BACKGROUND: This systematic review and meta-analysis report the long-term efficacy and safety of Excimer Laser Trabeculostomy (ELT) with the AIDA (TUI-Laser AG, Germering, Germany) or ExTra laser system (MLase AG,Germering, Germany) when used as stand-alone or phaco-ELT treatment in open-angle glaucoma (OAG) or OHT patients.

METHODS: A systematic literature search according to PRISMA guidelines was performed by two independent reviewers using PubMed and EMBASE databases to identify published articles that examined the efficacy and safety of the ELT procedure performed in adult patients with glaucoma. Data was extracted after screening articles using a pre-defined patient, intervention, comparison, and outcome (PICO) process. Meta-analysis was performed using R version 4.1.0 with the meta package.

RESULTS: The meta-analysis of key clinical efficacy endpoints showed that stand-alone ELT and phaco-ELT improve visual acuity while reducing medication burden and intraocular pressure (IOP). The improvement in visual acuity was -0.23 LogMAR (95% CI: -0.32, -0.14; n=564) at 1-year follow-up and -0.12 LogMar (95% CI: -0.20, -0.05; n=70) at 2-year follow-up, which was only measured in patients who underwent phaco-ELT. The absolute reduction in glaucoma medication was 0.37 (95% CI: -0.18, 0.92; n=107) at 1-year follow-up and 1.26 (95% CI: 0.74, 1.78; n=95) at 2-year follow-up after standalone ELT. In patients undergoing phaco-ELT, the absolute reduction in glaucoma medication was 0.73 (95% CI: 0.49, 0.97; n=854) at 1-year follow-up and 0.58 (95% CI: 0.33, 0.83; n=130) at 2-year follow-up. The absolute reduction in IOP was 6.18 mmHg (95% CI: 3.69, 8.68; n=127) at 1-year follow-up and 7.10 mmHg (95% CI:6.25, 7.95; n=105) at 2-year follow-up after standalone ELT. In patients undergoing phaco-ELT, the absolute reduction in IOP was 5.41 mmHg (95% CI: 4.12, 6.70; n=847) at 1-year follow-up and 6.72 mmHg (95% CI: 3.01, 10.42; n=130) at 2-year follow-up. The meta-analysis of the key safety endpoints showed a low complication rate and a low rate of additional surgeries following standalone ELT or phaco-ELT.

CONCLUSIONS: This meta-analysis concludes that ELT is an efficacious and safe option. Based upon current reimbursement rates in markets where ELT is available; it is likely that ELT is cost-effective and a potentially cost-saving treatment option for patients with OAG and OHT. Country specific cost-effectiveness modeling performed by payors and HTA bodies may support future coverage and payment decisions when evaluating ELT in the MIGS category.