Harms   L. Kleineberg   V. Roka   U. Giers     

Abstract Details

Purpose:

To evaluate the long-term, 12 year, intraocular pressure lowering efficacy and safety of Excimer Laser Trabeculostomy (ELT), both as a stand-alone procedure and combined with phacoemulsification (ELT+Phaco) in patients with open-angle glaucoma (OAG) and in patients with co-existing OAG and surgical cataract.

Setting:

Augen Laser Klinik, Detmold, Germany

Methods:

24 patients were followed for 12 years. 11/46 eyes with open angle glaucoma or ocular hypertension treated medically underwent ab-interno Excimer Laser Trabeculostomy. 13/37 eyes with open angle glaucoma or ocular hypertension treated medically with surgical cataract underwent ELT combined with phacoemulsification. Patients were followed at 1 day, 1 month, 3 months, 6 months, 1 year, and every year thereafter until 12 years from initial treatment. The primary outcome measures are mean change in IOP (without washout) and number of glaucoma medications from baseline. Secondary outcome measures are change in visual acuity (BCVA), surgical complications, and adverse events (AE).

Results:

At 12 years, the mean IOP in the ELT group was reduced by 28.5% from a pre-op IOP of 23.0±5.1mmHg to 16.5±3.6mmHg (p-value IOP <0.005). In the ELT+Phaco group, the mean IOP was reduced by 30.0% from a pre-op IOP of 20.8±5.8mmHg to 14.7±3.8mmHg (p-value IOP <0.002). The number of glaucoma medications at 12 years for the ELT group was 1.5±1.4 medications compared to 1.9±0.8 medications at pre-op (p-value meds 0.47). The number of medications for the ELT+Phaco group was 2.0±1.3 medications compared to 1.3±0.6 medications at pre-op (p-value meds 0.04).

Conclusions:

ELT both as a stand-alone MIGS procedure and ELT+Phaco are clinically safe and effective and enable long-term, consistent, significant reductions in IOP in patients with OAG. Glaucoma medication requirements were similar to pre-op in the ELT alone group but increased in the ELT+Phaco group. 12-year post-ELT IOP reduction with no implants was equivalent to 1- & 5-year IOP-lowering data following combined phacoemulsification with iStent implants. This study presents the longest post MIGS procedure data which validates the concept of MIGS procedures for long-term IOP lowering.

Financial Disclosure:

None