PURPOSE: This systematic review and meta-analysis aimed to evaluate the long-term efficacy and safety of excimer laser trabeculostomy (ELT) as a standalone procedure or combined with phacoemulsification (Phaco-ELT) in the treatment of patients with glaucoma.

METHODS: ELT is an implant-free, ab-interno, minimally-invasive glaucoma surgery that creates microchannels in the trabecular meshwork, facilitating aqueous outflow while preserving angle anatomy. It can be performed as a standalone procedure or combined with phaco. A systematic literature review was conducted by two independent reviewers using PubMed and EMBASE databases to identify articles that examined efficacy and safety endpoints of ELT or Phaco-ELT procedures in adult patients with glaucoma. Endpoints included absolute reduction in glaucoma medication, intraocular pressure (IOP), and visual acuity at 1 and 2 years follow-up. A total of 14 eligible articles (N=1549 eyes) were identified.

RESULTS: At Year 2, the IOP reduction achieved with ELT and Phaco-ELT was 7.10 mmHg (95%CI:6.25, 7.95; n=105) and 6.72 mmHg (95%CI: 3.01, 10.42; n=130), respectively. Absolute glaucoma medications were reduced by 1.26 (95%CI: 0.74, 1.78; n=95) and 0.58 (95%CI: 0.33, 0.83; n=130), respectively. In patients undergoing phaco-ELT, visual acuity improved by –0.12 LogMAR (95% CI: –0.20, –0.05; n=70). After 1 year, the total complication rate with ELT and Phaco-ELT was 2.67% (95% CI: 1.00, 6.89; n=150) and 4.09% (95% CI: 1.96, 8.34; n=171), respectively, and the rate of additional surgeries was 30.82% (95% CI: 24.14, 38.41; n=159) and 5.55%, respectively.

CONCLUSIONS: This analysis found that ELT reduced IOP and IOP-lowering medication burden in patients with glaucoma, with minimal occurrence of complications and a low rate of secondary interventions. When combined with phaco, ELT results in a simultaneous improvement in visual acuity.