PURPOSE: The purpose of this study was to assess the effectiveness of excimer laser trabeculostomy (ELT) using the ELIOS device in reducing intraocular pressure (IOP) in patients with glaucoma undergoing cataract surgery. ELIOS uses a precision non-thermal 308 nm XeCL excimer laser system to create 210-μm diameter microchannels in the trabecular meshwork, without the use of a retained device, and with minimal tissue damage at the periphery of the ablation zone. This enables effective IOP lowering while preserving the delicate physiology of this structure. ELIOS is considered an established option for experienced cataract surgeons considering the introduction of glaucoma surgery into their practice. ELIOS has been CE-marked in Europe since 2014.

SETTING: This was a retrospective, non-randomized 18-month clinical trial conducted at one site in Italy. Surgeries were performed by one investigator between 04 October 2023 and 03 December 2024.

METHODS: Eligible patients were aged ≥45, with primary or secondary glaucoma regardless of stage, medicated IOP of ≥20 mmHg, and phakic eyes requiring cataract surgery. All patients underwent cataract surgery followed by ELIOS. Patients with previous glaucoma surgery were excluded. Number of medications, IOP, visual acuity, and cup-to-disc ratio (C/D) were assessed at baseline, 6 months, 12 months, and 18 months.

RESULTS: A total of 44 patients (50 eyes) underwent the procedure (mean±SD age 74±8years). At baseline, mean±SD medicated and unmedicated IOP was 16.0±5.0mmHg and 25.4±7.0mmHg, respectively, number of medications was 2.9±1.0, BCVA was 0.26±0.20 logMAR, and C/D was 0.70±0.20. Compared with unmedicated baseline, mean±SD IOP at 6 (n=50), 12 (n=39), and 18 months (n=28) was 13.5±3.1mmHg, 13.3±2.9mmHg, and 14.6±3.0mmHg, respectively, corresponding to a 43%, 44%, and 41% reduction, all p<0.001. Mean±SD number of medications was 0.7±1.0, 0.6±1.0, and 0.5±0.9, respectively. At last follow-up, 32 patients (69.6%) were on zero medications, mean±SD BCVA was 0.06±0.15 logMAR, and C/D was 0.68±0.20. One eye had loss of ≥2 Snellen lines.

CONCLUSIONS: These results demonstrate a clinically meaningful reduction in IOP, below the EGS-recommended targets for mild-to-moderate disease (≥25% reduction to below 17 mmHg). The reduction in number of medications overall and the number of patients on zero medications also demonstrates a potential improvement in QoL. As adherence to medication is often poor in patients with glaucoma, reducing the number of required medications represents an important indicator of treatment utility. Further data are required to assess the safety profile of the combined procedure compared with phacoemulsification alone, to further demonstrate the clinical utility of the ELIOS device.