Posters

Excimer laser trabeculostomy (ELT): initial results in Spain

Poster Details

First Author: A.Moreno Valladares SPAIN

Co Author(s):    N. Puerto Amoros   F. Gonzalez Lopez   M. Berlin              

Abstract Details

Purpose:

Excimer Laser Trabeculostomy (ELT) is a laser based minimally-invasive glaucoma surgery (MIGS) procedure of the trabecular meshwork without an implant. ELT creates ten laser channels which connect the anterior chamber with Schlemm´s canal. Laser channels are created by a non-thermal 308nm XeCl excimer laser. We present the initial clinical results from Spain reflecting the learning curve of two surgeons.

Setting:

This is a ten month, prospective, non-randomized, open-label, non-comparative case-series of patients with open angle glaucoma (OAG). Surgeries were performed by two previously ELT naive glaucoma specialists at the University Hospital of Albacete, a level one medical center in the Spanish Public Health network, serving a population of 400,000 people.

Methods:

During ELT, ten laser channels (diameter 200mm) were created in the inferotemporal quadrant with an ab interno fiber-optic probe delivering 20 pulses at 20Hz with 1.28mJ each. Efficacy (i.e. IOP and anti-glaucoma drugs (AGD) reduction) and safety (adverse events and change in endothelial cell count) were evaluated. In addition, IOP spikes in the early postop period (i.e. IOP increase of ≥10 mmHg from baseline) were recorded.

Results:

24 eyes of 24 patients (5 ELT alone and 19 combined phaco+ELT) were included (mean age 71.5±9.0years, mean defect -7.78±6.3dB). Mean follow-up was 3±1 months and is ongoing. Baseline medicated IOP was 20.8±2.3mmHg on 1.8±0.5 AGD. IOP was reduced by 18% (P=0.02) and AGD by 70% (P>0.001). 60% of the eyes were medication-free at 2 months. A micro-hyphema was seen in three cases and two IOP spikes occurred. All resolved within 48 hours. There was no hypotony. Endothelial count did not show any significant changes (pre-op 2474 and at 1month 2407cells/mm2).

Conclusions:

ELT is a non-thermal laser based MIGS procedure without an implant. Both IOP and AGD were significantly reduced. ELT alone demonstrated comparable IOP reduction to combined phaco+ELT. No serious adverse events occurred. These initial results of two surgeons even during their learning curve validate the safety and efficacy of ELT in early and moderate OAG patients. IOP lowering efficacy in this case series is similar to previous published studies except for the two patients’ IOP spikes noted in this learning curve series.

Financial Disclosure:

None