[Efficacy and safety of the new generation of excimer laser trabeculotomy in a heterogeneous patient population-1-year follow-up].

Abstract

Background: Microinvasive procedures have become established in glaucoma surgery and are preferred for patients with target pressure values that are not too low. Excimer laser trabeculotomy (ELT) represents such a minimally invasive approach and can easily be combined with cataract surgery.

Objective: Over 12 months the reduction in intraocular pressure (IOP), the number of antiglaucoma drugs and the incidence of adverse events were evaluated using the new Elios^TM method (Elios Vision GmbH, Germering, Germany) for real-life data from a heterogeneous patient population undergoing ELT in combination with cataract surgery (phaco-ELT).

Material and methods: In this study 20 eyes of 13 patients who underwent phaco-ELT were retrospectively analyzed. After standard phacoemulsification with posterior chamber lens implantation, 10 microchannels were created using the excimer laser. The patients were followed for 12 months and the intraocular pressure (IOP), number of antiglaucoma drugs and the occurrence of adverse events were analyzed.

Results: The average age was 65 years. The preoperative IOP was 17.5 (± 5.3) mm Hg. The mean IOP reduction was 4.8 mm Hg (27.4%, p < 0.001) on the first postoperative day, 3.2 mm Hg (18.3%, p = 0.22) after 6 months and 2.5 mm Hg (14.3%, p = 0.14) at 12 months. The number of antiglaucoma drugs decreased from an average of 3.2 (± 1.3) preoperatively to 0.5 (± 0.9) on day 1 (p < 0.001), 1.9 (± 1.2) after 6 months (p = 0.008) and 2.2 (± 1.3) after 12 months (p = 0.013).

Discussion: In our cohort ELT in combination with cataract surgery is a safe minimally invasive procedure leading to an IOP reduction of 14.3% and a reduction of pressure-lowering medication by 1 active ingredient in patients with low initial pressure at 1‑year follow-up. As no implant is used in ELT and the conjunctiva remains untouched, subsequent procedures, including bleb-related surgery, are not negatively affected.