PURPOSE: Glaucoma treatment focuses on intraocular pressure (IOP) reduction to prevent the progressive visual damage characteristic of glaucoma. Excimer laser trabeculostomy is a minimally invasive glaucoma surgery (MIGS) that allows precise removal of tissue with a minimal wound-healing response. The ELIOS device (Bausch+Lomb) creates ten 210-μm diameter microchannels in the trabecular meshwork to lower IOP and reduce the risk of progressive visual field loss. The purpose of this study was to evaluate the progression of glaucoma after combined ELIOS and phacoemulsification (phaco) in patients with open-angle glaucoma (OAG) over a five-year follow-up in a real-world setting.

SETTING: This was a retrospective, single-centre study of patients with mild-to-moderate OAG with visually significant cataracts requiring surgery. Combined phaco-Elios procedures were performed between October 2019 and December 2020.

METHODS: The ELIOS procedure uses a 308-nm XeCL excimer laser to create ten 210-µm diameter microchannels in the TM within a 90–110° treatment area to optimise aqueous outflow. Outcomes included visual field damage mean deviation in dB as measured by Humphrey Field Analyzer 3 and mean peripapillary retinal nerve fibre layer thickness (PRNFLT) as measured by Heidelberg Spectralis OCT each year from baseline through 5 years of follow-up. A total of 73 eyes of 59 patients were included in the analysis, with a mean±standard deviation (SD) age of 74±9.2 years, and 45% were male.

RESULTS: At baseline, glaucoma severity was classified as mild (65%), moderate (20%), or severe (15%). Mean±SD visual field deviation was −5.38±5 dB. Overall mean±SD PRNFLT was 82.5±17.2 μm (84.6 for mild, 75.8 for moderate, and 70.5 μm for severe glaucoma). At 5 years of follow-up, the mean±SD field deviation was −4.81±6 dB, corresponding to an overall 11% improvement (p=0.73). The change for mild, moderate, and severe glaucoma was −0.9, +2.4, and +3.0 dB, respectively. Mean±SD PRNFLT was 82.9±17.6 μm at 1 year, then decreased by 0.58 μm each year to 79.6±18.6 μm at 5 years (p<0.001). The change for mild, moderate, and severe glaucoma was −2.3, +2.9, and −6.2μm, respectively. No major adverse events were recorded during follow-up.

CONCLUSIONS: In this study of patients with OAG undergoing phaco-Elios, there was an improvement in mean field deviation and a significant improvement in the rate of PRNFLT decrease compared with the expected decrease for patients with glaucoma. The decrease in PRNFLT values and field deviation were close to physiological normal (up to 0.5 μm/year and −0.2 dB/year, respectively), demonstrating the effectiveness of phaco-Elios in reaching the primary goal of glaucoma treatment, which is to prevent vision loss beyond that of normal ageing. The follow-up at 5 years demonstrates this effect is durable without further intervention. Additional data with more eyes is needed to validate these findings further.